The Effect of Motivational Interviewing on Self Efficacy and Self Management in Diabetes Patients
|School||Huazhong University of Science and Technology|
|Keywords||motivational interviewing self-efficacy self-management diabetes|
1, ObjectiveTo investigate self-efficacy and self-management of hospitalized diabetes patients;to analyze factors affecting self-efficacy and self-management in diabetes patients;to analyze the effect of motivational interviewing on self-efficacy and self-management of diabetes patients,underpining foundation for later researches and clinical practices.2,Research MethodsThis study is an Quasi-experimental survey,104patients who were hospital admission in a hospital located in wuhan city during the period of september,2012to December2012were selected,using the statistic method table of random number,the total population were divided into two groups,the control group and the intervention group,which contains52research objects respectively.the control group received routine nuring, while the intervention group received routine nursing plus nursing on the basis of motivational interviewing,the intervention group received two unique nursing interventions before discharge,in the first time,the researcher focused on her patients cases in order to find out abnormal physical index to give feedback to patients,then explained which efforts should be taken to keep and promote good situation,what is more,the researcher should pay attention to patients psychological situation and help them relive stress and resolve trouble in daily life when necessary,evaluated barriers and motivation on changes of life style,and then designed sustainable goals and formated goals which should apply the following principles:SMART,specific,measurable,achivable,realistic,timable.in the second time,other things should be mentioned instead of things that have been done in the first time,firstly,the researcher should review what progress has been made by patients,and give encouragement which is essential for futher progress,and then ask patients about their feeling during the intervention interals and behavor difficlties which exist in the implementation of the target,then revise the target when the researcher finds that it is no longer suitable for patients,in the whole intervention process,the researcher should follow the principles and techniques of motivational interviewing:AREDS and AROES:avoid argument,roll with resistance,express empathy,develop difference,support self-efficacy;affirmation,reflective listening,open questions, summary.3,results(1)self-efficacy and self-managent of diabetes patients:among different aspects of self-efficacy,compliance of medication is in the highest proportion,accounting for52%in the good level,while blood glucose monitoring and regular exercise is in the lowest proportion in the good level, accounting for26.5%and19.6%respectively.in terms of self-management,compliance of medication also occupies the highest part in good level,with45.1%,however,the proportion of blood glucose monitoring and diet control accounted for10.8%and17.6%respectively,meaning very poor.(2)Factors affecting self-efficacy and self-managementDiabetes overall self-efficacy and self-management are considered as dependent variable respectively,at the same time,patients age,gender,occupation,disease-related facors,the support system are treated as independent variable to analyze factors affecting patients self-efficacy and self-management using the statistic method logistic regression.level into the equation is0.05,and level excluding is0.10,factors affecing the overall self-efficacy contains:occupation,monthly cost for treatment.factors affecting the overall self-management are:disease course,whether using insulin,pattern of medical payment.(3)relationship between self-efficacy and self-managementThe spearman correlation analysis was used and it indicated that the correlation coefficient between the overall self-efficacy and general self-managment is0.674,at a confidence level of0.01,the correlation is substencially significant. (4)the short-time effect of motivational interviewingResults suggested that the experimental group showed obvious statistic differences on self-efficacy after two times of intervention during inhospital period,and it also appeared obvious statistic meaning on all aspects of self-managent (p<0.05),the control group received conventional nursing care, aspects of exercising(p=0.021),blood monitoring(p=0.001) and total self-management level(p=0.034) appealed statistic differences during the period of hospitality on self-management,there is no difference on self-efficacy and self-management at the time of hospital adimisson between the control group and the experimental group,so they can be compared with each other,after admission,the two groups received different nursing measures,and before discharge,there was difference of self-efficacy between the two groups:diet control and preventing abnormal blood glucose level,with p=0.031and p=0.040respectively.as for self-management,there was no difference on different aspects between the two groups.(5)long-time effects of motivational interviewing on diabetesIn terms of experimental group,there was no difference with respect to self-efficacy and self-management six months after discharge,however,there was statistic difference on objective physical index HbAle,with p=0.008,indicating the level of HbAlhas got obvious improvement.as for the control group,after six months of follow-up,aspects of blood monitoring(p=0.020),prventing abnormal blood glucose level(p=0.003) and the toal self-management level(p=0.034) had statistic differences;after six months,the two groups had no differences between self-efficacy and self-management,and the objective physical index HbAl had no difference between the two groups.4,conclusion(1)Status quo of self-efficacy and self-management and factors affecting thenrpatients are in different levels of different aspects of self-efficacy and self-management,it indicated that patients can do well in compliance of medication,however they performed badly on blood glucose monitoring,diet control and regular exercise.factors affecting diabetes overall self-efficacy contains:occupation,medical payment and pattern of paying.factors affecting self-management are disease course, whether using insulin and pattern of paying.(2)Self-efficacy and self-management have a high degree of correlation,nurses should pay attention to the culture of self-efficacy of diabetes patients in researches and implementation of education,in order to achieve a good level of self-management,and to improve their quality of life.(3)The short effect of motivational interviewing on self-efficacy and self management:it has a significant effect on the improvement of initial self-efficacy before discharge,including:diet control,regular exercise,foot care,prevention of high and low blood glucose,the overall self-efficacy level.the long-term effects of self-efficacy in diabetic patients(six months)din not show its superiority and it still needs follow-up study to prove its efficacy on diabetes.