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研究生: 練淑靜
論文名稱: 第2型糖尿病病人自我照顧行為及其相關因素之研究--以台中市某診所病人為例
指導教授: 呂昌明
學位類別: 碩士
Master
系所名稱: 健康促進與衛生教育學系
Department of Health Promotion and Health Education
論文出版年: 2008
畢業學年度: 96
語文別: 中文
論文頁數: 118
中文關鍵詞: 第2型糖尿病自我照顧行為自我效能社會支持互動關係糖化血色素
英文關鍵詞: Type 2 diabetes, self-care behavior, self-efficacy, social support, interaction, glycosylated hemoglobin (HbA1c)
論文種類: 學術論文
相關次數: 點閱:288下載:117
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  • 本研究主要目的在於探討台中市某診所之第2型糖尿病病人的自我照顧行為及其相關因素之自我效能、社會支持、與治療團隊成員之互動程度 。收案時間自民國96年7月至96年10月止,以台中市某診所加入糖尿病共同照護且接受治療團隊衛教2次(含2次)以上的第2型糖尿病病人為研究對象, 以自填式問卷方式進行資料收集,共得有效樣本190人。所得資料以單因子變異數分析、皮爾森積差相關和複迴歸等方法進行分析,主要結果如下:
    一、研究對象之自我照顧行為尚佳,其中以藥物自我照顧行為得分最高,自我監測血糖行為得分最低。
    二、研究對象之自我效能強度尚佳,其中以藥物自我效能得分最高,自我監測血糖自我效能得分最低。
    三、研究對象之社會支持程度尚可,其中以情緒性支持得分最高,實質性支持得分最低。
    四、研究對象與治療團隊成員互動尚佳,其中與護理師互動最好。
    五、在社會人口學特性及疾病狀況方面,年齡較大、已婚者、與家人同住、罹病時間較久、治療方式以注射胰島素者有較好的自我照顧行為。已婚、注射胰島素治療及有相關併發症者,其糖化血色素較低。
    六、自我效能、社會支持、與治療團隊成員中護理師互動與自我照顧行為均呈正相關,且達顯著水準。其中自我效能中的飲食效能、運動效能、藥物效能與自我監測血糖效能與相因應的自我照顧行為皆有顯著性相關。
    七、糖化血色素數值與自我照顧行為呈負相關,且達顯著水準。將自我照顧行為分為飲食行為、運動行為、藥物行為與自我監測血糖行為四項後,其中只有藥物行為與糖化血色素有顯著負相關。
    八、自我照顧行為的最佳預測因子為自我效能。

    The purpose of this study was to investigate the self-care behaviors and related factors among Type 2 diabetes patients. By using a purposeful sampling method, 190 adult diabetes patients who attend diabetes sharing care and accept more than two times of health education offer by the heath care providers team were selected to participate in this survey. The data was collected by a self-administrated questionnaire in a Taichung City clinic from July to Oct. 2007. One-way ANOVA, Pearson’s product-moment correlation and multiple regression were used to analyze the data.
    The result indicated that:
    1.The subjects’ self-care behaviors belonged moderate. In which, the highest score was medication and the lowest score was self-monitor blood glucose.
    2.The subjects’ self-efficacy belonged moderate. In which, the highest score was medication and the lowest score was self-monitor blood glucose.
    3.The subjects’ social support belonged moderate. In which, the highest score was emotional support and the lowest score was substantial support.
    4.The subjects’ had interaction with their health care providers team belonged moderate, They had best interaction with the nurses.
    5.Old age, married, lived with family, longer disease duration and use insulin treatment patients had better self-care behaviors. Married, use insulin treatment and with related complications patients had lower HbA1c level.
    6.Self-efficacy, social support, interaction between diabetes patients and their health care providers team were significantly associated with self-care behaviors. Including specific items in self-efficacy were significantly correlated with corresponding items in self-care behaviors.
    7.Glycosylated hemoglobin (HbA1c)level was negative significantly associated with self-care behaviors.
    8.Self-efficacy was the strongest predictor of self-care behaviors.

