【摘要】：研究背景工業(yè)化、城鎮(zhèn)化和人口老齡化的不斷發(fā)展帶來了生活方式的巨大轉(zhuǎn)變,與之相關(guān)的慢性病及其危險因素也在快速增加。糖尿病作為一種與生活方式密切相關(guān)的慢性病,已經(jīng)成為影響社會發(fā)展和居民健康的重大公共衛(wèi)生問題。2010年中國慢性病及其危險因素監(jiān)測報告顯示：2010年18歲及以上居民糖尿病患病率為9.7%,知曉率僅為36.1%,控制率僅為34.7%,可見居民糖尿病知曉和控制情況不甚樂觀。在我國,龐大的糖尿病患病人群和相對緊缺的衛(wèi)生資源決定了患者自身必須承擔(dān)大部分疾病管理的工作。國際上的大量研究已經(jīng)證明：采取以健康教育為主要手段的綜合措施,社區(qū)糖尿病自我管理能提高糖尿病患者的自我效能、激發(fā)患者的主動性和潛能,有效得幫助他們進(jìn)行血糖控制,進(jìn)而預(yù)防和減少并發(fā)癥,減輕家庭和社會的疾病負(fù)擔(dān)。另一方面糖尿病的自我管理本身就體現(xiàn)了“從單純治療到健康管理和疾病管理”、“從專業(yè)行動到群眾行動”等新型慢性病防治理念,契合了新型的“生理-心理-社會”醫(yī)學(xué)模式。為此,本研究在糖尿病自我管理干預(yù)的國內(nèi)外研究的基礎(chǔ)上,繼續(xù)深入探討以社區(qū)為基礎(chǔ)的糖尿病自我管理干預(yù)的模式與效果,并對其近期成本-效果進(jìn)行分析,為進(jìn)一步完善糖尿病自我管理模式提供科學(xué)參考,為政策制定者提供實踐參考和證據(jù)支持。研究目的1.研究社區(qū)糖尿病患者自我管理干預(yù)在增加糖尿病相關(guān)知識、增強自我效能、改善行為方式、改善糖尿病相關(guān)體格測量指標(biāo)和生化指標(biāo)方面的效果及近期成本-效果。2.研究糖尿病患者自我管理干預(yù)效果的影響因素。3.探討社區(qū)糖尿病患者自我管理干預(yù)模式的優(yōu)勢和不足,為進(jìn)一步完善推廣提供證據(jù)支持。研究方法和內(nèi)容選擇從北京市房山區(qū)4個街道共17個社區(qū)/村招募到的510名2型糖尿病患者作為研究對象。將510名研究對象在每個村內(nèi)隨機分組,形成17個干預(yù)組和17個對照組。以中國疾病預(yù)防控制中心慢病中心編寫的《慢性病患者自我管理實踐—糖尿病》(ISBN 978-7-117-18927-9/R·18928)一書作為教材,對干預(yù)組研究對象實施糖尿病患者自我管理小組活動干預(yù)。在實施干預(yù)之前和之后一個月分別在510名研究對象中開展基線調(diào)查和終末調(diào)查,采用體格測量、實驗室檢測和問卷調(diào)查的方式收集數(shù)據(jù)和信息。選取糖尿病患者知識得分、自我效能得分、相關(guān)行為、體格測量指標(biāo)和生化指標(biāo)作為效果指標(biāo),并對相應(yīng)指標(biāo)進(jìn)行近期成本-效果分析和干預(yù)效果的影響因素分析。采用Epidata3.1軟件建立數(shù)據(jù)庫,對調(diào)查問卷進(jìn)行雙錄入；清洗數(shù)據(jù)后形成最終的數(shù)據(jù)庫。運用SAS9.3軟件對數(shù)據(jù)進(jìn)行統(tǒng)計分析,計量資料如服從正態(tài)分布則采用均數(shù)、標(biāo)準(zhǔn)差描述其集中趨勢和離散趨勢,采用t檢驗對組間均數(shù)和自身前后均數(shù)進(jìn)行比較,并采用多元線性回歸分析某些指標(biāo)的影響因素,如不服從正態(tài)分布則采用中位數(shù)描述其集中趨勢,采用秩和檢驗對組間均數(shù)和自身前后均數(shù)進(jìn)行比較；計數(shù)資料采用率或構(gòu)成比進(jìn)行統(tǒng)計描述,采用χ2或Fisher確切概率法進(jìn)行組間率和自身前后率的比較。參數(shù)估計和假設(shè)檢驗的水準(zhǔn)為a=0.05.研究結(jié)果1.一般情況終末調(diào)查時共收集到合格有效問卷500份,其中干預(yù)組259份,對照組241份。全部研究對象的平均年齡61.66±7.64歲,最大年齡84歲,最小年齡31歲。其中男性174人(34.80%),女性326人(65.20%)。兩組研究對象在重要人口學(xué)特征(性別、年齡、文化程度、婚姻狀況、家庭人均月收入等)上經(jīng)檢驗差異無統(tǒng)計學(xué)意義(P0.05)。2.效果及近期成本-效果2.1知識：干預(yù)后干預(yù)組在“三多一少”癥狀、空腹血糖正常范圍、慢性并發(fā)癥、體重指數(shù)正常范圍、自我血糖監(jiān)測、低血糖成因、血壓推薦控制目標(biāo)、食物交換中的一份和合理的行動計劃9道題目正確回答率均高于對照組(P0.05)；干預(yù)后干預(yù)組知識總得分為82.32±15.10分,對照組為66.31±22.01分,干預(yù)組高于對照組(P0.01)。2.2自我效能：干預(yù)后干預(yù)組在飲食自我效能、運動自我效能、藥物自我效能、血糖監(jiān)測自我效能、足部護理自我效能、高低血糖的預(yù)防和處理自我效能及總自我效能方面的得分分別25.80±3.58分、17.37±2.83分、13.89±1.90分、15.38±3.29分、22.36±3.18分、18.10±2.44分和112.9±14.58分,對照組的得分分別為23.27±-4.51分、16.10±3.70分、13.51±2.13分、13.57±3.70分、20.57±4.64分、16.90±3.01分和103.9±17.98分,且干預(yù)組得分均高于對照組(P0.05)。2.3行為：2.3.1血糖自我監(jiān)測：干預(yù)后干預(yù)組掌握自我血糖監(jiān)測方法的率和家中備有血糖儀的率分別為87.26%和69.50%,對照組為63.07%和57.68%,干預(yù)組均高于對照組(P0.05)；干預(yù)后干預(yù)組和對照組自我血糖監(jiān)測頻率分別為2天/周和1天/周,干預(yù)組均高于對照組(P0.01)。2.3.2足部護理：干預(yù)后干預(yù)組在合適溫度的水洗腳、水平得剪指甲、使用護膚類油膏和定期找醫(yī)生檢查足執(zhí)行率分別為98.07%、84.94%、69.50%、42.47%,對照組分別為87.97%、72.61%、50.62%、31.12%,干預(yù)組均高于對照組(P0.05)；干預(yù)后干預(yù)組和對照組足部自我檢查頻率分別為7天/周和5天/周,干預(yù)組均高于對照組(P0.01)。2.3.3健康飲食：干預(yù)后干預(yù)組和對照組遵循健康飲食要求的頻率分別為6天/周和5天/周,干預(yù)組高于對照組(P0.01)；干預(yù)后干預(yù)組和對照組食用高膳食纖維食物的頻率分別為為3天/周和2天/周,干預(yù)組高于對照組(P0.01)。2.3.4有氧運動：干預(yù)后干預(yù)組和對照組做30分鐘及以上的有氧運動頻率分別為7天/周和6天/周,干預(yù)組均高于對照組(P0.01)。2.3.5服藥和吸煙飲酒：服藥方面,干預(yù)后干預(yù)組和對照組在自行停藥率上低于對照組,差異有顯著性(P0.05)。吸煙方面,干預(yù)前干預(yù)組的吸煙率高于對照組,差異有顯著性(P0.05),干預(yù)后兩組間吸煙率差異無顯著性(P0.05)。飲酒方面,干預(yù)前后干預(yù)組和對照組的飲酒率差異均無顯著性(P0.05)。2.4體格測量指標(biāo)和生化指標(biāo)干預(yù)前后干預(yù)組的平均體重降低1.49kg,對照組升高1.14kg,差異有顯著性(P0.05)；干預(yù)后干預(yù)組和對照組在糖尿病相關(guān)生化指標(biāo)上差異無顯著性(P0.05)。2.5近期成本-效果糖尿病自我管理干預(yù)使自我效能提高一分的總成本為8795.55元,人均成本為33.96元；使每周自我監(jiān)測血糖天數(shù)增加一天的總成本為70012.60元,人均成本為270.32元；使每周自我檢查足部天數(shù)增加一天的總成本為70012.60元,人均成本為270.32元；使每周遵循糖尿病健康飲食天數(shù)每增加一天的總成本為70012.60元,人均成本為270.32元；使每周進(jìn)行30分鐘及以上有氧運動天數(shù)增加一天的總成本為70012.60元,人均成本為270.32元；使體重每降低lkg的總成本為26620.76元,人均成本為102.78元。