跳到主要內容

臺灣博碩士論文加值系統

(3.235.120.150) 您好!臺灣時間:2021/08/03 07:15
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

: 
twitterline
研究生:梁靖雯
研究生(外文):LEONG CHENG MAN
論文名稱:使用衛教影片導入「北醫之愛」社群媒體對糖尿病態度及自我照護能力之評估
論文名稱(外文):Evaluation of TMU-Line Oriented Video Education (TMU-LOVE) to Enhance Diabetes Self-management and Attitudes in Taiwan
指導教授:陳香吟陳香吟引用關係
指導教授(外文):CHEN, HSIANG-YIN
口試委員:白其卉張雅惠
口試委員(外文):BAI, CHYI-HEUYCHANG, YA-HUI
口試日期:2021-06-10
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:藥學系碩士班
學門:醫藥衛生學門
學類:藥學學類
論文種類:學術論文
論文出版年:2021
畢業學年度:109
語文別:英文
論文頁數:97
中文關鍵詞:第2型糖尿病健康教育2019新型冠狀病毒疾病糖尿病態度移動醫療視頻教育
外文關鍵詞:Type 2 diabetesCOVID-19 pandemichealth educationdiabetes patients’ attitudemHealthvideo education
數位影音連結:糖尿病衛教影片
相關次數:
  • 被引用被引用:0
  • 點閱點閱:24
  • 評分評分:
  • 下載下載:5
  • 收藏至我的研究室書目清單書目收藏:0
Background: The global increasing popularity in diabetes, as well as the impact of the coronavirus disease 2019 (COVID-19) burden, raised difficulties in health education. It was crucial to develop an innovative and effective educational program for diabetes. Objectives: This randomized clinical trial evaluated the clinical and humanistic outcomes of Line-based diabetic education platform, Taipei Medical University-Line Oriented Video Education (TMU-LOVE) for type 2 diabetes patients. Methods: There were164 type 2 diabetes patients recruited and randomly assigned to either intervention (n=82) or control (n=82) group. The educational platform had 51 videos, including 10 for understanding diabetes and daily care, 6 for nutrition care, 21 for diabetes drug and 4 for quizzes. The intervention group received 2-3 videos every week and care messages every two weeks through TMU-LOVE for 3 months, in addition to the usual care. The control group received care as usual. Outcomes including HbA1C, attitude by Diabetes Care Profile- Attitudes Towards Diabetes Scale, knowledge by Simplified true/false version of revised Diabetes Knowledge Scale and self-care activities by Summary of Diabetes Self-Care Activities were measured at baseline and 3 months after the intervention. Health literacy was also measured by the Newest Vital Sign at baseline. Results: Over 12 weeks of intervention, attitudes in intervention group changed from 3.59 ± 0.39 to 3.85 ± 0.44 (P<.001) which were in different from the change in the control group. (mean difference to control group 0.20, 95% CI -0.31 to -0.01; P<.001). The changes of A1C were not significantly different in both groups (from 6.95 ± 0.87 to 7.03 ± 0.91 in intervention group, P=.34 and from 6.75 ± 0.63 to 6.76 ± 0.69 in control group, P=.91). Positive effect was seen in self-care activities within the intervention group, from 3.69 ± 1.26 to 3.98 ± 1.23 (P=.02). In addition, both groups experienced an increase in knowledge score at 12 weeks, with percentage correct of 67.74% ± 16.99% into 77.32% ± 11.87% (P<.001) and 65.27 ± 18.07 into 72.83 ± 12.93 (P<.001) in the intervention and control group respectively. Among the 51 videos, medication-related videos had the highest utility rate. Conclusion: The social-media based program, TMU-LOVE, was effective in enhancing diabetes patients’ knowledge, attitudes and self-care activities during the COVID-19 pandemic. It was also helpful to patients with inadequate health literacy. The program could be a potential tool assisting patient education in clinical settings with an advantage to reduce in-person discussion.