    目 次 中文摘要 …………………………………………………… I 英文摘要 …………………………………………………… II 第一章 緒論 第一節 研究動機………………………………………… 1 第二節 研究目的………………………………………… 5 第三節 研究問題………………………………………… 6 第四節 研究假設………………………………………… 7 第五節 名詞界定………………………………………… 7 第六節 研究限制………………………………………… 8 第二章 文獻探討 第一節 第2型糖尿病概述……………………………… 10 第二節 第2型糖尿病病人之自我照顧行為現況及其血糖 控制情形………………………………………… 13 第三節 第2型糖尿病病人之自我照顧行為及其相關因素 之研究…………………………………………… 20 第三章 研究方法 第一節 研究架構………………………………………… 35 第二節 研究對象………………………………………… 36 第三節 研究工具………………………………………… 37 第四節 研究步驟………………………………………… 40 第五節 資料處理與分析………………………………… 41 第四章 結果與討論 第一節 研究對象之社會人口學變項及疾病狀況分布情形 43 第二節 研究對象之自我效能、社會支持、與治療團隊 成員之互動、自我照顧行為及糖化血色素等變 項之整體趨向情形……………………………… 50 第三節 研究對象之社會人口學變項及疾病狀況分別與 自我效能、社會支持、與治療團隊成員之互動 、自我照顧行為及糖化血色素間的關係……… 63 第四節 研究對象之自我效能、社會支持、與治療團隊 成員之互動與自我照顧行為的關係…………… 80 第五節 研究對象之自我照顧行為與糖化血色素之關係 83 第六節 研究變項對自我照顧行為之預測情形………… 84 第五章 結論與建議 第一節 結論……………………………………………… 88 第二節 建議……………………………………………… 90 參考文獻..………………………………………………………. 92 附錄一 糖尿病控制自我效能、自我照顧量表使用同意書… 101 附錄二 社會支持量表使用同意書………………………… 102 附錄三 與治療團隊成員之互動量表使用同意書………… 103 附錄四 研究同意書………………………………………… 104 附錄五 預試問卷…………………………………………… 105 附錄六 正式問卷…………………………………………… 112 圖表目次 圖目次 圖3-1 研究架構…………………………………………… 35 表目次 表4-1 研究對象之社會人口學變項及疾病狀況分布情形 48 表4-2 研究對象之自我效能分布情形…………………… 52 表4-3 研究對象之社會支持分布情形…………………… 55 表4-4 研究對象與治療團隊成員之互動分布情形……… 58 表4-5 研究對象之自我照顧行為分布情形……………… 61 表4-6 研究對象之糖化血色素分布情形………………… 63 表4-7 研究對象之社會人口學變項及疾病狀況與自我效能 的變異數分析……………………………………… 65 表4-8 研究對象之社會人口學變項及疾病狀況與社會支持 的變異數分析……………………………………… 67 表4-9 研究對象之社會人口學變項及疾病狀況與治療團隊 成員互動的變異數分析…………………………… 69 表4-10 研究對象之社會人口學變項及疾病狀況與治療團隊 成員中醫師互動的變異數分析…………………… 70 表4-11 研究對象之社會人口學變項及疾病狀況與治療團隊 成員中護理師互動的變異數分析………………… 71 表4-12 研究對象之社會人口學變項及疾病狀況與治療團隊 成員中營養師互動的變異數分析………………… 72 表4-13 研究對象之社會人口學變項及疾病狀況與自我照顧 行為的變異數分析………………………………… 76 表4-14 研究對象之社會人口學變項及疾病狀況與糖化血色 素的變異數分析…………………………………… 79 表4-15 自我效能、社會支持、與治療團隊成員之互動與自 我照顧行為之相關分析…………………………… 82 表4-16 自我效能與自我照顧行為之相關分析…………… 82 表4-17 自我照顧行為與糖化血色素之相關分析………… 84 表4-18 自我照顧行為的變項之共線性診斷結果………… 86 表4-19 自我照顧行為之預測變項複迴歸分析表……

    參考文獻
    壹、中文部分
    中華民國糖尿病學會編印(2006)‧2006第2型糖尿病照護指引 :台北。
