Avaliação da intervenção telefônica em Diabetes Mellitus tipo 2: ensaio clínico

Abstract

The telephone intervention is considered an innovative technology in health; it is low cost and easy access. This kind of intervention points out positive and promising results in relation to improvement of health conditions of users with diabetes mellitus. Aim: To evaluate the effectiveness of telephone intervention of diabetes mellitus type 2 with psychosocial self-efficacy, self-care practices and glycemic control. Method: The cluster randomized clinical trial was conducted in six Basic Health Units with users with diabetes mellitus type 2. The units were allocated by drawing Control Group (CG=94) or Experimental Group (EG=69).The data were collected in three phases: the first phase occurred before the start of the intervention (T0), it was considered the pre-test and the second phase occurred after 12 months (T12). Clinical variables, socio demographic data, anthropometric measurements, self-efficacy and self-care data about diabetes mellitus were collected at T0 and T12.The telephone intervention for EG was divided into four cycles with three months intervals between each one. In the first cycle, the users with diabetes mellitus attended to face-to-face meeting and telephone intervention. These occurred with the purpose to approximate and strengthen the link between user and health professionals, to know the context of life that users live and their expectations about research, and to clarify the meaning of plan of goals. In the second and third cycles, each user with diabetes mellitus received four telephone interventions. These interventions were used to assist the user of EG in the identification of barriers that were disturbing to practice a physical activity and follow a diet, and to establish a plan of goals to overcome those barriers. In the fourth cycle, three telephone interventions occurred in order to assist the user of EG in the maintenance of self-care practices and to inform about the end of the research. Therefore, there were eight telephone interventions for each user with diabetes mellitus. On each interval, users received a phone call, characterized as telephone monitoring, whose purpose was to clarify any doubts and follow the development of plan of goals. The data were analyzed with the assistance of program STATA ®, version 12.0. Students t and Mann-Whitney tests were used to compare averages and medians, and Pearsons chi-square test was used to compare proportions. Paired Students t- and Wilcoxon tests were used to compare averages and medians in order to evaluate the intervention effectiveness. A descriptive statistics with the tables of frequency distribution and calculations of measures of central tendency and dispersion were used. In all analyses, the significance level adopted was 5% (p<0.05). Results: 89 users with diabetes mellitus type 2 from CG and 62 users from EG completed the study. In both groups, the average age of users is above 60 years; most are married, without occupation, live with a partner, and have less than eight years of schooling. The barriers more mentioned by users of GE were those related to psychosocial and culture factors (42%). In the elaboration of plan of goals, diet (55.7%) was the factor more mentioned as target of change. The comparison of T12 and TO pointed out that EG presented improvements on scores of self-care (p <0.001), self-efficacy (p<0.001) and reduction of glycohemoglobin level (p<0.001). The CG presented reduction on scores of self-care (p<0.001) and self-efficacy (p=0.813), and increasing the value of glycohemoglobin (p=0.143). The comparison between the values of variables on initial and final times of experimental and control groups demonstrated that the medians of these groups were statistically different for glycohemoglobin (p<0.001), self-care (p<0.001), and self-efficacy (p<0.001). Conclusion: Telephone intervention was effective to improve psychosocial self-efficacy, self-care practices, and glycemic control of users with diabetes mellitus type 2.