3.干預(yù)效果影響因素3.1糖尿病患者自我管理知識得分干預(yù)效果的影響因素為基線知識得分、年齡(歲)、文化程度、家庭人均月收入(元)、對小組活動的整體評價和社區(qū)醫(yī)生參與頻率(P0.05)。3.2糖尿病患者自我管理自我效能得分干預(yù)效果的影響因素為基線自我效能得分、小組活動總體評價、活動內(nèi)容的難易程度(P0.05)。3.3糖尿病患者自我管理體重干預(yù)效果的影響因素為基線體重(kg)、性別、家庭人均月收入(元)(P0.05)。4.滿意度和意向4.1干預(yù)組滿意度和自我評估干預(yù)組研究對象對自我管理小組活動的總體滿意度為96.14%,84.94%的干預(yù)組研究對象表示會繼續(xù)參加自我管理小組活動。在吸引糖尿病患者參加自我管理小組活動的原因中,排在首位的是“能學(xué)到有用的知識”,在導(dǎo)致糖尿病患者缺席的原因中,排在首位的是“家庭或工作事務(wù)太多”。在8項自我管理的任務(wù)中,干預(yù)組研究對象認(rèn)為自己“做得最好”和“做得最差”排在首位的分別是“適量運動”和“掌握胰島素注射技巧”。4.2對照組意向和自我評估80.08%的對照組研究對象表示如果以后開展糖尿病自我管理活動“會愿意參加”。在8項自我管理的任務(wù)中,干預(yù)組研究對象認(rèn)為自己“做得最好”和“做得最差”的排在首位的分別是“適量運動”和“自我血糖監(jiān)測”。研究結(jié)論本研究在國內(nèi)首次運用統(tǒng)一規(guī)范的教材實施社區(qū)糖尿病患者自我管理干預(yù),采用患者小組長和社區(qū)醫(yī)生配合的形式帶領(lǐng)小組活動,設(shè)立平行對照組對其干預(yù)效果及近期成本-效果進(jìn)行評價,結(jié)果發(fā)現(xiàn)社區(qū)糖尿病患者自我管理干預(yù)在提高糖尿病患者知識、自我效能、改善行為方面有效。建議將社區(qū)糖尿病患者自我管理干預(yù)納入基本公共衛(wèi)生服務(wù),以保證其長效發(fā)展。本研究還發(fā)現(xiàn)糖尿病患者在“自我血糖監(jiān)測”、“足部護理”、“掌握胰島素注射技巧”和“運動強度的評估”等方面的知識、自我效能、行為或自我評價相對較差,建議在以后開展社區(qū)糖尿病患者自我管理活動時對以上方面予以針對性加強。
[Abstract]:Background Industrialization, urbanization and population aging have brought about tremendous changes in lifestyle, and the related chronic diseases and risk factors are also increasing rapidly. In 2010, the prevalence rate of diabetes was 9.7%, the awareness rate was only 36.1%, and the control rate was only 34.7%. This shows that the awareness and control of diabetes is not very optimistic. In China, a large number of diabetic patients and relatively scarce health resources determine the patients themselves. A large number of international studies have proved that community diabetes self-management can improve the self-efficacy of patients with diabetes, stimulate their initiative and potential, effectively help them to control blood glucose, and then prevent and reduce diabetes. On the other hand, self-management of diabetes itself embodies the new concept of chronic disease prevention and treatment, from simple treatment to health management and disease management, from professional action to mass action, and accords with the new "physiological-psychological-social" medical model. Based on the research of self-management intervention on diabetes mellitus at home and abroad, the model and effect of community-based self-management intervention on diabetes mellitus were further explored, and its short-term cost-effectiveness was analyzed to provide a scientific reference for further improving the self-management model of diabetes mellitus and provide practical reference and evidence support for policy makers. Objective 1. To study the effect and short-term cost-effectiveness of self-management intervention on diabetes related knowledge, self-efficacy, behavior, physical and biochemical indexes. 2. To study the influencing factors of self-management intervention on diabetic patients. The research method and content selected 510 type 2 diabetic patients recruited from 17 communities/villages in 4 streets of Fangshan District in Beijing as the subjects. 