    中華民國糖尿病衛教學會編印(2004)‧糖尿病的心理評估與支持‧糖尿病衛教課程教材-流病病理、處置治療、心理行為、教育管理 :台北。
    王惠芳、林宏達(2006)‧糖化血色素之臨床意義‧臨床醫學,58(5)342-346。
    王璟璇、王瑞霞、林秋菊(1998)‧門診診斷初期非胰島素依賴型糖尿病患者的自我照顧行為及其相關因素之探討‧護理雜誌,45 (2),60-73。
    白玉玲(2005)‧老年第二型糖尿病患者憂鬱、自我照顧行為及其相關因素之探討‧未發表碩士論文,高雄:輔英科技大學護理系。
    行政院衛生署國民健康局(2003)‧糖尿病防治手冊‧台北:遠流。
    行政院衛生署(2007)‧台灣地區主要死亡原因‧線上檢索日期: 2007年12月21日‧網址 : http://www.doh.gov.tw/statistic/data/死因摘要/96年/表1.xls
    江金玲(1997)‧非胰島素依賴型糖尿病患者家庭支持、生活滿意度、自我照顧行為與糖尿病控制之研究‧未發表碩士論文,台北:國立台灣大學醫學院護理研究所。
    江鳳葦(2003)‧非胰島素依賴型糖尿病患者家庭支持、生活滿意度、自我照顧行為與糖尿病控制之研究‧長庚科技學刊,2,27-50。
    何千惠(2003)‧第2型糖尿病患者自我效能及社會支持與遵醫囑行為之相關研究-以台北縣某區域教學醫院為例‧台北:國立台灣師範大學衛生教育研究所。
    余文彬(2004)‧糖尿病患者的血糖控制、自我效能、自我照顧和生活品質之探討‧未發表碩士論文,台北:國立台北護理學院護理研究所。
    杜幸芳、馬素華、黃明達、莊峻煌(1998) ‧衛教合併行為策略對糖尿病人代謝控制的影響‧台灣醫學,2,8-17。
    吳淑芳、Courtney,M., Edwards, H.,et al(2006)‧糖尿病個案自我效能增進訓練及應用‧台灣醫學,10 (1),115-122。
    邱愛芳(1997)‧花蓮地區非胰島素依賴型糖尿病患者居家自我照顧行為及其相關因素之探討。未發表碩士論文,花蓮:慈濟大學醫學院護理學研究所。
    邱馨誼(2002)‧社區第2型糖尿病患者之自我照顧行為與健康信念關係之研究‧未發表碩士論文,台北:國立台灣大學醫學院護理研究所。
    林冠品(2004)‧與公衛護士互動關係感受、疾病知識、疾病態度與糖尿病自我照顧行為的關係‧台灣衞誌,23(6),479-486。
    洪秀吉(1995)非胰島素依賴型糖尿病病患之健康信念與社會支持對自我照顧與糖尿病控制之研究‧未發表碩士論文,台北:國立台灣大學護理學研究所。
    陳秀女(1994)老年糖尿病患之自我照顧行為與糖尿病知識、社會支持相關性的研究‧未發表碩士論文,台北:國防護理研究所。
    陳姿伶、黃紫寶、盧介祥、林金玉(2000)‧「糖尿病共同照護計畫」實施前門診糖尿病患照護現況‧公共衛生,26(4),319-331。
    陳滋茨、張媚、林豔君(1998)‧自我效能、社會支持與糖尿病病人居家自我照顧行為相關之探討‧護理研究,6 (1),31-42。
    張峰紫、林秋菊(1997)‧以自我效力評估胰島素依賴型糖尿病患者之自我照顧情形‧高雄醫學科學雜誌,13 (6),351-359。
    張峰紫、邱啟潤、辛錫璋、蔡瑞雄(1991)‧糖尿病患者的家庭支持與其認知態度、遵從行為及糖化血色素之研究‧護理雜誌,38(3),56-69。
    張新儀(2005)‧以全國代表性資料分析台灣糖尿病患自我照顧行為與其相關因素--2001年國民健康訪問調查結果‧國家衛生研究院簡訊,10(3),29-32。
    郭寶蓮、蔡秀鸞、陽琪(2002)‧充能訓練對糖尿病患者糖化血色素、自我效能和照護之成效‧台灣醫學,6 (6),848-857。
    黃久美(1995) ‧糖尿病患者家庭支持、醫病關係、疾病壓力與遵醫囑行為之相關研究‧輔英學報15,27-52。
    蔡世澤(2000)‧台灣糖尿病照護現況與省思‧臨床醫學,18 (2),113-131。
    鄭綺(1999)‧第二型糖尿病患者執行有氧運動之血糖立即反應和長期成效-前驅研究‧護理研究,7 (1),29-39。
    鄭英裕(2001)‧某區域教學醫院門診糖尿病患者遵醫囑行為及其相關因素之探討‧未發表碩士論文,台北:台北醫學大學醫學研究所。
    鄭曉璘(2005) ‧糖尿病患者與其治療團隊成員之互動對於患者自我照顧行為的影響‧未發表碩士論文,台北:台北醫學大學醫務管理學系。
    劉見祥、曲同光、陳玉敏(2002)‧糖尿病共同照護與健保給付‧台灣醫學,6 (4),581-584。
