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研究生:沙米娜
研究生(外文):Aminatta Sarr
論文名稱:DiabetesSelf-Management:PerspectivesofGambianPatientsAttendingtheMedicalClinic,RoyalVictoriaTeachingHospital(RVTH),2009
論文名稱(外文):Diabetes Self-Management: Perspectives of Gambian Patients Attending the Medical Clinic, Royal Victoria Teaching Hospital (RVTH), 2009
指導教授:邱淑媞邱淑媞引用關係
指導教授(外文):Shu-Ti Chiou
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:公共衛生研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2010
畢業學年度:98
語文別:英文
論文頁數:62
中文關鍵詞:N/A
外文關鍵詞:N/A
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Abstract
Background: Managing a chronic disease demands a life-long engagement of the patient who should be encouraged and supported to take up that role. People living with diabetes need guidance in learning how to self-manage their condition and in taking responsibility for their daily diabetes care

Objectives: To assess diabetic patients’ self-management behaviors and its associated factors in a country experiencing rapid emergence of the new epidemic and to also assess treatment adherence among diabetic patients.
Design: A cross-sectional survey.
Setting: The Medical Clinic, Royal Victoria Teaching Hospital.
Participants: A sample of 350 participants was recruited, and 349 completed the study. Inclusion criteria :( 1)All Patients with diabetes 1 or 2 according to their medical records(2) Patients were 18- 85 years.(3)Patients were attending RVTH and should have at least 2 visits in the study clinic in the past 6 months. Exclusion criteria: (1) Patients more than 86 years (2)Gestational diabetic patients (3)Patient that were too sick(especially those with elevated Fasting blood sugar)
Methods
Sampling: A systematic sampling was done to select subjects from patients attending the clinic, during waiting time.
Data Collection: A face-to-face interview surveys were conducted using structured questionnaire consisting both closed and opened ended questions. Ethical issues: Informed consent was obtained from each participants and approval for the study was obtained from Ethics and Research Committee of RVTH.
Results:
70% of participants were female, majority of the participants were age 35-64years(69%), had no formal education (75%), had a fasting. blood sugar greater than 7.1mmol(80%) on the day of the survey and a BMI greater than 24.9(67%).
CONCLUSION: Results from this study highlight the challenges of diabetes self-Management in resource-poor setting. Improving diabetes care will required a national diabetes programs capable of handing current patients and newly diagnose patients especially those living in poverty who lack access to basic diagnostic and treatment suppliers. Also this programs can also address literacy which may be particular beneficial for patients with low knowledge of diabetes.
TABLE OF CONTENT

INTROUDUCION
The country Profile 1
Health Profile 1
Health Care Delivery System 2
Literature Review 3-8
Study significance and specific aims 9
Objectives 10
Analytical Framework 11
METHODOLOGY
Study Design 12
tudy Frame 12
Study setting 12
Sampling 13
Study Procedure 13
Statistical analytical methods 15
RESULTS 16-21
DISCUSSIONS22-25
Study Limitation 26
CONCLUSIONS 27
POLICY IMPLICATION 28
LIST OF TABLES 29-48
REFERENCES 49-51
QUESTIONNAIRES 53-62
REFERENCES
1. World Health Organization Web site. WHO country cooperation strategy 2008-2013. http://www.who.int/countryfocus/cooperation_strategy/ccs_gmb_en.pdf. Accessed June 20, 2010.

2. World Health Organization Web site. Country 2010 http://www.who.int/countries/gmb/en/ June 20, 2010

3. World Health Organization Web site. Diabetes programme 2010. http://www.who.int/diabetes/en/ Accessed June 20,2010.
4 Kumar & Clark, 2002.Clinical medicine textbook, fifth edition
5. Dijkstra, R., J. Braspenning, and R. Grol, Implementing diabetes passports to focus practice reorganization on improving diabetes care. Int J Qual Health Care, 2008. 20(1): p. 72-7.
6. Standards of medical care in diabetes--2008. Diabetes Care, 2008. 31 Suppl 1: p. S12-54.
7. Bastiaens, H., et al., Supporting diabetes self-management in primary care: Pilot-study of a group-based programme focusing on diet and exercise. Prim Care Diabetes, 2009.
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9. Heisler, M., et al., The relative importance of physician communication, participatory decision making, and patient understanding in diabetes self-management. J Gen Intern Med, 2002. 17(4): p. 243-52.
10. de Alba Garcia, J.G., et al., "Diabetes is my companion": lifestyle and self-management among good and poor control Mexican diabetic patients. Soc Sci Med, 2007. 64(11): p. 2223-35.
11 Rothman R.L, Self-Management Behaviors, Racial Disparities, and Glycemic Control Among Adolescents With Type 2 Diabetes. Pediatrics 2008;121;e912-e919

