Avaliação da efetividade do programa de empoderamento para o autocuidado em diabetes mellitus na atenção primátia à saúde.

Abstract

Objective: To evaluate the effectiveness of the empowerment program for self care in diabetes mellitus type 2 in the primary health care users in Divinopolis, MG. Method: Clinical trial with cluster randomized trial in 10 Health Teams units Family with users with diabetes mellitus type 2 were allocated by lot: five units as a control group and five as intervention group. The study consisted of six stages of follow-up. Prior to the start time, held exploratory with descriptive analysis of all users with Health Strategy diabetes Urban Family municipality. In the initial time (Ti), data were collected from clinical, sociodemographic, anthropometric variables, knowledge, attitudes, self-care and empowerment of scale for the control and intervention groups; held randomization into two groups (control: 142; intervention: 162). At time zero (T0), three months (T3) and six months (T6) after, there were educational practices, with an interval of three months between the time and telephone monitoring once a month these intervals for the intervention group. In the end time (Tf), threemonths time six months (T6) again was held collection of clinical, sociodemographic, anthropometric variables, knowledge, attitudes, self-care and empowerment of scale for the control and intervention groups. In time twelve months (T12), a month after the end of time(Tf), held a final meeting for delivery and guidelines on examination and closure of the program for the control groups with 111 participants and 127 intervention participants. Data were analyzed with the support of statistical programming environment R Core Team(2015) with software support rstudio (0.98.1103) and the Statistical Package for the Social Sciences® (SPSS) version 20.0. The tests were for comparisons of mean and median of independent groups, we used the t test and Mann Whitney student, respectively. To compare proportions, performed the chi-square test of Pearson. To evaluate the effectiveness of the intervention, thestudent t test were used and paired Wilcoxon for comparison of means and medians, respectively. Descriptive statistics were performed with frequency distribution tables, calculations of measures of central tendency and dispersion. For all analyzes, we adopted thesignificance level of 5% (p <0.05). Results: With the exploration data before the experiment (1320 users), described to the population of people with diabetes characteristics and analyzed the association between the time of the disease and the onset of diabetes complications,identifying that among users who had the diagnosis of the disease for over 10 years, the percentage of those who had complications 156 (32.2%) was higher than among those who had the diagnosis for less than 10 years 45 (12.1%). For the experiment, concluded the study111 members of the control group and 127 in the intervention group. For the intervention group, in relation to meeting targets for favoring of behavior change and improved control of diabetes mellitus, 33.9% (43) of users self declared that partially fulfilled and 66.1% (84) entirely fulfilled. Regarding the empowerment scale, the overall chance of fulfillment of goals in the group with the highest score is 2.98 times (95% CI: 1.30-6.86) the chance in the group with less empowerment scores. Regarding gender, the overall chance of meeting targets in themale group is 0.41 times (95% CI: 0.18-0.95) that chance in the female group. For the experiment (control group and the intervention group) compared to glycated hemoglobin, the mean effect on the intervention and control groups were respectively a mean increase of3.93% (p = 0.29) and reduce 13.05% (p <0.001) with statistically significant difference between groups (p <0.001). The other metabolic indicators and survey responses showed statistically significant difference in the intervention group compared to the control group.Conclusion: The empowerment program improved the metabolic control of diabetes mellitus type 2 in users of the study. It showed the association between achievement of goals and empowerment for self-care practices favoring the improvement of diabetes mellitus control.