    劉淑娟(1999)‧台北市立醫院門診糖尿病病患健康自我管理及其相關因素之探討‧榮總護理,16 (3),286-297。
    樓美玲、李怡娟、葉明珍、張彩秀(2004)‧社區非胰島素依賴型糖尿病患者家庭功能與自我照顧行為‧長期照護雜誌,8 (2),195-212。
    賴妙芬、劉潔心(2003)‧促進糖尿病患者社會支持與充能效果之介入研究‧衛生教育學報,20,1-28。
    盧美秀、林秋香(1991)‧比較團體衛教和個別衛教對糖尿病人知識態度、行為和血糖變化的影響‧護理雜誌,38 (4),101-112。

    貳、英文部分
    Agurs,C.T., Kumanyika,S., Ten,H.T.& Adams,C.L.(1997).A randomized controlled trial of weight reduction and exercise for diabetes management in older African-American subjects. Diabetes Care,20(11),1503-1511.
    Aikens,J.E, Bingham,R.,& Piette,J.D.(2005).Patient-provider communication and self-care behavior among type 2 diabetes patients. The Diabetes Educator, 31(5),681-690。
    Albright,T.L., Parchaman,M., Burge,S.K.,& the RRNeST investigators. (2001). Predictors of self-care behavior in adults with type 2 diabetes : An RRNeST Study. Family Medicine,33(5),354-360.
    Aljasem,L.I., Peyrot,M. Wissow,L., & Rubin,R.R.(2001).The impact of barriers an self-efficacy on self-care behavior in type 2 diabetes. The Diabetes Educator, 27(3),393-404.
    American Diabetes Association(2006).Standards of Medical Care in Diabetes-2006. Diabetes Care 29(Suppl.1),S4-S42.
    Anderson,R.M.(1995).Patient empowerment and the traditional medical model. Diabetes Care, 18(3),412-415.
    Anderson,R.M., Fitzgerald,J.T.,& Oh,M. (1993). The relationship between diabetes-related attitudes and patients’self-reported adherence. The Diabetes Educator,19(4),287-292.
    Anderson R.M.,& Funnell M.M. (2000).Compliance and adherence are dysfunctional concepts in diabetes care. The Diabetes Educator, 26, 597-604.
    Arseneau,D.L., Mason,A.C. Wood,O.B., Schwab,E., & Green,D.(1994). A comparison of learning activity packages and classroom instruct- tion for diet management of patient with non-insulin dependent diabetes mellitus. The Diabetes Educator,20(6),509-514.
    Bandura,A.(1986).Social foundations of thought and action:a social cognitive theory. Englewood Cliffs,NJ:Prentice-Hall.