510 subjects were randomly divided into 17 intervention groups in each village. The self-management practice of patients with chronic diseases - diabetes mellitus (ISBN 978-7-117-18927-9/R.18928), written by the Center for Chronic Diseases of the Center for Disease Control and Prevention of China, was used as a textbook. The participants in the intervention group were intervened in the activities of self-management group of diabetes mellitus patients before and one month after the intervention. Baseline and final surveys were conducted among the subjects. Data and information were collected by physical measurement, laboratory tests and questionnaires. Knowledge score, self-efficacy score, related behavior, physical measurement index and biochemical index of diabetic patients were selected as the effect indicators, and the short-term cost-effectiveness analysis of the corresponding indicators was carried out. Establish a database with Epidata 3.1 software, double-input the questionnaire, and form the final database after cleaning the data. Use SAS 9.3 software to analyze the data. If the measurement data obey normal distribution, use mean, standard deviation to describe its centralized trend and discrete trend, and use t-test. The mean between groups was compared with the mean before and after themselves, and the influencing factors of some indexes were analyzed by multiple linear regression. If not obeying normal distribution, the median was used to describe the centralized trend, and the rank sum test was used to compare the mean between groups and the mean before and after themselves. Results 1. A total of 500 valid questionnaires were collected at the end of the general survey, including 259 in the intervention group and 241 in the control group. There were 174 males (34.80%) and 326 females (65.20%). There was no significant difference between the two groups in demographic characteristics (gender, age, education, marital status, per capita monthly income, etc.) (P 0.05). 2. Effect and short-term cost-effectiveness 2. The rate of correct answers to 9 questions of fewer symptoms, normal range of fasting blood glucose, chronic complications, normal range of body mass index, self-monitoring of blood glucose, causes of hypoglycemia, recommended control targets of blood pressure, a reasonable plan of action in food exchange was higher than that of the control group (P 0.05), and the total score of knowledge in the intervention group was 82.32 (15.10), the control group. The self-efficacy of the intervention group was higher than that of the control group (P 0.01). The self-efficacy of the intervention group was higher than that of the control group (P 0.01). The self-efficacy of the intervention group in diet self-efficacy, exercise self-efficacy, drug self-efficacy, blood glucose monitoring self-efficacy, foot care self-efficacy, prevention and treatment self-efficacy of high and low blood glucose, and total self-efficacy were 25.80 + 3.58, 17. The scores of control group were 23.27 (- 4.51), 16.10 (- 3.70), 13.51 (- 2.13), 13.57 (- 3.70), 20.57 (- 4.64), 16.90 (- 3.01) and 103.9 (- 17.98), respectively. The scores of intervention group were higher than those of control group (P Monitoring: After intervention, the rate of self-monitoring blood glucose in intervention group and the rate of equipped with blood glucose meter in home were 87.26% and 69.50% respectively, and 63.07% and 57.68% in control group. The frequency of self-monitoring blood glucose in intervention group and control group were higher than that in control group (P 0.05). 2.3.2 Foot care: After intervention, the intervention group washed feet with water at the right temperature, and the level of nail clipping, using skin care ointment and regular doctor check feet were 98.07%, 84.94%, 69.50%, 42.47% respectively. The control group was 87.97%, 72.61%, 50.62%, 31.12% respectively. The intervention group was higher than the control group (P 0.05). The frequency of self-examination was 7 days/week and 5 days/week respectively, and the intervention group was higher than the control group (P 0.01). 