背景:全球日益上升的糖尿病人口以及2019年冠狀病毒疾病的影響下,糖尿病伴隨著衞教的不足,因此為糖尿病病人發展一個創新以及有效的衛教方式是很重要的。目的:本研究以社群媒體”Line@”發展「北醫之愛」社群並探討此衛教模式對於糖尿病病人血糖控制,態度,知識以及自我照護的影響。方法:此研究一共收錄184位病人,病人被隨機分派成兩組。「北醫之愛」社群裡一共有51部衛教影片,其中認識糖尿病和日常照護各有10部影片、營養照護有6部影片、藥物小學堂有21部影片以及牛刀小試有4部影片。試驗組除了接受常規衛教以外,也透過「北醫之愛」社群,每週會收到2-3部影片和每2週的關心訊息,控制組則是接受常規衛教,每位受訪者研究期間為12週。此研究於試驗的第一天以及12週後進行問卷測量以及糖化血色素的數據記錄,問卷內容包括Diabetes Care Profile-Attitudes Toward Diabetes Scales,測定病人面對糖尿病的態度、Summary of Diabetes Self Care Activities,瞭解病人日常生活照護的情況及Simplified True / False version of Diabetes Knowledge Scale,瞭解病人對於糖尿病相關知識的認知。此外,於試驗的第一天也會以Newest Vital Sign,瞭解病人的健康素養狀況。結果:經過12週後,不同於控制組,試驗組中糖尿病的態度從3.59 ± 0.39上升至3.85 ± 0.44 (P<.001),試驗組和控制組之間的差異為 0.20, 95%信賴區間為-0.31到-0.01 (P<.001)。而兩組的糖化血色素均無明顯變化,試驗組從6.95 ± 0.87到7.03 ± 0.91 (P=0.34);控制組從6.75 ± 0.63到6.76 ± 0.69 (P=0.91)。自我照護能力僅在試驗組中的進步有顯著,從3.69 ± 1.26到3.98 ± 1.23, P=.019。此外,兩組對於糖尿病知識的得分都有所提高,答對率在試驗組中從67.74 ± 16.99上升至77.32 ± 11.87 (P<.001),在控制組中從65.27±18.07上升至72.83 ± 12.93 (P<.001)。在51部衛教影片中,藥物相關的影片觀看比例是最高的。結論:在 2019新型冠狀病毒疾病大流行期間,「北醫之愛」有效地提高了糖尿病病人的知識,態度和自我照護習慣,也能幫助健康識能不足的病患。「北醫之愛」是有潛能運用在臨床上,協助給予病患衛教。

Abstract Ⅰ
Abstract in Chinese Ⅲ
Acknowledgment Ⅴ
Content Ⅶ
Tables Ⅹ
Figures XI
Abbreviation and Acronyms XII

Chapter 1. Background 1
Chapter 2. Literature Reviews
2.1 Diabetes Care
2.1.1. Role of Health Literacy in Self-management 3
2.1.2. Strategies for Improving Diabetes Care 4
2.2 eHealth
2.2.1. Social Media in Taiwan 6
2.2.2. eHealth for Diabetes Self-management 7
2.3 Questionnaires
2.3.1. Diabetes Knowledge-Related Questionnaire 8
2.3.2. Diabetes Attitudes-Related Questionnaire 11
2.3.3. Diabetes Self-Care Activities-Related Questionnaire 13
2.3.4. Diabetes Health Literacy-Related Questionnaire 15
Chapter 3. Objective 17
Chapter 4. Methods
4.1 Study Design 18
4.2 Study Subjects
4.2.1. Inclusion Criteria 20
4.2.2. Exclusion Criteria 20
4.2.3. Control Group 20
4.2.4. Intervention Group 20
4.2.5. Sample Size Calculation 21
4.2.6. Randomization 21
4.3 Study Tools
4.3.1. Line-based Diabetes Education Program 22
4.3.2. Data Collection 25
4.3.3. Data Collection Instrument 26
4.3.4. Assessment of Knowledge 27
4.3.5. Assessment of Self Care Activities 27
4.3.6. Assessment of Attitudes 27
4.3.7. Assessment of Health Literacy 28
4.4 Statistical Analysis 29
Chapter 5. Results 30
5.1 Demographics 32
5.2 Primary Outcomes
5.2.1.HbA1C 35
5.3. Secondary Outcomes
5.3.1. Score of SDKS 36
5.3.2. Score of SDSCA 38
5.3.3. Score of DCP-ATDS 40
5.3.4. Utility Rate of Educational Videos 42
5.4. Subgroup Analysis
5.4.1. Effect of Health Literacy 44
5.4.2. Attitudes and Self-care Improvements 45
Chapter 6. Discussions
6.1 Main Findings 46
6.2 Difficulties of a Subgroup in Self-care Activities 47
6.3 mHealth Lessons from the COVID-19 Pandemic 47
6.4 Need for Diabetic Medication Education 48
6.5 Health Literacy Level in Taiwan 48
6.6 Clinical Implications 49
6.7 Limitations 49
Chapter 7. Conclusions 51
References 52
Appendices
1. Top five reasons patients found it difficult to engage in self-care activities 58
2. Certificate of TMU-Joint Institutional Review Board 59
3. Authorization to use the Chinese version of SDSCA questionnaire 61
4. Authorization to use the Chinese version of NVS questionnaire 62
5. Questionnaire used in this study 63