    Barrera,M., Sandier,I.N., Ramsay,T.B.(1981)Prelimiary development of a scale of social support:studies on college students. American Journal of Community Psychology,9(4),435-447.
    Bartol,T.N.(2002).Educating patients : diabetes self-care. The Nurse Practitioner,27 (sup :2002 sourcebook),16-23.
    Bernal,H., Woolley,S., Schensul,J.J.,& Dickinson,J.K.(2000). Cor-
    relates of self-efficacy in diabetes self-care among Hispanic adults with diabetes. The Diabetes Educator, 26(4), 678-680.
    Boule,N.G., Haddad,E., Kenny,G.P., Wells, G.A., Sigal,R.J.(2001). Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled trial, JAMA, 286(10)1218-1227.
    Bowles,K.H., & Dansky,K.H.(2002).Teaching self-management of diabetes. Home Healthcare Nurse, 20(1) ,36-42.
    Brown,S.A., Harrist,R.B., Viliagomezo,E.T., Sequra,M. Barton, S.A., & Hanis,C.C.(2000).Gender and treatment differences in knowledge, health beliefs and metabolic control in Mexican Americans with type 2 diabetes.The Diabetes Educator,26(3), 425-438.
    Chuang,L.M., Tsai,S.T., Huang,B.Y., Tai,T.Y., DIABCARE (Taiwan) Study Group.(2001). The current state of diabetes management in Taiwan. Diabetes Research and Clinical Practice, 54 (Suppl 1), S55-65.
    Charman, D.( 2000). Burnout and diabetes: reflections from working with educators and patients. J Clin Psychol. 56, 607-617.
    Ciechanowski,P.S., Katon,W.J., Russo,J.E., & Walker,E.A.(2001).The patient-provider relationship : Attachment theory and adherence to treatment in diabetes. Am J Psychiatry.158,29-35.
    Clark,C.M.,Fradkin,J.E.,& Hiss,R.G.(2000).Promoting early diagno- sis and treatment of type 2 diabetes. JAMA,284,363-365.
    Coates,V.E.,& Boore,J.R.P.(1996).Knowledge and diabetes self- management .Patient Education and Counseling,29,99-108.
    Connell,C.M., Fisher,F.B., & Hoston,C.A.(1992).Relationship among social support, diabetes outcomes, and women. Journal of Aging and health,4,77-100.
    Connor,H., Annan,F., Bunn, E., et al.(2003).Nutrition Subcommittee of the Diabetes Care Advisory Committee of Diabetes UK. The implementation of nutritional advice for people with diabetes. Diabet Med, 20 (10),786-807.
    Diabetes Control and Complications Trial Research Group (DCCT). (1993).The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The New England Journal of Medicine,329,977-986.
    Fitzgerald, J.T., Gruppen, L.D., Anderson, R.M, et al.(2000).The influence of treatment modality and ethnicity on attitudes in type 2 diabetes. Diabetes Care,23(3),313-318.
    Franz M.J., Bantle J.P., Beebe C.A., et al.(2002).Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care, 25 (1),148-198.
    Funnell,M.M., & Meritt,J.H.(1993).The challenges of diabetes and order adult. Nursing Clinics of North America,28(1),45-53.
    Gallant,M.P.(2003). The influence of social support on chronic illness self-management: a review and directions for research. Health Education and Behavior, 30 (2), 170-195.
    Gallichan,M.(1997).Self-monitoring of glucose by people with diab- etes:evidence based practice,BMJ,314,964-967.
    Glasgow,R.E., Anderson,R.M.( 1999). In diabetes care, moving from compliance to adherence is not enough: something entirely different is needed. Diabetes Care. 22, 2090-2092.
    Gleeson-Kreig,J., Bernal,H., Woolley, S.(2002).The role of social support in the self-management of diabetes mellitus among a Hispanic population. Public Health Nursing,19(3),215-222.
    Harris,M.I. (2000).Health care and health status and outcomes for patients with type 2 diabetes. Diabetes Care, 23(6),754-758.
