Tip 1 diyabeti olan çocuk ve ebeveynlerine uygulanan hemşirelik müdahalelerinin hastalığa uyumuna etkisi: Sistematik derleme ve meta analiz
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Tarih
2024
Yazarlar
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Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi, Sağlık Bilimleri Enstitüsü
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Tip 1 diyabeti olan çocuk ve ebeveynlerinin hastalığa uyumunu etkileyen birçok faktör bulunmaktadır. Bu faktörler arasında çocuğun yaşı, cinsiyeti, gelişimsel durumu, hastalık süresi, tedavi tipi, sosyoekonomik durum, ırk/etnik köken, aile yapısı, başa çıkma becerileri, sosyal yeterlilik, özyönetim düzeyleri, stres, depresyon, davranış ve yeme bozukluğu gibi durumlar sayılabilir. Tip 1 diyabeti olan çocuk ve ebeveynlerinin hemşirelik bakımında bu faktörler göz önüne alınarak çocuk ve ebeveynlerin hastalığa uyumunu geliştirmeye yönelik çeşitli müdahaleler yapılmaktadır. Bu çalışmanın amacı Tip 1 diyabeti olan çocuk ve ebeveynlerinin hastalığa uyumuna hemşirelik müdahalelerinin etkisini literatürün sistematik incelemesi ve meta-analiz ile ortaya koymaktır. Çalışma araştırmacılar tarafından PICO’ya göre belirlenen anahtar kelimeler ile 01.01.2003-30.04.2023 tarihleri arasında Türkçe ve İngilizce dilinde yayınlanmış araştırmaları kapsayacak şekilde CINAHL Ultimate, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ultimate, ProQuest Dissertations & Theses Global, Scopus, TR Dizin, Web of Science, Wiley ve YÖK Ulusal Tez Merkezi olmak üzere toplam dokuz veri tabanında tarama yapılarak gerçekleştirildi. Çalışmanın protokolü PROSPERO veri tabanına kaydedildi. Meta analiz protokolünün oluşturulmasında Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) rehberi kullanıldı. Tarama sonucunda elde edilen 97 312 çalışma dahil etme kriterlerini karşılama durumu göz önüne alınarak iki bağımsız değerlendirici tarafından ayrıldı. Meta analize 18 randomize kontrollü çalışma dahil edildi. Dahil edilen çalışmaların metodolojik kalitesi Cochrane Yanlılık (Bias) Risk Değerlendirme Aracı ile değerlendirildi. Veriler Comprehensive Meta Analysis 3 programı ve Stata 16 ile analiz edildi. Verilerin analizinde, etki büyüklüğü istatistiği olarak Hedge’s g ve Cohen d etki büyüklüğü değeri kullanıldı. Etki büyüklüklerinin heterojenliğini test etmek için I 2 testi kullanıldı. Yayın yanlılığını test etmek için huni grafiği, Begg ve Mazumdar sıra korelasyonu, Egger testi kullanıldı. Meta analize dahil edilen çalışmalar incelendiğinde; hemşirelerin bireysel ve grup eğitimi, tele-sağlık uygulamaları, davranışsal müdahaleler ve başetme becerisi geliştirme gibi müdahalelerde bulundukları görüldü. Yapılan meta analiz sonucunda hemşirelik müdahalelerinin 6.ayda HbA1c değeri üzerinde etkisi deney ve kontrol grubu arasında anlamlı bulunmamakla birlikte deney grubunun müdahale öncesi ve sonrası HbA1c değerleri üzerindeki (z=2.43; p=0.02) etkisi anlamlıydı. Hemşirelik müdahalelerinin 6.ayda, çocukların hastalığa uyumunda hem deney ve kontrol grubu arasında (z=1.99; p=0.05) hem de deney grubunun müdahale öncesi ve sonrasındaki (z=-2.00; p=0.05) sonuçları üzerinde anlamlı etkisi olduğu bulundu. Müdahalelerin ebeveynlerin 6.ay hastalığa uyum sonuçları üzerinde deney ve kontrol grubu arasındaki (z=2.98; p=0.00) etkisi anlamlı bulundu. Müdahalelerin 12. ay HbA1c, çocuk ve ebeveynlerin hastalığa uyum sonuçları üzerinde anlamlı bir etkisi bulunamadı. Bu meta analiz çalışması sonucunda hemşirelik müdahalelerinin 6. ayda HbA1c değerleri, Tip 1 diyabeti olan çocuk ve ebeveynlerinin hastalığa uyumu üzerinde olumlu etkiler gösterdiği ancak 12.ay izlemlerde bu etkinin devam etmediği belirlendi. Bu sonuçlar doğrultusunda uyumun geliştirilmesi ve uzun süreli etkisinin devam etmesi için hemşirelik müdahalelerinin izlem ve hatırlatma müdahaleleri ile desteklenerek yüz yüze veya uzaktan yöntemler ile düzenli aralıklarla tekrarlanması önerilebilir.
