Avaliação da visita domiciliar nas unidades Estratégia Saúde da Família: adesão e empoderamento das práticas de autocuidado em diabetes mellitus tipo 2

Abstract

The diabetes mellitus type 2 is a chronic health condition that presents low adherence rates because it imposes daily self-care challenges. Diabetes control as well as the prevention of acute and chronic complications can be accomplished through the home visitingeducational strategy based on the empowerment approach that allows the user to assist in the development of skills and to make informed decisions to improve the management of their condition Chronic health. Objective: To evaluate the effects of home visits on adherence andempowerment of the user with diabetes type 2 for self-care practices. Method: This is a cluster-randomized clinical trial involving 145 users with diabetes type 2, 34 in the intervention group and 111 in the control group. All users were linked to the Family Health Strategy Units of a Minas Gerais municipality. The home visit was performed in three cycles(1, 2 and 3), with an interval of three months between cycles. In cycle 1 three meetings were held, one per week. In cycles 2 and 3 two encounters with a 15 day interval between them were performed. Subjects discussed at the home visit referred to self-care practices related to feelings and emotions about living with diabetes, healthy eating, physical activity practice, prevention of diabetes complications, and barriers that users identified that interfered with health care. Two instruments were applied: Self-Care Questionnaire on Diabetes (ESM), and Diabetes Empowerment Scale-Short Form (DES-SF) at initial time (T0) and end of time (Tf). The tests used were t test and Mann Whitney student for comparison of means and medians of independent groups. Proportions were compared using the chi-square test of Pearson. Toevaluate the effectiveness of the intervention, the student t test were used and paired Wilcoxon for comparison of means and medians. For self-care and empowerment variables, the effect of the experiment was defined as the difference between their values in the final period and initial period (W), divided by the initial value. For all analyzes, a significance level of 5% (p<0.05). Results: In the comparison analysis of pre and post education periods, the intervention group presented a statistically significant increase of the median score in this group (p<0.05). Among users of the control group, the same did not happen. In the comparison between the intervention group and the control group, the effect on the self-cmare score (WESM) in the intervention group was considered statistically different from the effect in the control group (p<0.001). Regarding empowerment, measured by the DES-SF scale, astatistically significant increase of the median score after the study was obtained in both the intervention and control groups (p<0.05). However, this increase was not considered statistically different between the two groups (p=0.607). Conclusion: The home visiting educational strategy had a beneficial effect in improving adherence to self-care practices indiabetes mellitus type 2.