臺灣博碩士論文加值系統

摘要
研究背景：糖尿病自我管理，包括保持健康的飲食、進行定期的運動和自我血糖監測，對有效管理糖尿病並減少長期併發症的風險至關重要。本研究目的為探討索馬里蘭成年人糖尿病患者遵循飲食建議、運動和自我血糖監測的現況以及影響因子，並探討病患遵從性對糖化血色素（HbA1C）的影響。本研究也探討了性別在糖尿病自我管理遵從性與HbA1C之間的關聯。
研究方法：本研究為橫斷面研究。本研究於醫院案422名年齡在18歲及以上的成年糖尿病患者。抽樣方法為系統隨機抽樣，抽取定期於醫院回診之糖尿病病患。本研究使用面訪結構式問卷。統計方法使用羅吉斯迴歸模型估計與飲食建議、運動，和自我血糖監測遵從性相關的因素。估計結果以勝算比 (adjusted odds ratio, AOR) 呈現，並進一步按性別做分層分析。
研究結果：在本研究中，僅有26.1%、48.2% 和 36.1% 的參與者分別遵守了飲食建議、運動建議和自我血糖監測。參與者的性別、年齡、教育程度、糖尿病知識、食物缺乏、家中是否有血糖儀、腎病、視網膜病變以及由糖尿病併發症引起的足部潰瘍與遵守飲食建議、體育鍛鍊和自我血糖監測具顯著相關。在迴歸分析中，糖尿病知識在所有三個遵從性測量中都是最強的預測因子；與飲食遵從性（AOR=6.66，95% CI:3.80 - 11.67）、運動遵從性（AOR=2.22，95% CI:1.28 - 3.85）和自我血糖監測遵從性（AOR=2.04，95% CI:1.22 - 3.41）顯著相關。遵守運動和自我血糖監測的參與者顯示出有良好血糖控制百分比的概率較高。此外，飲食、運動、自我血糖監測與血糖控制之間的關係在男性和女性之間存在顯著差異。
結論：本研究探討索馬里蘭糖尿病患者在飲食、運動，和自我血糖監測的遵從性。在索馬里蘭遵從性偏低。由於糖尿病遵從性和人口學和與健康相關的因素顯著相關，突顯了糖尿病管理不同影響因子互為關聯的重要性，因此政策可針對全面的糖尿病管理策略和有效的干預措施來增強遵從性並改善糖尿病管理。

Introduction: Adherence to diabetic self-care practices, including maintaining a healthy diet, engaging in regular physical exercise, and self-blood glucose monitoring, is crucial for effectively managing diabetes and mitigating the risk of long-term complications. Therefore, we comprehensively investigated factors influencing dietary recommendations, physical activity, and self-blood glucose monitoring adherence among adult diabetic patients in Hargeisa, Somaliland, and their subsequent impact on Hemoglobin A1C levels (HbA1C). Additionally, we explored how sex might modify the association between diabetic self-care adherence and HbA1C levels.
Methods: We conducted a hospital-based cross-sectional study and a total of 422 adult diabetic patients, aged 18 years and older, who attended regular follow-ups at the selected hospitals were selected using systematic random sampling technique to participate in the study. Data was collected through face-to-face interviews with structured questionnaires. Multiple logistic regression model was used to estimate the AOR with 95% confidence intervals between factors associated with dietary, physical activity, and self-blood glucose monitoring adherence recommendations. To assess the marginal effect of dietary, physical activity, and self-blood glucose monitoring adherence on HbA1c, ordinal logistic regression was fitted, and the final model was further stratified by the respondent’s sex.
Results: In this study, only 26.1%, 48.2%, and 36.1%, of the participants adhered to dietary, physical activity, and self-blood glucose monitoring recommendations respectively. Participant’s sex, age, educational level, diabetic knowledge, food security, availability of a glucometer at home, kidney diseases, retinopathy, and foot ulcers due to diabetic complications were significantly associated with adherence to dietary, physical activity, and self-blood glucose monitoring. In the regression analysis, diabetic knowledge emerged as the strongest predictor across all the three adherence measurements. It showed significant association with dietary adherence (AOR=6.66, 95% CI:3.80 - 11.67), physical activity adherence (AOR=2.22, 95% CI:1.28 - 3.85) and self-blood glucose monitoring adherence (AOR=2.04, 95% CI:1.22 - 3.41)
Participants who adhered to physical activity and self-blood glucose monitoring showed substantially higher odds of percentage points of achieving good glycemic control. moreover, the association between dietary, physical activity, self-blood glucose monitoring, and glycemic control differs between males and females.
Conclusion: This study unveils the low adherence rates to dietary, physical activity, and self-blood glucose monitoring among participants with diabetes. Significant associations were identified between these adherence behaviors and various demographic and health-related factors, highlighting the interplay of diabetes management. These findings underline the need for comprehensive strategies and effective interventions to enhance adherence and improve health outcomes in diabetes management, given the importance of adhering to diabetes self-care practices for optimal health.

Table of Contents
AbstractV
CHAPTER ONE1
1.Introduction1
1.2Purpose Statement5
CHAPTER TWO7
2.SOMALILAND HEALTHCARE SYSTEM7
2.1 An Overview of Somaliland’s healthcare system7
2.2 Magnitude of diabetes In Somaliland8
2.3 Diabetic Care in Somaliland9
CHAPTER THREE9
3.LITERATURE REVIEW9
3.1 Magnitude of adherence to diabetes self-care practices9
3.2Factors associated with adherence to diabetes self-care practices.13
3.2.1 Factors associated with adherence to dietary recommendation practice.15
3.2.2 Factors associated with adherence to physical activity recommendation practices.17
3.2.3 Factors associated with adherence to self-blood glucose monitoring (SBGM).18
3.2.4 Factors associated with Hemoglobin A1c (HbA1c) levels.20
3.3Research Objectives21
3.4Conceptual framework22
CHAPTER FOUR24
4 METHODS AND MATERIALS24
4.1 Study Setting and Period24
4.2 Study design25
4.3 participants25
4.4 Inclusion and exclusion criteria25
4.5 Sample size determination25
4.6 Data collection tool and procedure28
4.7 Sampling procedure29
4.8 Measurements of the Study Variables30
4.8.1 Outcome variables30
4.8.2 Independent variables32
4.9 Data Quality Assurance33
4.10 Data processing and analysis34
4.11 Ethical considerations34
CHAPTER FIVE35
5.RESULTS35
5.1 Descriptive Analysis35
5.1.1 General Characteristics of the study population35
5.1.2 Distribution of dietary recommendations, physical activity, and self-blood glucose monitoring adherence across sociodemographic and economic factors36
CHAPTER SIX58
6.DISCUSSION58
6.1 Strengths and limitations65
6.2 Conclusions and Public Health Implications66
Annex I:67
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