| 摘要: | 背景及目的：糖尿病影響病童的生理、心理健康及生長發育。第一型糖尿病兒童及青少年必須每天完成許多自我照顧行為如胰島素注射、血糖監測、飲食控制、規律運動等複雜的醫療處置。良好的自我照顧行為對兒童及青少年的糖尿病控制很重要。而本研究將比較第一型糖尿病兒童及青少年自我照顧行為與自我照顧成效之差異，並欲瞭解影響其自我照顧行為的重要因子。
方法：本研究以結構式問卷進行資料蒐集。問卷內容包括，個人基本特性、糖尿病疾病特性、自我照顧行為量表。樣本來自中部某醫學中心小兒內分泌科門診七至十九歲第一型糖尿病患者，問卷採當面填答及回收，問卷發出104份，共得有效問卷104份，回收率100％。研究資料以SPSS12.0統計軟體進行分析，除描述性分析及雙變項分析外，並運用複迴歸分析探討影響兒童及青少年自我照顧行為之相關因素。
結果：兒童自我照顧行為之總分平均為156.16分，青少年自我照顧行為之總分平均為141.00分，兒童及青少年其在自我照顧行為兩組間皆達統計上的顯著差異（p=0.0002）。研究對象之就學情況、主要照顧者之教育程度、家庭平均月收入、驗血糖頻率、胰島素注射執行者、驗血糖執行者及因糖尿病缺課天數與自我照顧行為皆達統計上的顯著差異（p<0.0001、p=0.0004、p=0.0216、p=0.0079、p=0.0030、p=0.0137、p=0.0244）。兒童及青少年自我照顧行為與糖化血色素呈顯著負相關（p=0.002，r=-0.297）；自我照顧行為與自覺健康狀況呈顯著正相關（p<0.0001，r=0.395）。兒童與青少年之自我照顧成效，糖化血色素未達統計上的顯著差異，但在自覺健康狀況達統計上的顯著差異（p=0.0155）。研究對象之就學情況、主要照顧者之教育程度及因糖尿病缺課天數與自覺健康狀況達統計上的顯著差異（p=0.0359、p=0.0035、p=0.0018）。複迴歸分析顯示影響自我照顧行為之因素為，就學情況之高中(職)或專科1~3年級、大學1~2年級或專科4~5年級、家庭平均月收入之85001元以上及每週測量血糖1~3次。
結論：兒童的自我照顧行為優於青少年，研究對象的就學狀況、家庭平均月收入及驗血糖頻率為兒童及青少年自我照顧行為的重要影響因子。本研究結果可作為醫護人員衛教和照護的指引和參考，以協助此類兒童及青少年能及早自我管理血糖並期獲得正常的生長發展。
Background and Objective: Diabetes affects a child’s physical and mental health as well as growth and development. Children and adolescents with type 1 diabetes must daily perform several complicated self-care tasks such as insulin injection, blood glucose monitoring, meal planning, and regular exercise. Good self-care behavior is important for control of diabetes. We studied the differences in self-care behaviors and their outcomes among children and adolescents with type 1 diabetes. Factors that significantly influenced self-care behaviors were also explored.
Method: Data were collected via structured questionnaire survey. Content of the questionnaire included personal characteristics, condition of diabetes, and self-care behavior assessment scale. Subjects were type 1 diabetic patients 7-19 years of age treated at the pediatric endocrinology clinic of a central Taiwan medical center. Questionnaires were completed and collected at the time of visit. A total of 104 questionnaires were distributed and 100% valid responses were collected. Statistical analyses were performed using SPSS 12.0 software. Other than descriptive and binomial variable analyses, factors influencing child and adolescent self-care behavior were analyzed using multiple regression analysis.
Results: The average self-care behavior score was 156.16 among children and 141.00 among adolescents. The difference was statistically significant (p = 0.0002). Self-care behavior score was significantly associated with schooling, education level of the primary caregiver, average family income, frequency of blood glucose monitoring, insulin administrator, blood glucose monitoring administrator, and absence from school due to diabetes (p<0.0001, p=0.0004, p=0.0216, p=0.0079, p=0.0030, p=0.0137, p=0.0244 respectively). Child and adolescent self-care behaviors were negatively correlated with self-care outcome as measured by glycosylated hemoglobin value (p=0.002，r=-0.297). Self-care behaviors were positively correlated with self-perception of health status. (p<0.0001, r=0.395). Comparing self-care outcomes between children and adolescents, the difference in glycosylated hemoglobin levels did not reach statistical significance, but the difference in self-perception of health status was statistically significant (p=0.0155). Self-perception of health status was significantly associated with degree of schooling, education level of primary caregiver, and absence from school due to diabetes (p=0.0359, p=0.0035, p=0.0018 respectively). Multi-regression analysis revealed factors that significantly influenced self-care behaviors include enrollment in senior high or vocational school during the first to third year, in university during first to second year, in professional school during fourth to fifth year, monthly family income above NT 85,001, and monitoring of blood glucose 1-3 times per week.
Conclusion: Children scored better than adolescents in self-care behaviors. Level of schooling, monthly family income, and frequency of blood glucose monitoring were significant factors influencing self-care behavior among children and adolescents. The results of this study may guide care providers when establishing self-management among children and adolescent, thereby helping them to attain normal growth and development. |