6. Informed consent form 69
7. List of educational videos 75
8. Code Book 85

Tables
Table 1 Diabetes knowledge-related questionnaires 10
Table 2 Diabetes attitude-related questionnaires 12
Table 3 Diabetes self-care-related questionnaires 14
Table 4 Health literacy-related questionnaires 16
Table 5 Baseline Characteristics 33
Table 6 Mean score of pre-test 34
Table 7 HbA1C Outcome 35
Table 8 Score of SDKS 37
Table 9 Score of SDSCA 38
Table 10 Score of DCP-ATDS 40
Table 11 Mean differences within and between groups 41
Table 12 Effect of health literacy to knowledge, attitudes and self-care activities 44
Table 13 Mean differences in DCP-ATDS between patient with and without improvement in score of SDSCA 45

Figures
Figure 1 Study design 19
Figure 2 Line educational platform 23
Figure 3 The five categories of educational videos 24
Figure 4 Delivery order of videos 25
Figure 5 Outcome measurement 26
Figure 6 Study flowchart 31
Figure 7 Utility rate of educational videos 43


1.Chrvala CA, Sherr D, Lipman RD. Diabetes self-management education for adults with type 2 diabetes mellitus: A systematic review of the effect on glycemic control. Educ Couns. 2016;99(6):926-43.
2.American association of diabetes educators. An effective model of diabetes care and education: Revising the AADE7 Self-Care Behaviors®. Diabetes Educ. 2020;46(2):139-160.
3.Tshiananga JKT, Kocher S, Weber C, et al. The effect of nurse-led diabetes self-management education on glycosylated hemoglobin and cardiovascular risk factors: a meta-analysis. Diabetes Educ. 2012;38(1):108-23.
4.Nathan DM, Genuth S, Lachin J, et al. Diabetes control and complications trial research group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med..1993;329(14):977-986.
5.He X, Li J, Wang B, et al. Diabetes self-management education reduces risk of all-cause mortality in type 2 diabetes patients: a systematic review and meta-analysis. Endocrine. 2017;55(3):712-731
6.Tang TS, Funnell MM, Oh M. Lasting effects of a 2-year diabetes self-management support intervention: outcomes at 1-year follow-up. Prev Chronic Dis. 2012;9:E109.
7.Cochran J, Conn VS. Meta-analysis of quality of life outcomes following diabetes self-management training. Diabetes Educ. 2008;34(5):815-823.
8.Shubrook JH, Brannan GD, Wapner A, et al. Time needed for diabetes self-care: Nationwide survey of Certified Diabetes Educators. Diabetes Spectr. 2018;31(3):267-271.
9.Hunt CW. Technology and diabetes self-management: an integrative review. World J Diabetes. 2015;6(2):225–33.
10.Lim S, Kang SM, Shin H, et al. Improved glycemic control without hypoglycemia in elderly diabetic patients using the ubiquitous healthcare service, a new medical information system. Diabetes Care. 2011;34(2):308-13.
11.Holmen H, Torbjørnsen A, Wahl AK, et al. A Mobile health intervention for self-management and lifestyle change for persons with type 2 diabetes, part 2: one-year results from the Norwegian randomized controlled trial RENEWING HEALTH. JMIR mHealth uHealth. 2014;2(4):e57
12.Johnston N, Bodegard J, Jerström S, et al. Effects of interactive patient smartphone support app on drug adherence and lifestyle changes in myocardial infarction patients: A randomized study. Am Heart J .2016;178:85-94.
