外来における継続的個別糖尿病患者教育プログラムの 作成と評価

The Planning and Evaluation of A Long-term Individual Instruction Program for Diabetic Patients

　本研究の目的は，外来通院糖尿病患者を対象とした，自己効力感を高め心理的支援に配慮した継続的個別教育プログラムを検討し，その効果を自己効力感尺度（SE尺度）と血糖コントロールにより確認することである．教育プログラムはBanduraの自己効力理論をもとに作成された先行研究などを参考に考案した．本プログラムの特徴は，患者の生活状況などの個別性を考慮し，疾患や治療への患者の情緒的反応の緩和と治療に主体的に取り組むことができることを目指すものである．対象は総合病院糖尿病外来通院中の40歳以上の2型糖尿病患者45名で，最終的には介入群17名，非介入群15名の32名となった．プログラム適用20週間後に介入群のHbA1cのみに有意な差が認められた（p=0.01）．多重ロジスティック回帰分析ではHbA1cのみ教育介入が改善に有意に影響していた（オッズ比6.4，95％信頼区間1.0～41.0）．以上より本プログラムの有効性が示唆された．

　The objectives of this study are to analyze a long-term individual instruction program of psychological support for ambulatory diabetic patients to enhance their self-efficacy, and to evaluate the effects of the program based on the scales of self-efficacy (SE scales) and controlled blood sugar levels. The instruction program was drawn up with reference to previous studies based on Bandura's self-conscious efficacy theory. The program is characterized in that it not only allows the patients to relax emotionally from their suffering of the disease and treatment, but also enhances the efficacy of treatment considering the diversities of life styles and characters of individual patients. Forty-five subjects participating in the study were ambulatory patients (40 years old or over) with Type II diabetes, who are receiving regular outpatient treatment in a general hospital. 32 patients were finally screened and divided into two groups, 17 in the participating group and 15 in the non-participating group. 20 weeks after starting the program, a significant improvement was observed in only HbA1c values for the participant group (p=0.01). Multi-logistic progression analysis showed that the program had a positive effect on HbA1c values (odds ratio 6.4, 95％confidence interval 1.0-41.0). Thus, the effectiveness of the program was proven.