There are many factors that affect the adherence of children with type 1 diabetes and their parents to the disease. These factors include the child's age, gender, developmental status, disease duration, treatment type, socioeconomic status, race/ethnicity, family structure, coping skills, social competence, self-management levels, stress, depression, behavior and eating disorders. Considering these factors in the nursing care of children with type 1 diabetes and their parents, various interventions are carried out to improve the adherence of the child and parents to the disease. The aim of this study is to reveal the effect of nursing interventions on the adherence of children with Type 1 diabetes and their parents to the disease through a systematic review of the literature and meta-analysis. The study will include research published in Turkish and English between 01.01.2003-30.04.2023 with keywords determined by the researchers according to PICO, including CINAHL Ultimate, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ultimate, ProQuest Dissertations & Theses Global, It was carried out by scanning a total of nine databases, including Scopus, TR Index, Web of Science, Wiley and YÖK National Thesis Center. The protocol of the study was recorded in the PROSPERO database. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guide was used to create the meta-analysis protocol. 97 312 studies obtained as a result of the screening were separated by two independent evaluators, considering whether they met the inclusion criteria. 18 randomized controlled trials were included in the metaanalysis. The methodological quality of the included studies was assessed with the Cochrane Bias Risk Assessment Tool. Data were analyzed with Comprehensive Meta Analysis 3 program and Stata 16. In the analysis of the data, Hedge's g and Cohen's d effect size values were used as effect size statistics. The I2 test was used to test the heterogeneity of effect sizes. Funnel plot, Begg and Mazumdar rank correlation, and Egger test were used to test publication bias. When the studies included in the meta-analysis are examined; It was observed that nurses provided interventions such as individual and group training, tele-health applications, behavioral interventions and coping skill development. As a result of the meta-analysis, the effect of nursing interventions on the HbA1c value at 6 months was not found to be significant between the experimental and control groups, but the effect of the experimental group on the HbA1c values before and after the intervention (z = 2.43; p = 0.02) was significant.It was found that nursing interventions had a significant effect on children's adherence to the disease at the 6th month, both between the experimental and control groups (z = 1.99; p = 0.05) and on the results of the experimental group before and after the intervention (z = -2.00; p = 0.05). The effect of the interventions on the parents' 6-month disease adherence results between the experimental and control groups (z = 2.98; p = 0.00) was found to be significant. No significant effect of the interventions was found on 12-month HbA1c and child and parent adherence outcomes. As a result of this meta-analysis study, it was found that nursing interventions had positive effects on HbA1c values and adherence to the disease of children with Type 1 diabetes and their parents at the 6th month, but the significance disappeared at the 12th month follow-up. In line with these results, it may be recommended that nursing interventions be repeated at regular intervals by face-to-face or remote methods, supported by monitoring and reminder interventions, in order to improve adherence and maintain its long-term effect.
There are many factors that affect the adherence of children with type 1 diabetes and their parents to the disease. These factors include the child's age, gender, developmental status, disease duration, treatment type, socioeconomic status, race/ethnicity, family structure, coping skills, social competence, self-management levels, stress, depression, behavior and eating disorders. Considering these factors in the nursing care of children with type 1 diabetes and their parents, various interventions are carried out to improve the adherence of the child and parents to the disease. The aim of this study is to reveal the effect of nursing interventions on the adherence of children with Type 1 diabetes and their parents to the disease through a systematic review of the literature and meta-analysis. The study will include research published in Turkish and English between 01.01.2003-30.04.2023 with keywords determined by the researchers according to PICO, including CINAHL Ultimate, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ultimate, ProQuest Dissertations & Theses Global, It was carried out by scanning a total of nine databases, including Scopus, TR Index, Web of Science, Wiley and YÖK National Thesis Center. The protocol of the study was recorded in the PROSPERO database. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guide was used to create the meta-analysis protocol. 97 312 studies obtained as a result of the screening were separated by two independent evaluators, considering whether they met the inclusion criteria. 18 randomized controlled trials were included in the metaanalysis. The methodological quality of the included studies was assessed with the Cochrane Bias Risk Assessment Tool. Data were analyzed with Comprehensive Meta Analysis 3 program and Stata 16. In the analysis of the data, Hedge's g and Cohen's d effect size values were used as effect size statistics. The I2 test was used to test the heterogeneity of effect sizes. Funnel plot, Begg and Mazumdar rank correlation, and Egger test were used to test publication bias. When the studies included in the meta-analysis are examined; It was observed that nurses provided interventions such as individual and group training, tele-health applications, behavioral interventions and coping skill development. As a result of the meta-analysis, the effect of nursing interventions on the HbA1c value at 6 months was not found to be significant between the experimental and control groups, but the effect of the experimental group on the HbA1c values before and after the intervention (z = 2.43; p = 0.02) was significant.It was found that nursing interventions had a significant effect on children's adherence to the disease at the 6th month, both between the experimental and control groups (z = 1.99; p = 0.05) and on the results of the experimental group before and after the intervention (z = -2.00; p = 0.05). The effect of the interventions on the parents' 6-month disease adherence results between the experimental and control groups (z = 2.98; p = 0.00) was found to be significant. No significant effect of the interventions was found on 12-month HbA1c and child and parent adherence outcomes. As a result of this meta-analysis study, it was found that nursing interventions had positive effects on HbA1c values and adherence to the disease of children with Type 1 diabetes and their parents at the 6th month, but the significance disappeared at the 12th month follow-up. In line with these results, it may be recommended that nursing interventions be repeated at regular intervals by face-to-face or remote methods, supported by monitoring and reminder interventions, in order to improve adherence and maintain its long-term effect.
Açıklama
Doktora Tezi
Anahtar Kelimeler
Aile, Çocuk, Hemşire, Tip 1 Diyabet, Uyum, Adherence, Child, Family, Nurse, Type 1 Diabetes
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Kaleci, E. (2024). Tip 1 diyabeti olan çocuk ve ebeveynlerine uygulanan hemşirelik müdahalelerinin hastalığa uyumuna etkisi: Sistematik derleme ve meta analiz. (Yayımlanmamış doktora tezi). Necmettin Erbakan Üniversitesi, Sağlık Bilimleri Enstitüsü Hemşirelik Anabilim Dalı, Konya.