2.3.3 Healthy diet: The frequency of the intervention group and the control group following the healthy diet requirements were 6 days/week and 5 days/week respectively, and the intervention group was higher than the control group (P 0.01). Intervention group was higher than control group (P 0.01). 2.3.4 Aerobic exercise: After intervention, the frequency of aerobic exercise for 30 minutes and more in intervention group and control group were 7 days/week and 6 days/week respectively. Intervention group was higher than control group (P 0.01). 2.3.5 medication and smoking and drinking: medication, intervention group and control group were self-medication after intervention. Smoking rate of intervention group was higher than that of control group (P 0.05). There was no significant difference in smoking rate between intervention group and control group (P 0.05). Indicators and biochemical indicators before and after intervention, the average weight of intervention group decreased by 1.49 kg, the control group increased by 1.14 kg, the difference was significant (P 0.05); intervention group and control group in diabetes related biochemical indicators were not significantly different (P 0.05). 2. The total cost of increasing the days of self-monitoring blood glucose per week was 70012.60 yuan, and the average cost was 270.32 yuan. The total cost of increasing the days of self-examination feet per week was 70012.60 yuan and the average cost per capita was 270.32 yuan. The total cost was 70012.60 yuan and the per capita cost was 270.32 yuan. The influencing factors of intervention effect were baseline knowledge score, age (age), education level, per capita monthly income (yuan), the overall evaluation of group activities and the frequency of community doctor participation (P 0.05). 3.2 The influencing factors of intervention effect were baseline self-efficacy score and group activities overall evaluation. The baseline weight (kg), sex, monthly income per capita (yuan) (P 0.05). 4. Satisfaction and intention 4.1 in intervention group and self-evaluation intervention group were 96.14% and 84.9% respectively. Four percent of the participants in the intervention group said they would continue to participate in self-management group activities. In the intervention group, 80.08% of the control group and 80.08% of the control group indicated that they would be willing to participate in diabetes self-management activities if they did the best and the worst respectively. Among the eight self-management tasks, participants in the intervention group rated themselves as the best and worst performers as "moderate exercise" and "self-monitoring of blood sugar", respectively. A parallel control group was set up to evaluate the intervention effect and the short-term cost-effectiveness. The results showed that the self-management intervention was effective in improving the knowledge, self-efficacy and behavior of diabetic patients. This study also found that diabetic patients had relatively poor self-efficacy, behavior or self-evaluation in terms of "self-monitoring of blood glucose", "foot care", "mastery of insulin injection skills" and "evaluation of exercise intensity". It was suggested that community development should be carried out in the future. The above aspects should be strengthened in the self-management activities of diabetic patients.
【學(xué)位授予單位】：中國疾病預(yù)防控制中心
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R587.1

