Intervención educativa problematizadora para promover hábitos saludables en personas ancianas con diabetes: ensayo clínico aleatorizado

Borba, Anna Karla de Oliveira Tito; Arruda, Ilma Kruze Grande de; Marques, Ana Paula de Oliveira; Leal, Márcia Carrera Campos; Diniz, Alcides da Silva; Linhares, Francisca Márcia Pereira

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 73 (suppl 3) • 2020 • https://doi.org/10.1590/0034-7167-2019-0719 copiar

Intervención educativa problematizadora para promover hábitos saludables en personas ancianas con diabetes: ensayo clínico aleatorizado

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

evaluar los efectos de una intervención educativa problemática para la promoción de hábitos saludables en personas mayores con diabetes.

Métodos:

ensayo clínico aleatorizado, realizado con 202 individuos elegidos para dos grupos: intervención y control. La intervención consistió en problematizar las actividades educativas grupales, mensualmente, durante seis meses. El grupo de control participó en el monitoreo convencional en la unidad de salud. Los datos fueron recolectados a través de entrevistas semiestructuradas antes y después de la intervención, además de las pruebas de laboratorio.

Resultados:

después de la intervención, un aumento en el conocimiento sobre la enfermedad (p<0.001), una actitud positiva hacia el autocuidado (p=0.011), actividad física (p=0.020), variedad de dieta (p=0.002) y menor consumo de aceites y grasas (p<0.05), en comparación con el grupo de control.

Conclusión:

la intervención realizada tiene un efecto beneficioso para la promoción de hábitos saludables.

Descriptores:
Ancianos; Diabetes Mellitus Tipo 2; Educación en Salud; Estilo de vida Saludable; Ensayo Clínico

Variables	Experimental Group (n=101)^* * Elderly people with diabetes who started the study (n=202);	Control Group (n=101)^* * Elderly people with diabetes who started the study (n=202);	p value
Sex (women)^† † Variables of proportion;	67.3	79.2	0.056^‡ ‡ Pearson's chi-square test;
Age (years)^§ § Variables with non-normal distribution;	66.0	66.0	0.958^\|\| \|\| Mann-Whitney U test;
Education (≤ 8 years)^† † Variables of proportion;	77.2	83.2	0.289^‡ ‡ Pearson's chi-square test;
Diagnostic time (months)^§ § Variables with non-normal distribution;	108.0	108.0	0.939^\|\| \|\| Mann-Whitney U test;
A1C (%)^¶ ¶ A1C - glycated hemoglobin; ^§ § Variables with non-normal distribution;	5.8	5.9	0.810^\|\| \|\| Mann-Whitney U test;
Quality of the diet^ Variables with normal distribution;	77.2	75.8	0.395^†† †† Student's t-test for unpaired samples;
Physical activity (min/week)^§ § Variables with non-normal distribution;	450.0	430.0	0.739^\|\| \|\| Mann-Whitney U test;
Knowledge about diabetes^ Variables with normal distribution;	5.9	5.6	0.420^†† †† Student's t-test for unpaired samples;
Attitude for self-care ^ Variables with normal distribution;	59.9	58.1	0.147^†† †† Student's t-test for unpaired samples;
Smoke^† † Variables of proportion;	5.9	8.9	0.421^‡ ‡ Pearson's chi-square test;
Alcohol consumption^† † Variables of proportion;	23.5	30.8	0.698^‡‡ ‡‡ Fisher's exact test;
Weight (kg)^ Variables with normal distribution;	71.8	68.2	0.064^†† †† Student's t-test for unpaired samples;
Height (m)^ Variables with normal distribution;	1.6	1.6	0.169^†† †† Student's t-test for unpaired samples;
BMI (kg/m2)^§§ §§ BMI - Body Mass Index;	27.5	26.9	0.301^\|\| \|\| Mann-Whitney U test;
WC (cm)^ Variables with normal distribution; ^\|\|\|\| \|\|\|\| WC - waist circumference.	100.7	99.5	0.498^†† †† Student's t-test for unpaired samples;

