A comparative study of the effects of a health care package on knowledge, attitudes and self-care behaviours in older Taiwanese aboriginal and non-aboriginal adults with type 2 diabetes in Taiwan
Chao, Ying-Hua (2009) A comparative study of the effects of a health care package on knowledge, attitudes and self-care behaviours in older Taiwanese aboriginal and non-aboriginal adults with type 2 diabetes in Taiwan. PhD thesis, James Cook University.
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Abstract
In 2005, the five leading causes of death in Taiwan were malignant neoplasm, cerebrovascular disease, heart disease, diabetes mellitus, and trauma. Of these, diabetes is the most rapidly increasing disease. Older adults are the fastest growing segment of the population; high incidence and prevalence rates of chronic diseases are associated with aging and older adults are likely to require and consume the high cost of long-term care. Taiwanese groups include Non-Aborigines: Holo, Hakkas, Mainlander and Aborigines who total 13 groups. Aborigines have a unique culture, traditional religion and customs, that are all very different from Taiwanese non-Aboriginal people. From a cultural perspective, different ethnic groups may have different "thinking, decisions, and actions in patterned ways" (Leininger, 1985, p.209).
The primary purpose of this study was to test the hypothesis that the diabetes self care knowledge, attitudes and behaviours, medical status, and quality of life of Taiwanese elderly with Type 2 diabetes mellitus, could be improved by the delivery of a specific health care package. The theoretical model used to drive the study was the Health Education Model based on the Revised Pender's Health Promotion Model (RHPM). The secondary purpose of the study was to compare the different ethnic groups and how their lifestyle impacted on their perceptions of diabetes. Comparisons were drawn between the Taiwanese Aborigines and non-Aborigine groups. This study utilised an experimental design with a cluster randomized sample (N=500, included experimental group 241 and control group 259, after three and six months followed-up, N= 485, experimental group 235 and control group 250) of Taiwanese elderly with Type 2 diabetes mellitus. Outpatients from Middle to Northern Taiwan included experimental group from 5 public health centres, 1 private clinic and 1 regional hospital and control group from 1 public health centre, 1 private clinic and 3 regional hospitals.
Data were analyzed using SPSS for Windows, version 12.0 and STATA for Windows, release 8. Five research questionnaires were inquired in the study: Diabetes Personal Data Sheet which includes patient's demographic data and health status; the Rand Social Health Battery and Social Services questionnaire which includes an 11 item self-report scale that provides for social resources and social interaction; the Social Services questionnaire, adapted from the "Structured Interview Guide" (Ervin, 2004) which uses questions focused on the family's experiences of using services from various agencies and social services; the Health perceptions questionnaire (HPQ) (Ware, 1976) which includes 33 self-report items that records perceptions of past, present, and future health, resistance to illness, and attitude toward sickness; the Summary of Diabetes Self-Care Activities (SDACA) which consists of 11 items and 14 additional questions about diet, exercise, self-monitoring of blood glucose, foot care and smoking termination; and the Quality of Life (WHOQOL-Brief-TAIWAN) which contains four domains, and 26 facets include physical, psychological health, social relationship, and environment and which is adapted for use in Taiwan.
The results indicated that the intervention health care package had a strong effect on blood glucose levels and well-controlled levels increased from about 60% to 80% in the intervention group. At 6 months of follow-up medical risk markers for complications were significantly reduced for patients in the intervention group compared to control group. Further, the intervention group improved in exercise, healthy diet choices, and blood glucose data but this had no effect on overall quality of life. Aboriginal participants were more likely than non-Aboriginal participants to understand the complications of diabetes complications other chronic diseases however the Aboriginal participants were less likely than the non-Aboriginal participants to have friends who supported them, attend religious services, participate in voluntary group activities, and eat fruit and vegetables.
The study concluded that the special health care package developed for Taiwanese elderly with Type 2 diabetes mellitus was able to affect diabetes participants' knowledge, attitudes and behaviours and improve clinical data outcomes. The intervention did not however improve participants' quality of life. Further investigation is required to confirm the effects of the intervention in younger patients and patients of other ethnic backgrounds such as foreigners who live in Taiwan.
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