Efecto de un modelo de apoyo telefónico en el auto-manejo y control metabólico de la Diabetes tipo 2, en un Centro de Atención Primaria, Santiago, Chile / Effect of a tele-care model on self-management and metabolic control among patients with type 2 diabetes in primary care centers in Santiago, Chile

Background: Telephone based self-management support may improve the metabolic control of patients with type 2 (DM2) diabetes if it is coordinated with primary care centers, if telephone protocols and clinical guidelines are used and if it is provided by nurses trained in motivational interviewing. Aim: To assess the efficacy ofi a tele-care self-management support model (ATAS) on metabolic control of patients with DM2 attending primary care centers in a low income area in Santiago, Chile. Material and Methods: Two primary care centers were randomly assigned to continue with usual care (control group, CG) or to receive additionally 6 telecare self-management support interventions (IG) during a 15 month period. Glycosylated hemoglobin (HbA1c) was used to measure metabolic control of DM2; the “Summary of Diabetes Self-care Activities Measure” and the “Spanish Diabetes Self-efficacy” scale were used to measure self-management and self efficacy, respectively. Changes in the use of health services were also evaluated. Results: The IG maintained its HbA1c level (baseline and final levels of 8.3 ± 2.3 percent and 8.5 ± 2.2 percent respectively) whereas it deteriorated in the CG (baseline and final levels of 7.4 ± 2.3 and 8.8 ± 2.3 percent respectively, p < 0.001). The perception of self-efficacy in the IG improved while remaining unchanged in the CG (p < 0.001). Adherence to medication, physical activity and foot care did not change in either group. In the IG, compliance to clinic visits increased while emergency care visits decreased. Conclusions: The ATAS intervention, in low income primary care centers, significantly increased the probability of stabilizing the metabolic control of patients with DM2 and improved their use of health services.

Validación de una versión en español de la Escala de Conflicto Decisional / Validation of a Spanish version of the Decisional Conflict Scale

Background: In Chile, in approximately 50 percent of nursing students, nursing was not their first choice as career. Usually, during the first year, these students must decide whether they would like to continue in the same career. A valid tool is needed to identify decisional conflicts and their contributing factors among these students and to develop an appropriate strategy to support them duríng their decision-making process. Aim: To translate into Spanish and validate the Generic Decisional Conflict Scale (DCS). Material and methods: The DCS was translated from English to Spanish and was used with 331 first-year nursing students at the Pontificia Universidad Católica de Chile. The scale was assessed for validity and reliability using statistical tests, including factor analysis and Cronbach alpha test. Results: The Spanish version of the DCS had acceptable validity and reliability. Factorial analysis identified four factors and only the item: "advice" loaded the other factors. Cronbach alpha was 0.80. Conclusions: DCS is a valid and useful instrument to identify decisional conflicts and contributing factors to continue studies among nursing students.