PDF(Pubmed)
Abstract：
Diabetes mellitus is a prevalent and potentially devastating chronic illness affecting many older adults. Given spousal involvement in many aspects of diabetes management, coping with their partners is increasingly seen as a potential solution to make up for limited resources. This study aimed to identify the key conditions for optimal implementation of couple-based collaborative management model (CCMM) among Chinese older couples with type 2 diabetes mellitus.
Older couples and community healthcare practitioners were selected according to couples\' joint intervention attendance rate and community\'s average attendance rate. This mixed methods research consisted of a qualitative phase and a quantitative phase. In the qualitative phase, in-depth interviews were conducted among 12 pairs of couples in the intervention group and 4 corresponding practitioners, in the follow-up period of the multicentered RCT from January to April 2022. Qualitative comparative analysis (QCA) in the quantitative phase to identify conditions influencing CCMM\'s implementation and to explore necessary and sufficient combinations of conditions (i.e., solutions) for improving patients\' glycated hemoglobin (HbA1c) control (outcome).
Key conditions included implementation process, couple\'s role in diabetes management, their belief and perception of CCMM, as well as objective obstacles and subjective initiative for behavior change. Accordingly, major barriers in CCMM\'s implementation were patients\' strong autonomy (particularly among husbands), misbelief and misperception about diabetes management as a result of low literacy, and mistrust of the practitioners. QCA further revealed that no single condition was necessary for effective HbA1c control, while three types of their combinations would be sufficient. Solution 1 and 2 both comprised the presence of spousal willingness to help, plus correct belief and perception of diabetes management, well embodying the utility of couple collaborative management in supporting patients\' HbA1c control. On the other hand, solution 3 indicated that high-quality implementation even without spousal support, can promote the patient\'s subjective initiative to overcome objective obstacles, suggesting enhanced self-management for HbA1c control.
Tailored CCMM should be implemented in reference to older couple\'s preferences and literacy levels, to ensure intervention fidelity, and establish correct understanding of collaborative management among them.
Older couples and community healthcare practitioners were selected according to couples\' joint intervention attendance rate and community\'s average attendance rate. This mixed methods research consisted of a qualitative phase and a quantitative phase. In the qualitative phase, in-depth interviews were conducted among 12 pairs of couples in the intervention group and 4 corresponding practitioners, in the follow-up period of the multicentered RCT from January to April 2022. Qualitative comparative analysis (QCA) in the quantitative phase to identify conditions influencing CCMM\'s implementation and to explore necessary and sufficient combinations of conditions (i.e., solutions) for improving patients\' glycated hemoglobin (HbA1c) control (outcome).
Key conditions included implementation process, couple\'s role in diabetes management, their belief and perception of CCMM, as well as objective obstacles and subjective initiative for behavior change. Accordingly, major barriers in CCMM\'s implementation were patients\' strong autonomy (particularly among husbands), misbelief and misperception about diabetes management as a result of low literacy, and mistrust of the practitioners. QCA further revealed that no single condition was necessary for effective HbA1c control, while three types of their combinations would be sufficient. Solution 1 and 2 both comprised the presence of spousal willingness to help, plus correct belief and perception of diabetes management, well embodying the utility of couple collaborative management in supporting patients\' HbA1c control. On the other hand, solution 3 indicated that high-quality implementation even without spousal support, can promote the patient\'s subjective initiative to overcome objective obstacles, suggesting enhanced self-management for HbA1c control.
Tailored CCMM should be implemented in reference to older couple\'s preferences and literacy levels, to ensure intervention fidelity, and establish correct understanding of collaborative management among them.
摘要：
背景：糖尿病是一种普遍的、潜在的破坏性慢性疾病，影响许多老年人。鉴于配偶参与糖尿病管理的许多方面，与合作伙伴打交道越来越被视为弥补有限资源的潜在解决方案。本研究旨在确定在中国2型糖尿病老年夫妇中最佳实施基于夫妻的协作管理模式（CCMM）的关键条件。
方法：根据夫妻联合干预出勤率和社区平均出勤率选择老年夫妇和社区医护人员。这种混合方法研究包括定性阶段和定量阶段。在定性阶段,对干预组中的12对夫妇和4名相应的从业者进行了深入访谈，在2022年1月至4月的多中心RCT随访期间。定量阶段的定性比较分析（QCA），以确定影响CCMM实施的条件，并探索必要和充分的条件组合（即，解决方案）改善患者糖化血红蛋白（HbA1c）控制（结果）。
结果：关键条件包括实施过程，夫妇在糖尿病管理中的作用，他们对CCMM的信念和看法，以及行为改变的客观障碍和主观能动性。因此，CCMM实施的主要障碍是患者强烈的自主性(特别是在丈夫中)，由于识字率低，对糖尿病管理的误解和误解，以及对从业者的不信任。QCA进一步显示，有效控制HbA1c不需要单一条件，而三种类型的组合就足够了。解决方案1和2都包括配偶的帮助意愿，加上对糖尿病管理的正确信念和看法，很好地体现了夫妇协作管理在支持患者HbA1c控制方面的效用。另一方面,解决方案3表明，即使没有配偶支持，高质量的实施，能促进患者的主观能动性克服客观障碍,建议加强HbA1c控制的自我管理。
结论：量身定制的CCMM应参考年长夫妇的偏好和识字水平来实施，为了确保干预的真实性，并在其中建立对协同管理的正确认识。
方法：根据夫妻联合干预出勤率和社区平均出勤率选择老年夫妇和社区医护人员。这种混合方法研究包括定性阶段和定量阶段。在定性阶段,对干预组中的12对夫妇和4名相应的从业者进行了深入访谈，在2022年1月至4月的多中心RCT随访期间。定量阶段的定性比较分析（QCA），以确定影响CCMM实施的条件，并探索必要和充分的条件组合（即，解决方案）改善患者糖化血红蛋白（HbA1c）控制（结果）。
结果：关键条件包括实施过程，夫妇在糖尿病管理中的作用，他们对CCMM的信念和看法，以及行为改变的客观障碍和主观能动性。因此，CCMM实施的主要障碍是患者强烈的自主性(特别是在丈夫中)，由于识字率低，对糖尿病管理的误解和误解，以及对从业者的不信任。QCA进一步显示，有效控制HbA1c不需要单一条件，而三种类型的组合就足够了。解决方案1和2都包括配偶的帮助意愿，加上对糖尿病管理的正确信念和看法，很好地体现了夫妇协作管理在支持患者HbA1c控制方面的效用。另一方面,解决方案3表明，即使没有配偶支持，高质量的实施，能促进患者的主观能动性克服客观障碍,建议加强HbA1c控制的自我管理。
结论：量身定制的CCMM应参考年长夫妇的偏好和识字水平来实施，为了确保干预的真实性，并在其中建立对协同管理的正确认识。