Variables	Experimental Group (n=83)^* * Elderly people with diabetes who completed six months of follow-up in the study (n=164);			Control Group (n=81)^* * Elderly people with diabetes who completed six months of follow-up in the study (n=164);			Independent sample comparison
Variables	T0^† † T0 - Beginning of the study;	T6^‡ ‡ T6 - Six months after the study began;	p value	T0^† † T0 - Beginning of the study;	T6^‡ ‡ T6 - Six months after the study began;	p value	T6^‡ ‡ T6 - Six months after the study began; (Valor de p)
Knowledge about diabetes^§ § Variables with normal distribution;	6.2	9.6	<0.001 ^\|\| \|\| Paired Student's t-test;	5.5	6.7	<0.001 ^\|\| \|\| Paired Student's t-test;	0.000^¶ ¶ Student's t-test for unpaired samples;
Attitude for self-care^§ § Variables with normal distribution;	59.9	63.4	<0.001 ^\|\| \|\| Paired Student's t-test;	57.9	59.4	0.104^\|\| \|\| Paired Student's t-test;	0.011^¶ ¶ Student's t-test for unpaired samples;
Quality of the diet^§ § Variables with normal distribution;	77.2	77.5	0.873^\|\| \|\| Paired Student's t-test;	76.9	76.2	0.652^\|\| \|\| Paired Student's t-test;	0.506^¶ ¶ Student's t-test for unpaired samples;
Physical activity^ Variables with non-normal distribution;	465.0	535.0	0.236^†† †† Wilcoxon test;	470.0	390.0	0.115^†† †† Wilcoxon test;	0.020^‡‡ ‡‡ Mann-Whitney U test;
Smoking^§§ §§ Variables of proportion;	4.8	4.8	1.000^\|\|\|\| \|\|\|\| Fisher's exact test;	7.4	7.4	1.000^¶¶ ¶¶ Pearson's chi-square test.	0.532^\|\|\|\| \|\|\|\| Fisher's exact test;
Alcohol consumption^§§ §§ Variables of proportion;	20.0	45.5	0.111^¶¶ ¶¶ Pearson's chi-square test.	22.2	33.3	1.000^\|\|\|\| \|\|\|\| Fisher's exact test;	0.696^\|\|\|\| \|\|\|\| Fisher's exact test;

Variables	Experimental Group (n=83)^* * Elderly people with diabetes who completed the six-month follow-up in the study (n=164);			Control Group (n=81)^* * Elderly people with diabetes who completed the six-month follow-up in the study (n=164);			Independent sample comparison
Variables	T0^† † T0 - Beginning of the study;	T6^‡ ‡ T6 - Six months after the study began;	p value	T0^† † T0 - Beginning of the study;	T6^‡ ‡ T6 - Six months after the study began;	p value	T6^‡ ‡ T6 - Six months after the study began; (p value)
Cereals	4.0^§ § Mean;	3.4^§ § Mean;	0.026^\|\| \|\| Paired Student's t-test; Student's t-test for unpaired samples;	3.5^§ § Mean;	3.2^§ § Mean;	0.189^\|\| \|\| Paired Student's t-test; Student's t-test for unpaired samples;	0.439^¶
Fruit	2.2^§ § Mean;	2.3^§ § Mean;	0.660^\|\| \|\| Paired Student's t-test; Student's t-test for unpaired samples;	1.3^ Median;	1.7^ Median;	0.708^†† †† Wilcoxon test;	0.186^‡‡ ‡‡ Mann-Whitney U test.
Legumes	2.0^ Median;	1.2^ Median;	0.043^†† †† Wilcoxon test;	1.8^§ § Mean;	1.51^§ § Mean;	0.144^\|\| \|\| Paired Student's t-test; Student's t-test for unpaired samples;	0.473^‡‡ ‡‡ Mann-Whitney U test.
Milk and dairy products	0.6^ Median;	0.5^ Median;	0.102^†† †† Wilcoxon test;	0.6^ Median;	0.6^ Median;	0.936^†† †† Wilcoxon test;	0.895^‡‡ ‡‡ Mann-Whitney U test.
Meat and eggs	1.3^§ § Mean;	1.0^§ § Mean;	0.004^\|\| \|\| Paired Student's t-test; Student's t-test for unpaired samples;	1.1^ Median;	0.7^ Median;	0.035^†† †† Wilcoxon test;	0.542^‡‡ ‡‡ Mann-Whitney U test.
Oil and fat	0.2^ Median;	0.2^ Median;	0.624^†† †† Wilcoxon test;	0.6^ Median;	0.6^ Median;	0.245^†† †† Wilcoxon test;	0.004^‡‡ ‡‡ Mann-Whitney U test.
Total fat (%)	20.0^§ § Mean;	20.1^§ § Mean;	0.955^\|\| \|\| Paired Student's t-test; Student's t-test for unpaired samples;	20.5^§ § Mean;	22.8^§ § Mean;	0.068^\|\| \|\| Paired Student's t-test; Student's t-test for unpaired samples;	0.036^¶
Saturated fat (%)	5.5^§ § Mean;	5.2^§ § Mean;	0.353^\|\| \|\| Paired Student's t-test; Student's t-test for unpaired samples;	5.8^§ § Mean;	6.1^§ § Mean;	0.497^\|\| \|\| Paired Student's t-test; Student's t-test for unpaired samples;	0.039^¶
Diet variety	12.7^§ § Mean;	14.0^§ § Mean;	0.008^\|\| \|\| Paired Student's t-test; Student's t-test for unpaired samples;	12.0^ Median;	11.0^ Median;	0.670^†† †† Wilcoxon test;	0.002^‡‡ ‡‡ Mann-Whitney U test.