13.Yeung DL, Alvarez KS, Quinones ME, et al. Low-health literacy flashcards & mobile video reinforcement to improve medication adherence in patients on oral diabetes, heart failure, and hypertension medications. J Am Pharm Assoc. 2017 ;57(1):30-37
14.Yadav, A., Phillips, M.M., Lundeberg, M.A. et al. If a picture is worth a thousand words is video worth a million? Differences in affective and cognitive processing of video and text cases. J Comput High Educ. 2011;23, 15–37.
15.Tuong W, Larsen ER, Armstrong AW. Videos to influence: a systematic review of effectiveness of video-based education in modifying health behaviors. J Behav Med. 2014; 37(2):218–33.
16.Liron HB. Silimarweb Blog. 2019 April. URL: https://www.similarweb.com/corp/blog/research/market-research/mobile-messaging-app-map-january-2019 [access: 2021-06-01].
17.銀髮族科技應用現況,資策會FIND,2017. URL: https://www.cna.com.tw/postwrite/Detail/211132.aspx [access: 2021-06-01].
18.Health literacy, Centers for Disease Control and Prevention. Page last reviewed: May 19, 2021.
19.Stacy Cooper Bailey, Angela G. Brega, Trisha M. Crutchfield, et al. Update on health literacy and diabetes. Diabetes Educ. 2014;40(5):581-604.
20.Iris van der Heide, Ellen Uiters, Jany Rademakers, et al. Associations among health literacy, diabetes knowledge, and self-management behavior in adults with diabetes: results of a dutch cross-sectional study. J Health Commun. 2014;19 Suppl 2:115-31.
21.Fatima Al Sayah, Sumit R. Majumdar, Beverly Williams, et al. Health literacy and health outcomes in diabetes: a systematic review. J Gen Intern Med. 2013 ;28(3):444-52.
22.Terris R. Moss. The impact of health literacy on clinical outcomes for adults with type 2 diabetes mellitus. Advances in diabetes and metabolism. 2(1): 10-19, 2014.
23.Angela Yee Man Leung, Mike Kwun Ting Cheung, Iris Chi. relationship among patients' perceived capacity for communication, health literacy, and diabetes self-care. J Health Commun. 2014;19 Suppl 2:161-72.
24.American Diabetes Association. 1. Strategies for improving care. Diabetes Care. 2016;39 Suppl 1:S6-12.
25.Donna Tomky, Marjorie Cypress, Devra Dang, et al. AADE position statement. Diabetes Educ, 2008; 34: 445-449.
26.Powers M, Bardsley J, Cypress M, et al. Diabetes self-management education and support in type 2 diabetes: a joint position statement of the american diabetes association, the american association of diabetes educators, and the academy of nutrition and dietetics. Diabetes Care 2015; 38:1372–82.
27.American Diabetes Association. 5. Lifestyle management: standards of medical care in diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S46-S60.
28.Tshiananga JKT, Kocher S, Weber C, et al. The effect of nurse-led diabetes self-management education on glycosylated hemoglobin and cardiovascular risk factors: a meta-analysis. Diabetes Educ. 2012; 38:108-123.
29.Nathan DM, Genuth S, Lachin J, et al. Diabetes control and complications trial research group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977-986.
30.He X, Li J, Wang B, et al. Diabetes self-management education reduces risk of all-cause mortality in type 2 diabetes patients: a systematic review and meta-analysis. Endocrine. 2017;55(3):712-731
31.Tang TS, Funnell MM, Oh M. Lasting effects of a 2-year diabetes self-management support intervention: outcomes at 1-year follow-up. Prev Chronic Dis. 2012;9: E109.
32.Cochran J, Conn VS. Meta-analysis of quality of life outcomes following diabetes self-management training. Diabetes Educ. 2008;34(5):815-823.
33.Hootsuite & We Are Social (2020), “Digital-2020-taiwan” retrieved from https://datareportal.com/reports/digital-2020-taiwan.
34.Burson R, Moran KJ. The AADE 7. Home Healthc Nurse. 2014;32(9):556.
35.行動網路發展提高老年人口上網率,傳播學院新聞實驗室,國立政治大學, 2017.