    Heisler,M., Bouknight,R.R., Hayward,R.A., Smith,D.M., & Kerr,E.A. (2002). The relative importance of physician communication, participatory decision making, and patient understanding in diabetes self-management. J Gen Intern Med. 17, 243-252.
    Heisler,M., Smith,D.M., Hayward,R.A., Krein,S.L.,& Kerr,E.A.(2003). How well do patients assessments of their diabetes self- management correlate with actual glycemic control and receipt of recommended diabetes services? Diabetes Care,26(3),738-743
    Hu,F.B., Stampfer,M.J., Solomon,C., et al.(2001).Physical activity and risk for cardiovascular events in diabetic women.Ann Intern Med,134(2),96-105.
    Hurley,C.C., & Shea,C.A. (1992). Self-efficacy : Strategy for enhancing diabetes self-care. The Diabetes Educator, 18(2), 146-150。
    Irwin,M.L., Mayer-Davis,E.J., & Addy,C.L.(2000).Moderate-intensity physical activity and fasting insulin levels in women : the cross-cultural activity participation study. Diabetes Care, 23,449-454.
    Jones,H., Edwards,L., Vallis,T.M., et al.(2003). Changes in diabetes self-care behaviors make a difference in glycemic control.Diabetes Care,26(3),732-737.
    Kamel,N.M., Badawy,Y.A.,el-Zeiny,N.A., & Merdan,I.A.(2000). Sociodemographic determinants of management behavior of diabetes patients. Part II Diabetes Knowledge of their management behaviour.Eastern Mediterranean Health J,5, 974-983.
    Klein,B.E., Klein,R.,& Moss,S.E.(1998).Self-rated health and diabetes of long duration. The Wisconsin Epidemiologic of Diabetic Retinopathy. Diabetes Care,21(4),236-240.
    Kleinbaum,D.G., Kupper,L.L., & Mulier,K.E.(1988). Applied regression analysis and other multivariable methods. Duxbury Press.
    Krejcie,R.V.,& Morgan,D.W.(1970).Determining sample size for research activities. Educational and Psychological Measurement, 30,607-610.
    Kyngas,H., Hentinen M., & Barlow,J.H.(1998). Adolescents’ perception of physicians,nurses,parents and friends : Help or hindrance in compliance with diabetes self-care?Journal of Advanced Nursing, 27,760-769.
    Langford,C.P., Bowsher,J., Maloney,,J.P. & Lillis,P.P.(1997). Social support : a conceptual analysis.Journal of Advanced Nursing,25,95-100.
    LeRoith,D., Taylor,S.I., & Olefsky,J.M.(Eds).(2000).Diabetes Mellitus: A Fundamental and Clinical Text (2nd ed). Philadelphia : Lippincott Williams & Wilkins.
    Leslie,R.D., & Pozzilli, P.(2002).Change therapies for type 2 diabetes. United Kingdom Published.
    Lorig,K., Gonzalez,V.,& Laurent,D.(1997).The chronic disease self-management course leaders manual. Stanford(CA) : Stanford University.
    Mazzuca,S.A., Weinberger,M., Kurpius,D.J., Froehle,T.C.,& Heister, M.(1983). Clinician communication associated with diabetes patients’ comprehension of their therapeutic regimen. Diabetes Care, 6,347-350.
    Miedema,K.(2004).Towards worldwide standardization of HbA1c determination. Diabetologia, 47, 1143-1148.
    Mulcahy,K., Maryniuk, M., Peeples, M., et al.(2003).Diabetes self-management education core outcomes measures. The Diabetes Educator, 29(5),771-787.
    Norris,S.L., Engelgau,M.M.,& Narayan,K.M.(2001).Effectiveness of self-management training in type 2 diabetes : a systematic review of randomized controlled trials. Diabetes Care,24(3),561-587.
    Norris,S.L., Nichols,P.J., & Caspersen,C.J.(2002).Increasing diabetes self-management education in community settings : a systematic review. Am J Prev Med,22,39-66.
    O’Brien,M.K., Petrie,K., & Raeburn,J.(1992). Adherence to medication regimens : updating a complex medical issue. Med Care Rev. 49. 435-454.