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王秀花,劉兆蘭,聶玉芳;社區(qū)糖尿病患者健康教育的做法[J];中國初級衛(wèi)生保健;2004年06期

2 張?zhí)m花;淺析社區(qū)糖尿病患者的健康教育[J];中國婦幼保健;2005年07期

3 胡大蘭,劉芳,田玲;社區(qū)糖尿病患者的健康教育[J];社區(qū)醫(yī)學(xué)雜志;2005年03期

4 周春梅;路立華;荊卉;;社區(qū)糖尿病患者的自我護理[J];臨床肺科雜志;2006年02期

5 劉愛平;;護理程序在社區(qū)糖尿病患者健康教育中的應(yīng)用[J];中國民康醫(yī)學(xué);2008年24期

6 羅冬梅;張武政;;社區(qū)糖尿病患者健康管理方法與體會[J];中國社區(qū)醫(yī)師(醫(yī)學(xué)專業(yè)半月刊);2008年13期

7 高玲;;提高對社區(qū)糖尿病患者健康教育的對策探討[J];中外醫(yī)療;2009年02期

8 賈曉東;喬勇;趙希林;;社區(qū)糖尿病患者的健康教育[J];現(xiàn)代中西醫(yī)結(jié)合雜志;2009年09期

9 應(yīng)方方;;社區(qū)糖尿病患者健康教育初探[J];醫(yī)院管理論壇;2009年04期

10 姜宏娜;徐冬梅;姜宏偉;;對社區(qū)糖尿病患者實施健康教育的需求與措施[J];中國當(dāng)代醫(yī)藥;2009年22期

相關(guān)會議論文 前10條

1 陳雁;胡云;;社區(qū)糖尿病患者健康管理模式的建立和探討[A];全國第五屆糖尿病護理學(xué)術(shù)交流暨專題講座會議論文匯編[C];2007年

2 尹光霞;;社區(qū)糖尿病患者飲食和運動療法[A];中華護理學(xué)會2009全國靜脈治療護理學(xué)術(shù)交流暨專題講座會議論文匯編[C];2009年