36.© LINE Corporation. LINE. 2021. URL: https://tw.linebiz.com/login [access: 2021-06-01].
37.Hootsuite & We Are Social (2020), “Digital 2020 global digital overview,” retrieved from https://datareportal.com/reports/digital-2020-global-digital-overview.
38.WHO guideline Recommendations on Digital Interventions for Health System Strengthening. Geneva: World Health Organization; 2019.
39.Kebede MM, Pischke CR. Popular diabetes apps and the impact of diabetes app use on self-care behavior: a survey among the digital community of persons with diabetes on social media. Front Endocrinal (Lausanne). 2019; 10:135.
40.Gabarron E, Årsand E, Wynn R. Social media use in interventions for diabetes: rapid evidence-based review. J Med Internet Res. 2018;20(8): e10303.
41.Fitzgerald JT, Funnell MM, Hess GE, et al. The reliability and validity of a brief Diabetes Knowledge Test. Diabetes Care. 1998; 21:706-710.
42.James T. Fitzgerald, Martha M. Funnell, Robert M. Anderson, et al. Validation of the revised brief Diabetes Knowledge Test (DKT2). Diabetes Educ. 2016; 42: 2.
43.Garcia AA, Villagomez ET, Brown SA, et al. The Starr county diabetes education study: development of the Spanish-language diabetes knowledge questionnaire. Diabetes Care. 2001; 24:16–21.
44.G. S. Collins, S. Mughal, A. H. Barnett, et al. Modification and validation of the Revised Diabetes Knowledge Scale. Diabet Med. 2011;28(3): 306-10.
45.Yu-Feng Kuo. Psychometric evaluation of the simplified diabetes knowledge scale and attitudes towards diabetes scale in Taiwan: translation and validation. Clinical Pharmacy in School of Pharmacy Taipei Medical University master thesis. 2020.
46.Anderson RM, Fitzgerald JT, Funnell MM, et al. The third version of the Diabetes Attitude Scale. Diabetes Care. 1998;21(9):1403-7.
47.S. M. Dunn, H.H.S., L. J. Beeney, et al. Measurement of emotional adjustment in diabetic patients: validity and reliability of ATT39. Diabetes Care. 1986. 9(5).
48.J T Fitzgerald, W K Davis, C M Connell, et al. Development and validation of the Diabetes Care Profile. Eval Health Prof. 1996;19(2): 208-30.
49.Lou Q, Chen Y, Guo X, et al. Diabetes attitude scale: validation in type-2 diabetes patients in multiple centers in China. PLoS One. 2014;9(5): e96473.
50.Schmitt A, Gahr A, Hermanns N, et al. The Diabetes Self-Management Questionnaire (DSMQ): development and evaluation of an instrument to assess diabetes self-care activities associated with glycaemic control. Health Qual Life Outcomes. 2013; 13; 11:138.
51.Akohoue SA, Wallston KA, Schlundt DG, et al. Psychometric evaluation of the short version of the personal diabetes questionnaire to assess dietary behaviors and exercise in patients with type 2 diabetes. Eat Behav. 2017; 26:182-188.
52.Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care. 2000;23(7):943-50.
53.Li-Chun Hsieh, et al. School of Nursing National Taipei University of Nursing and Health Sciences. 2015. The Relationships among Disease Knowledge, Social Support and Self-Care Behavior of the Homeless with Type 2 Diabetes. URL: http://irlib.ntunhs.edu.tw/retrieve/5580/103NTCN0563089-001.pdf [access: 2021-06-01].
54.Baker DW, Williams MV, Parker RM, et al. Development of a brief test to measure functional health literacy. Patient Educ Couns. 1999;38(1):33-42
55.Davis T.C, Long S.W, Jackson R.H, et al. Rapid estimate of adult literacy in medicine: a shortened screening instrument. Fam. Med. 1993, 25, 391–395.
56.Huizinga MM, Elasy TA, Wallston KA, et al. Development and validation of the Diabetes Numeracy Test (DNT). BMC Health Serv Res. 2008;8:96.
57.Weiss BD, Mays MZ, Martz W, et al. Quick assessment of literacy in primary care: the newest vital sign. Ann Fam Med. 2005;3(6):514-22.
