運用跨理論模式探討認知行為教育課程介入對第二型糖尿病患者運動階段、運動自我效能及血糖控制之影響

The Impact of Cognitive-Behavioral Education Courses (CBEC) on Stage of Exercise, Exercise Self-Efficacy, and Blood Glucose Control among Type 2 Diabetes Patients: Applying Transtheoretical Model

10.6540/NTJN.2015.1.003

李書芬(Shu-Fen Lee)；紀玫如(Mei-Ju Chi)；鄭綺(Chii Jeng)

認知行為教育課程 ； 運動階段 ； 第二型糖尿病 ； Cognitive-Behavioral Education Courses (CBEC) ； Exercise stage ； type 2 diabetics

新臺北護理期刊

17卷1期（2015 / 03 / 01）

21 - 31

繁體中文

糖尿病是21世紀罹患率及死亡率增加最快速的慢性病，推動糖尿病衛教課程介入是公共衛生的一大課題。本研究目的在探討｢認知行為教育課程｣介入對運動階段、運動自我效能及血糖控制之影響。採單組前後測設計，自北區某醫院新陳代謝門診，招募運動階段處於「意圖前期」及「意圖期」之第二型糖尿病患者共67位，參與四週共12小時認知行為教育課程。結果顯示，認知行為教育課程介入後個案空腹血糖（t=4.286，p＜.001）及糖化血色素（t=3.978，p＜.001）均顯著改善，自我效能總分顯著提高（t=4.741，p＜.001）。有86.5%個案（58人）進階到下一運動階段。本研究結果支持四週認知行為教育課程，除了對個案血糖控制有改善外，亦能提升其運動行為。

Diabetes mellitus is the most rapid increasing chronic disease in the morbidity and mortality in the 21^st century. Implementation of Health education of diabetes plays a major role in prevention and management of diabetes. The purpose of this study is to explore the impact of applied Cognitive-Behavioral Education Courses on exercise behavior, exercise efficacy, and glucose control among type 2 diabetics. A total of 67 Type 2 diabetic patients who met the ＂pre-contemplation＂ and ＂contemplation stages of exercise were recruited from department of endocrine at a teaching hospital in the north of Taiwan .One-group pre-post test design, with four weeks on Cognitive-Behavioral Education Courses (CBEC) was selected. The results showed fasting glucose (t=4.286, p=.001) and HbA1c (t=3.978, p=.001) significantly improved after 4 week education. Also, the total scores of exercise self-efficacy significantly increased (t=4.741, p＜0.001). Thus, 86.5% of patients moved into an advanced exercise stage. The findings supported the CBEC. It not only had potential specific effects on glucose control, but also had promoted the exercise behavior among sedative diabetes groups.

