关键词: 糖尿病, 2型；健康教育；初级卫生保健；社区卫生服务；名义小组技术；循证医学

Abstract: Background　Most of the health education recommendations from Chinese guidelines ignore the characteristics and patient needs of primary health care，especially type 2 diabetes mellitus（T2DM） health education delivered by primary outpatient clinics is random，untargeted and so on. Objective　To develop a primary care needs-based health education services framework for T2DM patients using the nominal group technique（NGT），and to expand its essentials. Methods　From September to October 2020，NGT was used to conduct meetings in three groups of Chinese health professionals（n=23） in various medical specialties selected using purposive sampling. The results of meetings were recorded and transcribed，and divided into qualitative and quantitative data for analyses. After merging the similar ones of keywords of qualitative data of each group discussion，the list of network coded（NC） keywords was obtained，and essential contents of these key words were expanded，and analyzed using thematic analysis. Intra-group and overall ranking of keywords of the quantitative data in the list were determined. Finally，the hierarchical frameworkwas determined according to the quartile assigned by the overall ranking. Results　Twenty-eight keywords regarding T2DM health education were obtained through group discussions and decision-making，and classified into five themes by thematic analysis and content development：diabetes-related knowledge，self-management，community management，multiple comorbidities management，treatment and medication. After two rounds of ranking and stratification，a four-level hierarchical framework of health education for T2DM patients was finally determined. The A hierarchy includes four top-ranked keywords，accounting for 45.69% of the total mean rank scores. Conclusion　We applied NGT to develop a primary care needs-based health education services guiding framework for Chinese T2DM patients，and used an evidence-based approach to determine its four-level hierarchy and highlighted contents. As patients' primary care needs are complex，which need to be satisfied based on group decision-making，our framework may contribute to achieve a higher consistency between guidelines and clinical practice.

Key words: Diabetes mellitus, type 2；Health education；Primary health care；Community health services；Nominal group technique；Evidence-based medicine