58.Tang YH, Pang SM, Chan MF, et al. Health literacy, complication awareness, and diabetic control in patients with type 2 diabetes mellitus. J Adv Nurs. 2008;62(1):74-83.
59.Chun-Wen Lin, et al. 健康素養量表中文版之信效度檢驗與應用—以幼兒職前教師為例. Journal of Health Promotion and Health Education Contents. 2010. URL: http://rportal.lib.ntnu.edu.tw/bitstream/20.500.12235/242/1/ntnulib_ja_A0603_0034_001.pdf [access: 2021-06-01].
60.School of Pharmacy. Taipei Medical University. 2021. URL: http://pharmschool.tmu.edu.tw/activity/index.php?type=20 [access: 2021-06-01]
61.Goodarzi M, Ebrahimzadeh I, Rabi A, et al. Impact of distance education via mobile phone text messaging on knowledge, attitude, practice and self-efficacy of patients with type 2 diabetes mellitus in Iran. J Diabetes Metab Disord. 2012;11(1):10.
62.Goodarzi M, Ebrahimzadeh I, Rabi A, et al. Impact of education via mobile phone on knowledge, attitude, practice and hba1c of patients with type 2 diabetes mellitus in Karaj-Iran. J Diabetes Metab Disord. 2012;11(1):10.
63.Belsti Y, Akalu Y, Animut Y. Attitude, practice and its associated factors towards diabetes complications among type 2 diabetic patients at Addis Zemen District hospital, Northwest Ethiopia. BMC Public Health. 2020;20(1):785.
64.Rahaman KS, Majdzadeh R, Holakouie Naieni K, et al. Knowledge, Attitude and Practices (KAP) regarding chronic complications of diabetes among patients with type 2 diabetes in Dhaka. Int J Endocrinol Metab. 2017;15(3):e12555.
65.Taylor D, Grant J, Hamdy H, Grant L, et al. Transformation to learning from a distance. MedEdPublish. 2020; 9, [1], 76.
66.Rose S. Medical student education in the time of covid-19. JAMA. 2020;323(21): 2131-2132.
67.Bhaskar S, Bradley S, Chattu VK, et al. Telemedicine as the New Outpatient Clinic Gone Digital: Position Paper From the Pandemic Health System REsilience PROGRAM (REPROGRAM) International Consortium (Part 2). Front Public Health. 2020; 7;8:410.
68.Alromaihi D, Alamuddin N, George S. Sustainable diabetes care services during COVID-19 pandemic. Diabetes Res Clin Pract. 2020;166:108298.
69.Hare N, Bansal P, Bajowala SS, et al. Work Group Report: COVID-19: Unmasking Telemedicine. J Allergy Clin Immunol Pract. 2020;8(8):2461-2473.e3.
70.CDCES Fact Sheet. Certified Diabetes Care and Education Specialist. 2020. URL: https://www.cbdce.org/documents/20123/66178/CDCES_factsheet_4c_WEB.pdf/3a1c503d-cbde-72af-b50f-b2385e4e6ae4?t=1587662753440.
71.Shu-Tien Huang, Hung-Yu Chuang, Wen-Han Chang, et al. Explore patient-specific needs for mHealth solutions in Taiwan: a mixed study. Health technology. 2018;2(4).
72.Sørensen K, Pelikan JM, Röthlin F, et al. Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU). Eur J Public Health. 2015;25(6):1053-8.
73.Stewart CC, Yu L, Lamar M, et al. Associations of health and financial literacy with mortality in advanced age. Aging Clin Exp Res. 2020 ;32(5):951-957.
74.Abdullah A, Liew SM, Salim H, et al. Prevalence of limited health literacy among patients with type 2 diabetes mellitus: A systematic review. PLoS One 14(5): e0216402.
75.Tseng HM, Liao SF, Wen YP, et al. Adaptation and validation of a measure of health literacy in Taiwan: The Newest Vital Sign. Biomed J. 2018;41(4):273-278.
76.Singh-Manoux A, Kivimaki M, Glymour MM, et al. Timing of onset of cognitive decline: results from Whitehall II prospective cohort study. BMJ. 2012;344:d7622.
77.Kim SH, Utz S. Effectiveness of a social media-based, health literacy-sensitive diabetes self-management intervention: a randomized controlled trial. J Nurs Scholarsh. 2019;51(6):661-669.

QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top