The Effect of Modified Diabetes Self-management Education and Support on Self-care and Quality of Life among Patients with Diabetic Foot Ulcers in Rural Area of Indonesia

Abstract

BACKGROUND: Diabetes self-management education and support (DSMES) programs are patient-centered, holistic solution that enables it one of the best approaches for improving medication adherence enhanced coping, empowerment and self-efficacy, quality of life (QoL), and lower rates of depression, in people with type 2 diabetes mellitus (T2DM). In isolation, DSME strategies have not shown significant improvements to self-care and/or reduction of diabetic foot ulcer (DFU). AIM: This study sought to determine the effect of modified DSMES on self-care, DFU severity, and QoL in rural Indonesian patients with DFUs. METHODS: A quasi-experimental design with pre-test and post-test control group design, in Singkawang, West Kalimantan, Indonesia, with a total sample of 60 patients consisting of 30 patients in the intervention group and 30 patients in the control group. The DSMES has been adapted to cover 2 h of content for a period of 8 weeks and the eight-core components of DSMES. The curriculum was culturally adapted revised to incorporate culturally appropriate nature similarities, such as a prominent change to represent changes in glucose counts; to incorporate photos; to incorporate culturally relevant eating habits, such as fish and fruit; to communicate in detail the significance of medication adherence, with an emphasis on metformin’s organic, plant-based characteristics; and to emphasize engagement. Intention-to-treat analyses were conducted to determine the effect of modified DSMES on self-care, DFU severity, and QoL. RESULTS: The DSMES program improved outcomes in three of the three outcome indicators when compared to the control group at T1: In this study, (1) the DFU degree increased by 3.3% points (95% confidence interval [CI]: 0.018–0.194), (2) the diabetes foot self-care behavior score increased by a modest 8.8% points (95% CI: 0.021–0.203), and (3) the QoL increased by 32.7% points (95% CI: 00.075–0.689). The degree of DFU (difference-in-difference [DID] coef. 0.350, 95% CI 0.084–0.572), diabetes foot self-care behavior (DID coef. 0.085, 95% CI 0.065–0.405), and QoL (DID coef. 0.343, 95% CI 0.078–0.436) are all still significantly improved compared to the control at T2. CONCLUSION: The primary outcome analyses indicate that the adapted DSMES was more effective than standard care at improving self-care and QoL and decreasing DFU degree in this sample of Indonesians with DFU, both immediately after and 3 months after the intervention. As nurse educators, it is our responsibility to ensure that we evaluate all of the support options accessible to the patients in our care.

The Effectiveness of Social Support Management of Diabetes on Glucose Control of Type 2 Diabetes Mellitus Patients: Quasi-Experiments

“…Dietary management, treatment adherence, physical activity, blood glucose control, and foot care are critical components of diabetes self-care. However, this action has gone unnoticed, even though it is a significant element of awareness [9], [29] The SoSMeD was conducted for 3 months, with significant results on diabetes sugar control by comprehensive health education. Education to promote a healthy life needs to be undertaken to prevent and control DM [30].…”

“…However, it can be prevented and controlled by controlling risk factors [8]. The results of previous studies showed that primary outcome analyses indicate that the adapted Diabetes Self-Management Education and Support (DSMES) was more effective than standard care at improving self-care and quality of life and decreasing diabetic foot ulcers [9]. The management of DM risk factors can involve families because they have a role in caring for the patient, such as controlling the healthy diet.…”

Impact of diabetes self-management education in middleaged patients with type 2 diabetes mellitus: A systematic review

“…Furthermore, the results of a literature review from one of the studies on the effectiveness of diabetes self-management education showed that the self-care behaviour score increased by 8.8 %. This condition illustrates that diabetes self-management education positively affects self-care behaviour (35).…”

“…This study involved 60 type 2 DM patients divided into groups (30 intervention group people and 30 control group people). The design used was A Quasi-experimental design with a pre-test and post-test control group design (35).…”

Behaviours and educational effect on the improvement of self-care among the diabetics

“…12 Results of another experimental study concluded that tailored diabetes self-management instruction and support was superior to standard care in terms of enhancing self-care and quality of life as well as reducing the incidence of diabetic foot ulcers both immediately and three months after the intervention. 13 Results of a randomized trial showed that following self-management education based on self-care deficit nursing theory there was no statistically significant difference in HbA1c or self-care activities between the two groups, but a difference in self-care agency was seen between the two groups (p<0.05). When the pre-test and post-test results were compared, the intervention group's scores for selfcare agency and self-care activity were significantly higher after the interventions, and HbA1c value was significantly lower (p<0.05).…”