Variables	Experimental Group (n=83)^* * Elderly people with diabetes who completed the six-month follow-up in the study (n=164);			p	Control Group (n=81)^* * Elderly people with diabetes who completed the six-month follow-up in the study (n=164);			p	Independent sample comparison
	T0^† † T0 - Beginning of the study;	T3^‡ ‡ T3 - Three months after the study began;	T6^§ § T6 - Six months after the study began;		T0^† † T0 - Beginning of the study;	T3^‡ ‡ T3 - Three months after the study began;	T6^§ § T6 - Six months after the study began;		T0^† † T0 - Beginning of the study;	T3^‡ ‡ T3 - Three months after the study began;	T6^§ § T6 - Six months after the study began;
									p	p	p
Weight (kg)	72.6	71.6^\|\| \|\| Significant difference in relation to T0;	72.3^¶ ¶ Significant difference in relation to T3;	<0.001 ^ Generalized Linear Model with Bonferroni Test for multiple comparisons;	67.7	67.7	68.0	0.177^ Generalized Linear Model with Bonferroni Test for multiple comparisons;	0.030^†† †† Student's t-test for unpaired samples;	0.081^†† †† Student's t-test for unpaired samples;	0.052^†† †† Student's t-test for unpaired samples;
BMI (kg/m²)^‡‡ ‡‡ BMI - Body Mass Index;	28.0	27.7^\|\| \|\| Significant difference in relation to T0;	28.1^¶ ¶ Significant difference in relation to T3;	0.001^ Generalized Linear Model with Bonferroni Test for multiple comparisons;	27.8	27.0	27.2	0.078^ Generalized Linear Model with Bonferroni Test for multiple comparisons;	0.792^†† †† Student's t-test for unpaired samples;	0.367^†† †† Student's t-test for unpaired samples;	0.265^†† †† Student's t-test for unpaired samples;
WC (cm)^§§ §§ WC - waist circumference;	101.3	98.0^\|\| \|\| Significant difference in relation to T0;	100.7^¶ ¶ Significant difference in relation to T3;	<0.001 ^ Generalized Linear Model with Bonferroni Test for multiple comparisons;	99.4	96.4^\|\| \|\| Significant difference in relation to T0;	98.5^¶ ¶ Significant difference in relation to T3;	<0.001 ^ Generalized Linear Model with Bonferroni Test for multiple comparisons;	0.329^†† †† Student's t-test for unpaired samples;	0.383^†† †† Student's t-test for unpaired samples;	0.235^†† †† Student's t-test for unpaired samples;
A1C (%)^\|\|\|\| \|\|\|\| A1C - glycated hemoglobin; Mann-Whitney U test	6.1	6.2	6.3	0.327^ Generalized Linear Model with Bonferroni Test for multiple comparisons;	6.3	6.7^\|\| \|\| Significant difference in relation to T0;	6.6	0.037^ Generalized Linear Model with Bonferroni Test for multiple comparisons;	0.993^¶¶	0.013^¶¶	0.101^¶¶

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[1] Corresponding author: Anna Karla de Oliveira Tito Borba. E-mail: anninhatito@gmail.com