第2型糖尿病在全世界的盛行率一直在逐年的攀升中，研究預估至2025年全世界將有3億8千萬的成年人罹患糖尿病。糖尿病患者皆暴露於心血管疾病等慢性病的高風險中，要降低風險須加強血糖的控制。因此，本研究之目的在於病友團體「控糖樂活營」對第2型糖尿病胰島素控制血糖患者對糖尿病控制指標、糖尿病疾病態度及糖尿病自我效能之成效評估。本研究採介入前後兩次測量進行，介入時間為期3個月，以病歷查閱方式分別收集兩組個案於團體衛教介入執行3個月前後之糖化血色素值與體重變化，並以結構式問卷分別收集兩組個案3個月前後之糖尿病知識、糖尿病控制自我效能及糖尿病疾病態度情形。資料收集後以描述性、卡方檢定、獨立樣本t 檢定、配對t 檢定進行分析。本研究共收集72位以胰島素控制血糖之第2型糖尿病病患，其中加強團體衛教組有35人；一般照護組有37人。結果顯示在經過三個月的介入，加強團體衛教組的糖尿病知識(11.7 ± 2.4分與16.6 ± 1.6分)、糖尿病態度(47.3 ± 4.1分與54.2 ± 4.9分)、糖尿病自我效能(158.9 ± 3分與183.8 ± 16.4分)，均有顯著提升(p<0.05)。在一般照護組部分，糖尿病知識(14.5 ± 3.3分與15.0 ± 2.7分)、糖尿病態度(47.3 ± 4.1分與52.7 ± 3.9分)、糖尿病自我效能(151.0 ± 15.5分與152.7 ± 34.0分)。在糖尿病控制指標糖化血色素A1C方面，加強團體衛教組病患的糖化血色素A1C由9.3 ± 2.3 %下降至8.3 ± 0.9 %，一般照護組由8.9 ± 1.9 %下降至8.8 ± 1.9 %，結果顯著差異(p<0.05)。本研究顯示接受加強團體衛教照護之第2型糖尿病胰島素治療之病患其糖尿病控制指標、糖尿病知識、糖尿病自我效能、糖尿病態度都能有效提升及改善，並反應在糖化血色素及體重指標上。

The incidence of type 2 diabetes in the world has been rising year by year, the researchers forecast that to 2025 the world will have 380 million adults suffer from diabetes. Diabetic patients are exposed to a high risk of cardiovascular disease and other chronic diseases, the well blood sugar controlled is needed to reduce the risk.
Aim: The aim of this study was to examine the effect of group program (GP) on knowledge, attitude, self-efficacy in the patient with T2DM under insulin control. This study was pre-posttest design. Samples included in this study were who had diagnosed as type 2 diabetes and A1C was great than 7%. The intervention period is 3 monthes.Chart review for A1C and Body weight collecting, structured questionnaires were collected for the knowledge, attitude, and self-efficacy in the patient with T2DM under insulin control. Descriptive statistics, independent t-test, χ2, Mann-Whitney U test and Wilcoxon signed ranks test were used to analyse the data. There were 72 patients participated in this study, 35 patients in GP group and 37 in usual care (UC) group. After 6 months follow-ups, physical measure such as A1C of patients in the GP group was better improved than those of patients in the UC group. The score of knowledge, attitude, and self-efficacy in GP group were 11.7 ± 2.4 v.s. 16.6 ± 1.6, 47.3 ± 4.1 v.s. 54.2 ± 4.9, 158.9 ± 34.0 v.s. 183.8 ± 16.4. There was a significant difference in the mean scores of patients’ knowledge, attitudes and self-efficacy between GP groups (p< 0.05). The score of knowledge, attitude, and self-efficacy in UC group were 14.5 ± 3.3 v.s.15.0 ± 2.7, 47.3 ± 4.1 v.s. 52.7 ± 3.9, 158.9 ± 34.0 v.s.183.8 ± 16.4. The study indicates that after 3 monthes group program intervention on the T2DM patient with insulin controlled, there is significant improvement of the HbA1C, the scores patients’ knowledge, patients’ attitudes, and patients’ self-efficacy were also effectively enhance and improved in GP group than that of UC group.

中文摘要 I
Abstract III
致 謝 V
表目次 X
圖目次 XI
縮寫表 XII
第一章 緒 論 1
第二章 文獻回顧 4
第一節 糖尿病概述 4
第二節 糖尿病共同照護 11
第三節 糖尿病自我照顧 14
第四節 糖尿病自我效能(Self-efficacy) 17
第五節 糖尿病知識 22
第六節 糖尿病態度 24
第三章 研究動機與目的 26
第一節 研究背景與動機 27
第二節 研究目的 31
第三節 研究假設 32
第四節 名詞界定 33
第四章 材料與方法 38
第一節 研究執行流程圖與實驗設計 39
第二節 研究架構 42
第三節 受試者招募及排除 43
第四節 研究工具 44
第五節 研究步驟 49
第六節 團體衛教課程設計 52
第七節 資料處理與分析 54
第八節 研究對象權益維護 56
第五章 結 果 58
第一節 受試者招募人數 59
第二節 受試者基本資料的描述與比較 60
第三節 兩組照護行為對於糖尿病知識、糖尿病自我效能以及糖尿病態度之比較 64
第四節 兩組照護模式下對於糖尿病控制指標及體位變化之比較 71
第六章 討 論 73
第一節 病患基本特性 74
第二節 兩組照護模式對糖尿病知識、糖尿病態度、及糖尿病自我效能之影響 77
第三節 兩組照護模式對糖尿病控制指標之差異 83
第四節 研究限制 85
第七章 結 論 86
參考文獻 87
中文部分 87
英文部分 91
附 錄 99
附件1 授權同意書(糖尿病知識及態度量表) 99
附件2 授權同意書(糖尿病知識量表) 100
附件3 受試者基本資料 101
附件4 糖尿病知識量表 102
附件5 糖尿病態度量表 103
附件6 中文版糖尿病管理自我效能量表 104
附件7 電訪紀錄單 105
附件8 人體試驗委員會同意函 106
附件9 受訪者同意書 108
表目次
表 1 糖尿病的控制目標 36
表 2 研究設計 40
表 3 實驗組與對照組織照護模式比較 41
表 4 團體衛教組試驗時程 53
表 5 兩組個案之基本資料分析比較 (n=72) 63
表 6 兩組個案之糖尿病知識、糖尿病自我效能、糖尿病態度之前後差異比較 (n=72) 67
表 7 加強團體衛教組糖尿病知識得分情形 68
表 8 兩組個案之糖尿病代謝指標前後比較 72
圖目次
圖 1 以自我效能理論介入於第2型糖尿病病人之成效探討研究架構 42
圖 2 實驗流程圖 51

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