12. Beran, D. and J.S. Yudkin, Diabetes care in sub-Saharan Africa. Lancet, 2006. 368(9548): p. 1689-95.

13. Carbone, E.T., et al., Diabetes self-management: perspectives of Latino patients and their health care providers. Patient Educ Couns, 2007. 66(2): p. 202-10.
14. Kiawi, E., et al., Knowledge, attitudes, and behavior relating to diabetes and its main risk factors among urban residents in Cameroon: a qualitative survey. Ethn Dis, 2006. 16(2): p. 503-9.
15. Rolfe, M., et al., Diabetes mellitus in The Gambia, west Africa. Diabet Med, 1992. 9(5): p. 484-8.

16 . Morisky DE, Ang A, Krousel-Wood M, Ward H. Predictive Validity of a Medication Adherence Measure for Hypertension Control. Journal of Clinical Hypertension 2008; 10(5):348-354.
17. Ramachandran, A., et al., Awareness about diabetes and its complications in the general and diabetic population in a city in southern India. Diabetes Research and Clinical Practice 77 (2007) 433–437

18. Siervo M, Davies AA, Jebb SA, Jalil F, Moore SE, Prentice AM. Ethnic differences in the association between body mass index and impedance index (Ht^2/Z) in adult women and men using a leg-to-leg bioimpedance method Short communication in European Journal of Clinical Nutrition, 2007, 61:1337-1340
19.van der Sande MAB et al. Blood pressure patterns and cardiovascular risk factors in rural and urban Gambian communities Journal of Human Hypertension, 2000, 14:489-496, Additional data from personal communication: Marianne A. B. van der Sande
20.Morisky DE, Green W, Levine DM, et al. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67-74.

21. Krousel-Wood MA, Islam T, Webber LS, Morisky DE, Muntner P. Concordance of Self-Reported Medication Adherence by Pharmacy Fill in Patients with Hypertension. Am J Managed Care 2009; 15(1):59-66.
22.Baumann L, Kenneth C, et al., self-care beliefs and behaviors in Ugandan adults with type 2 diabetes. Journal of The Diabetes Educator 2010, 36(2):293-300.
23. Coates, V.E. and J.R. Boore, Knowledge and diabetes self-management. Patient Educ Couns, 1996. 29(1): p. 99-108.

24. Wang PS, Bohn RL, Knight E, Glynn RJ, Mogun H, Avorn J. Noncompliance with antihypertensive medications: the impact of depressive symptoms and psychosocial factors. J Gen Intern Med.
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26. Iskedjian M, Einarson TR, MacKeigan LD, et al. Relationship between daily dose frequency and adherence to antihypertensive pharmacotherapy: evidence from meta-analysis. Clin Ther.
2002;24(2):302-316.

27. World Health Organization Web site. Hypertension in adherence to long-term therapies: evidence for action. 2003. http://www.connectedhealth. org/programs/medication-adherence/research-materials—external-resources/adherence-to-long-term-therapies-evidence-foraction. aspx Accessed December 23, 2008


28. Wassertheil-Smoller S, Blaufox MD, Oberman A, et al. Effect of antihypertensives
on sexual function and quality of life: the TAIM study. Ann Intern Med. 1991;114(8):613-620.

29. Gregoire JP, Moisan J, Guibert R, et al. Tolerability of antihypertensive drugs in a community-based setting. Clin Ther. 2001;23(5):715-726.

30. Krousel-Wood MA, Thomas S, Jannu A, Muntner P, Morisky DE, Re RN. Low adherence to prescribed antihypertension medication and poorer quality of life in elderly hypertensive patients. Poster presented at: American Heart Association 2nd Scientific Conference on Compliance in Healthcare and Research, Washington DC, May 18, 2004.

31. Harmon G, Lefante J, Krousel-Wood MA. Overcoming barriers: the role of providers in improving patient adherence to antihypertensive medications. Curr Opin Cardiol. 2006;21(4):310-315.
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