3 余永貴;鄧漢軍;羅樹芳;;淺談社區(qū)糖尿病患者的健康教育[A];全國第九屆老年護理學(xué)術(shù)交流暨專題講座會議論文匯編[C];2006年

4 王玉婷;;社區(qū)糖尿病患者的健康教育[A];全國第五屆糖尿病護理學(xué)術(shù)交流暨專題講座會議論文匯編[C];2007年

5 丁蘭;李世華;武琳;李晶;;對社區(qū)糖尿病患者采用“以家庭為單位”的護理管理的效果評價[A];全國中醫(yī)、中西醫(yī)結(jié)合護理學(xué)術(shù)交流會議、全國社區(qū)護理學(xué)術(shù)交流會議論文匯編[C];2012年

6 孫莉敏;胡永善;吳毅;;社區(qū)糖尿病患者運動干預(yù)效果評價[A];中國康復(fù)醫(yī)學(xué)會第四屆會員代表大會暨第三屆中國康復(fù)醫(yī)學(xué)學(xué)術(shù)大會論文匯編[C];2001年

7 熊云云;趙倩華;郭起浩;丁玎;洪震;;社區(qū)糖尿病患者中癡呆患病率調(diào)查[A];第十一屆全國神經(jīng)病學(xué)學(xué)術(shù)會議論文匯編[C];2008年

8 陳敏;東黎光;丁靜;阮丹杰;張永順;田勇;王淑玉;陸菊明;竇京濤;;北京市社區(qū)糖尿病患者國家基本降糖藥物覆蓋率及血糖達(dá)標(biāo)情況的調(diào)查研究[A];中華醫(yī)學(xué)會糖尿病學(xué)分會第十六次全國學(xué)術(shù)會議論文集[C];2012年

9 何仙美;;對社區(qū)糖尿病患者實施健康行為干預(yù)的體會[A];全國內(nèi)科護理學(xué)術(shù)交流暨專題講座會議、全國心臟內(nèi)、外科護理學(xué)術(shù)交流暨專題講座會議、全國第8屆糖尿病護理學(xué)術(shù)交流暨專題講座會議、全國第8屆血液凈化護理學(xué)術(shù)交流暨專題講座會議論文匯編[C];2010年

10 申美霞;吳超紅;李春梅;雷紅英;;社區(qū)糖尿病患者生活質(zhì)量與家庭支持相關(guān)性研究[A];全國內(nèi)科護理學(xué)術(shù)交流暨專題講座會議、全國心臟內(nèi)、外科護理學(xué)術(shù)交流暨專題講座會議論文匯編[C];2008年

相關(guān)重要報紙文章 前1條

1 實習(xí)生 王佳;社區(qū)糖尿病患者可參與防治[N];大慶日報;2010年

相關(guān)碩士學(xué)位論文 前9條

1 張惺惺;社區(qū)糖尿病患者自我管理干預(yù)效果研究[D];中國疾病預(yù)防控制中心;2015年

2 熊云云;社區(qū)糖尿病患者中癡呆患病率及其危險因素研究[D];復(fù)旦大學(xué);2008年

3 黎么菊;對社區(qū)糖尿病患者相關(guān)知識及影響因素的調(diào)查分析與健康教育對策[D];湖北中醫(yī)學(xué)院;2007年

4 檀平;社區(qū)糖尿病患者自我管理初步效果及需求評估研究[D];中國疾病預(yù)防控制中心;2011年

5 戴曉橙;上海市社區(qū)糖尿病患者對不同健康傳播模式的需求研究[D];復(fù)旦大學(xué);2009年

6 袁久莉;社區(qū)糖尿病患者及高危人群健康教育指導(dǎo)與干預(yù)方式研究[D];吉林大學(xué);2009年

7 劉小麗;社區(qū)糖尿病患者自我管理KAB評價量表研究[D];中國疾病預(yù)防控制中心;2008年

8 毛凡;應(yīng)用RE-AIM框架進(jìn)行社區(qū)糖尿病患者自我管理項目的綜合評價[D];中國疾病預(yù)防控制中心;2014年

9 龍飛艷;團體咨詢對長沙市某社區(qū)糖尿病患者抑郁情緒的干預(yù)研究[D];中南大學(xué);2010年

，

本文編號：2210534