1. 徐錦興,曹德弘,張蕙雯(2011)。第二類型糖尿病人之身體活動建議量初探。臺灣公共衛生雜誌，30(1)，72-81。
   連結：
2. Butler, A. E.,Janson, J.,Bonner-Weir, S.,Ritzel, R.,Rizza, R. A.,Butler, P. C.(2003).Beta-cell deficit and increased Beta-cell apoptosis in humans with type 2 diabetes.Diabetes,52(1),102-110.
3. Hasler, T. D.,Fisher, B. M.,MacIntyre, P. D.,Mutrie, N.(2000).Exercise consultation and physical activity in patients with type 1 diabetes.Practical Diabetes International,14,44-48.
4. International Diabetes Federation, IDF. (2013).IDF annual report. Retrieved from http://www.idf.org/publications/annual-report
5. Jiang, Y. D.,Chang, C. H.,Tai, T. Y.,Chen, J. F.,Chuang, L. M.(2012).Incidence and prevalence rates of diabetes mellitus in Taiwan: Analysis of the 2000-2009 Nationwide Health Insurance database.Journal of the Formosan Medical Association,111(11),599-604.
6. Landry, J. B.,Solmon, M. A.(2002).Self-determination theory as an organizing framework to investigate women’s physical activity behavior.Quest,54,332-354.
7. Loughlan, C.,Mutrie, M.(1997).An evaluation of the effectiveness of three interventions in promoting physical activity in a sedentary population.Health Education Journal,56(2),154-165.
8. O'Conner, M. J.(1994).Exercise promotion in physical education: Application of the transtheoretical model.Journal of Teaching in Physical Education,14,2-12.
9. Prochaska, J. O.,DiClemente, C. C.(1982).Transtheoretical therapy: toward a more integrative model of change.Psychotherapy: Theory Research and Practice,19,276-288.
10. Prochaska, J. O.,DiClemente, C. C.,Norcross, J. C.(1992).In search of how people change: Applications to addictive behaviors.American Psychologist,47(9),1102-1114.
11. Purdie, N.,McCrindle, A.(2002).Self-regulation, self-efficacy and health behavior change in older adults.Educational Gerontology,28(5),379-400.
12. Shultz, J. A.,Sprague, M. A.,Branen, L. J.,Lambeth, S.(2001).A comparison of views of individuals with type 2 diabetes mellitus and diabetes educators about barriers to diet and exercise.Journal of Health Communication,6(2),99-115.
13. Stumvoll, M.,Goldstein, B. J.,Van Haeften, T. W.(2005).Type 2 diabetes: Principles of pathogenesis and therapy.Lancet,365(9467),1333-1346.
14. United Kingdom Prospective Diabetes Study=UKPDS(1998).Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes.Lancet,352(9131),837-853.
15. 中華民國糖尿病衛教學會(2010).糖尿病臨床照護指引2010.臺北:中華民國糖尿病學會.
16. 中華民國糖尿病衛教學會(2010).糖尿病衛教核心教材.臺北:中華民國糖尿病學會.
17. 中華民國糖尿病學會（2013）‧2013年糖尿病整合指引綱要‧取自http://www.endo-dm.org.tw/db/book/46/2013整合指引摘要.pdf
18. 全民糖尿病觀測站（2013）‧Low adherence to diet and exercise changes in type 2‧取自 http://www.diabetes.org.tw/epaper20131229.htm
19. 行政院衛生署中央健康保險局（2011）‧行政院衛生署國民健康局（2011）‧取自http://www.nhi.gov.tw/epaper/ItemDetail.aspx?DataID=2667&IsWebData=0&ItemTypeID=7&PapersID=227&PicID=
20. 行政院衛生署國民健康局（2011）‧2007年台灣地區高血壓、糖尿病及高血脂之追蹤調查研究‧取自http://www.bhp.doh.gov.tw/BHPNet/Portal/File/ThemeDocFile/201102111207511077/2007%e4%b8%89%e9%ab%98%e5%b0%88%e8%bc%af_%e7%b0%a1%e5%96%ae%e7%89%88_20110211.pdf
21. 李月萍,陳玉敏,邱美汝(2007)。安養機構老人規律運動行為現況及預測因子之探討。實證護理，3(4)，300-308。
22. 阮理瑛,林小玲,陳品汎,林宏達(2005)。台北榮民總醫院糖尿病衛教困難度之調查。內科學誌，16(5)，216-224。
23. 林生傳(2005).教育社會學.台北:巨流.
24. 林岱樺(1993)。台中，中山醫學大學護理研究所。
25. 林慶源,林耀豐(2009)。運動自我效能與運動行為之探討。屏東教大體育，12，217-231。
26. 郝立智,馬瀰嘉,趙海倫,簡崇仁,楊純宜,林興中,鄭錦翔(2007)。某地區教學醫院糖尿病門診病患個案管理照護之成效探討。中華民國內分泌暨糖尿病學會會刊，20(4)，11-33。
27. 張永昇（2014）‧別讓糖尿病慢性併發症，拖垮您的健康‧取自http://www.cch.org.tw/edm/edm_2_1.aspx?oid=42&pid=3&id=491
28. 張怡雅(2008)。桃園，南華大學自然醫學研究所。
29. 陳企萍(2009)。台南，國立成功大學護理研究所。
30. 陳春森,廖國盟(2005)。個別衛教對糖尿病患血糖控制之效果。北市醫學雜誌，2(5)，454-464。
31. 蔡明燕,黃盈翔,吳晉祥,張智仁,楊宜青(2007)。台灣糖尿病衛教師執行運動諮詢現況調查。實證護理，4(2)，157-166。
32. 蔡政麟(2006)。台中，亞洲大學健康管理研究所。

1. 陳佩琦(2016)。運用跨理論模式介入措施對糖尿病病人運動行為之成效。義守大學醫務管理學系學位論文。2016。1-86。