Does social support effect knowledge and diabetes self-management practices in older persons with Type 2 diabetes attending primary care clinics in Cape Town, South Africa?

BackgroundIn South Africa with one of the most rapidly ageing populations in Africa despite the demographic impact of the HIV/AIDS epidemic, diabetes is a major cause of morbidity and mortality. Self-management is challenging for all those with the condition but is likely to create a higher demand for those who may have existing co-morbidities associated with age, and long-standing chronic diseases.ObjectiveTo determine the relationship of social support, especially that of family and friends with their self-management.MethodsThis cross-sectional study was undertaken in the Cape Town metropole primary care clinics. The sample comprised 406 people drawn from four community health centres (CHC) that are served by Groote Schuur Hospital at the tertiary level.ResultsOf the 406 participants, 68.5% were females, 60.5% were living with a family member, and almost half were married. The mean duration of diabetes from diagnosis was eight years. More than half (57.4%) had no or only primary education. Half the participants (50.2%) had poor knowledge level in relation to symptoms and complications of diabetes. Multivariable linear regression showed older age was associated with poor knowledge (®: -1.893, 95% CI-3.754; -0.031) and higher income was associated with self-management practice (®: 3.434, 95% CI 0.797; 6.070). Most participants received family support to follow aspects of diabetes self-management. The ordinal logistic regression indicated that family support was positively associated with the self-management practice score for following a diabetic meal plan, taking care of feet, physical activity, testing blood sugar and handling participants’ feelings about being diabetic, but not for taking medication.ConclusionsConsideration needs to be given to developing and testing education programmes that focus on needs of older people with diabetes and emphases the role of family and friends.背景：尽管受艾滋病（HIV/AIDS）流行的人口学影响，南非仍是非洲人口老龄化速度最快的国家之一，糖尿病已成为致病与致死的主要诱因。糖尿病患者的自我管理本就颇具挑战，而对于合并有年龄相关共病及长期慢性病的患者而言，其自我管理的需求或将更高。 目的：本研究旨在探讨社会支持（尤其是来自亲友的社会支持）与糖尿病患者自我管理行为之间的关联。 方法：本项横断面研究于开普敦都会区的初级保健诊所开展，研究样本取自4家社区卫生中心（Community Health Centre, CHC），这些诊所的转诊上级三级医疗机构为格罗特舒尔医院，最终纳入406名研究对象。 结果：在406名参与者中，68.5%为女性，60.5%与家庭成员同住，近半数参与者已婚。糖尿病确诊后的平均病程为8年。超过半数（57.4%）的参与者仅接受过初等及以下教育。50.2%的参与者对糖尿病症状及并发症的认知水平较差。多变量线性回归分析显示，年龄越大与糖尿病认知水平越低呈显著相关（β：-1.893，95%置信区间CI：-3.754~-0.031）；而更高的收入水平与更优的自我管理行为呈显著相关（β：3.434，95%CI：0.797~6.070）。多数参与者能够获得亲友支持以践行糖尿病自我管理相关事项。有序逻辑回归分析结果表明，亲友支持与患者在遵循糖尿病饮食计划、足部护理、体育锻炼、血糖检测以及调适糖尿病相关心理状态等方面的自我管理行为评分呈正相关，但与服药行为无显著关联。 结论：未来应考虑开发并验证针对老年糖尿病患者需求的教育项目，同时强调亲友在患者自我管理中的重要作用。