    Olivarius, N.F., Beck-Nielsen, H., Anderson, A.H., Horder, M., & Pedersen, P.A. (2001). Randomized controlled trial of structured personal care of type 2 diabetes mellitus. BMJ, 323. 946-947.
    Paterson,B.(2001). Myth of empowerment in chronic illness. J Adv Nurs, 34, 574-581.
    Peel,E., Parry,O., Douglas,M., & Lawton,J.(2004).Blood glucose self-monitoring in non-insulin-treated type 2 diabetes: a qualitative study of patients’perspective. British Journal of General Practice,54,183-188.
    Polly,R.K.(1992).Diabetes health beliefs, self-care behaviors, and glycemic control among old adults with non-insulin-dependent diabetes mellitus.The Diabetes Educator,18,(4),321-327.
    Proadzisz,M.(2001).Variables affecting quality of life and adherence in adults with type 2 diabetes. University of Illinois at Chicago, Health Science Center**Ph. D.(163p).
    Ruggieo,L., Glasgow,R.E., Dryfoos,J.M., et al.(1997).Diabetes self-management self-reported recommendations and pattern on large population. Diabetes Care,20(4),568-576.
    Saaddine J.B., Engelgau M.M., Beckles G.L., Gregg E.W., Thompson T.J., & Narayan K.M. (2002).A diabetes report card for the United States: quality of care in the 1990s. Ann Intern Med.136(8),565-574.
    Schillinger D., Piette J., Grumbach K., et al.( 2003). Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med, 163, 83-90.
    Skelly,A.H., Marshall,J.R., Haughey,B.P., Davis,P.J., & Dunford,R.G.(1995). Self-efficacy and confidence in outcomes as determinants of self-care practices in inner-city, African-American women with non-insulin-dependent diabetes. Diabetes Educator, 21(1),38-46.
    Skinner,T.C., & Hampson,S.E.(2001).Personal models of diabetes in relation to self-care, well-being, and glycemic control. Diabetes Care, 24(5),828-833.
    Street,R., Piziak,V., Carpentier,W., Herzog,J.,& Hejl,J.(1993). Provider-patient communication and metabolic. Diabetes Care,16,714-721.
    Toljamo,M., & Hentinen,M.(2001).Adherence to self-care and glycaemic control among people with insulin-dependent diabetes mellitus. Advanced Nursing, 34(6),780-786.
    Trento,M.B., Passera,P., Tomalino,M., et al. (2001).Group visits improve metabolic control in type 2 diabetes : A 2-year follow-up. Diabetes Care,24(6),995-1000.
    United Kingdom Prospective Diabetes Study Group (UKPDS).(1998).Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS33) . Lancet, 352 (9131) , 837-853.
    van der Laar KEW., & van der Bijl,J.J.(2001). Strategies enhancing self-efficacy in diabetes education : A review. Scholarly Inquiry for Nursing Practice : An International Journal 15 235-48
    Vincze,G., Barner,J.C.,& Lopez,D.(2004).Factors associated with adherence to self-monitoring of glucose among persons with diabetes. The Diabetes Educator,30(1),112-125.
    Wang,C.Y.,& Fensky,M.M.(1996).Self-care of adults with NIDDM : influence of family and friends. The Diabetes Educator,22(5),465-470.
    Watkinson,M.(2003).Training in flexible intensive insulin management improved glycaemic control and quality of life in type 1 diabetes. Evidence-Based Nursing,6(3),77-81.
    White,N.E., Richter, J.M.,& Fry,C.(1992).Coping, social support and adaptation to chronic illness western. Journal of Nursing Research,14(2),211-224.
    Wild,S., Roglic,G., Green,A., Sicree,R.,& King,H.(2004). Global prevalence of diabetes-estimates for the year 2000 and projections for 2030. Diabetes care, 27(5), 1047-1053.
    Zinman,B., Ruderman,N., Campaigne,B.N., Devlin,J.T. & Schneider,S.H.(2002). Diabetes mellitus and exercise: American Diabetes Association. Diabetes Care,25,(supp l):S64-S68.

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