The Effect of Group Discussion-based Education on Self-management of Adults with Type 2 Diabetes Mellitus Compared with Usual Care: A Randomized Control Trial

Effect of educational intervention based on PRECEDE model on lifestyle modification, self-management behaviors, and hypertension in diabetic patients

BACKGROUND

Inappropriate lifestyle and poor self-management in diabetic patients lead to many complications including hypertension and increased disease burden. Because of insufficient studies on Effect of educational interventions on lifestyle, self-management and hypertension in diabetic patients, the present study aimed to evaluate the Effect of educational intervention based on PRECEDE model on lifestyle, self-management, and hypertension of diabetic patients.

METHODS

This clinical trial was conducted on 300 diabetic patients with hypertension. The patients were selected using simple random sampling and divided into 2 groups of intervention (150 people) and control (150 people). The intervention group was trained through ten 50-55 min sessions on lifestyle skills, self-management, and hypertension control based on the PRECEDE model. Before and after the intervention, lifestyle skills, self-management, and PRECED model constructs were evaluated using a standard questionnaire. Data were analyzed by SPSS 20 software using t-test, Kolmogorov-Smirnov, and Chi-Square tests (P < 0.05).

RESULTS

In the intervention group, the mean score of different dimensions of lifestyle and self-management significantly increased from 110.45 ± 18.78 to 172.58 ± 186.66 and 64.33 ± 15.24 to 144.32 ± 15.82, respectively (P = 0.001). Mean systolic and diastolic blood pressure also decreased from 148.5 ± 5.39 to 123.54 ± 5.32 and 95.41 ± 3.12 to 72.24 ± 3.06 (P < 0.001). Moreover, the mean score of all the PRECEDE model constructs significantly increased after the intervention. In the control group, the mean score of the PRECEDE model constructs, the dimensions of lifestyle, self-management, and systolic and diastolic blood pressure did not change significantly before and after the intervention (P > 0.05).

CONCLUSION

‌ Based on the study's results, the PRECEDE model was found to be a non-invasive, non-pharmacological, cost-effective method without any complication and as a complementary action along with other methods in the treatment of diabetic patients.

Occupational Therapy Practice Guidelines for Adults With Chronic Conditions

IMPORTANCE

Demand is increasing for occupational therapy practitioners to help the growing population of adults with chronic conditions manage their conditions.

OBJECTIVE

This Practice Guideline, which is informed by systematic reviews of the literature on the use of self-management interventions, is meant to guide occupational therapy practitioners' clinical decision making when working with community-dwelling adults with chronic conditions. The chronic conditions included heart disease, chronic lung conditions, diabetes, and kidney disease. The self-management interventions addressed ADLs and sleep and rest; IADLs; education, work, volunteering, leisure, and social participation; and the caregiver role.

METHOD

We reviewed, discussed, and integrated the clinical recommendations developed from four systematic reviews, supporting literature, and expert opinion to provide recommendations for practice.

RESULTS

A total of 102 articles were included in the systematic reviews, which served as the primary basis for the practice recommendations.

CONCLUSIONS AND RECOMMENDATIONS

Strong to moderate evidence supports clinical recommendations for the use of self-management interventions when working with clients with chronic conditions. We recommend the use of a multimodal approach that includes three components-education, goal setting, and problem solving-over an extended period to assist clients in establishing self-management habits and routines. On the basis of emerging evidence and expert opinion, we recommend that occupational therapy practitioners consider using a prevention approach, helping clients establish habits and routines, and emphasizing shared goal setting when addressing clients' self-management of chronic conditions. What This Article Adds: This Practice Guideline provides a summary of strong to moderate evidence that supports clinical recommendations for the use of self-management interventions with clients with chronic conditions. When guided by this evidence, occupational therapy practitioners are better able to help clients meet their occupational challenges.

Towards a better understanding of self-management interventions in type 2 diabetes: A concept analysis

OBJECTIVES

Diabetes self-management educational (DSME) interventions can vary considerably, and it is unclear what is the operational conceptualization of the ideal delivery to individuals with type 2 diabetes (T2D).

DESIGN

From a search conducted concurrently we extracted and evaluated the 50 most recently published DSME intervention studies. Based on an analysis of these studies, we undertook a concept analysis using the Walker and Avant framework.

RESULTS

Five attributes describing the concept were recognized and organized into two groups. Group (a): skills related attributes that included (1) decision making, (2) problem solving and (3) taking action. Group (b): information related attributes that included (4) patient-provider interaction and (5) resource utilization.

CONCLUSIONS

The outcomes of this study make the operational conceptualization of the ideal DSME intervention measurable through its attributes and hence clarifies its delivery. This will improve the implementation of the key attributes in diabetes self-management intervention programs for T2D.

The effect of group-based education on gastrointestinal symptoms and quality of life in patients with celiac disease: randomized controlled clinical trial

Background

In this trial, we investigated the effect of a group-based education program on gastrointestinal (GI) symptoms and quality of life (QOL) in patients with celiac disease (CD).

Method

In the present study, 130 patients with CD who were on a GFD for at least 3 months, randomly assigned to receive group-based education (n = 66) or routine education in the celiac clinic (n = 64) for 3 months. We assessed gastrointestinal symptoms and quality of life using the gastrointestinal symptom rating scale (GSRS) questionnaire and SF-36 questionnaire at baseline and 3 months after interventions.

Results

The mean age of the participants was 37.57 ± 9.59 years. There were no significant differences between the two groups regarding the baseline values. Results showed that the mean score of total GSRS score in the intervention group was significantly lower compared with the control group 3 months post-intervention (p = 0.04). Also, there was a significant difference in the mean score of SF-36 between the two groups 3 months post-intervention (p = 0.02).

Conclusion

Results showed that group-based education was an effective intervention in patients with celiac disease to improve gastrointestinal symptoms and quality of life.

Trial registration IRCT code: IRCT20080904001197N21; registration date: 5/23/2019.

Towards a better understanding of self-management interventions in type 2 diabetes: A meta-regression analysis

AIMS

Attributes that operationally conceptualize diabetes self-management education (DSME) interventions have never been studied previously to assess their impact on relevant outcomes of interest in people with type 2 diabetes (T2D). The aim of this study was to determine the impact of existing interventions classified by their delivery of skills or information related attributes on immediate (knowledge), intermediate (physical activity), post-intermediate (HbA1c), and long-term (quality of life) outcomes in people with T2D.

METHODS

PubMed, Embase, PsycINFO, and Cochrane Library/Cochrane CENTRAL as well as the grey literature were searched to identify interventional studies that examined the impact of DSME interventions on the four different outcomes. Eligible studies were selected and appraised independently by two reviewers. A meta-regression analysis was performed to determine the impact of delivery of the skills- and information-related attributes on the chosen outcomes.

RESULTS

142 studies (n = 25,511 participants) provided data, of which 39 studies (n = 5278) reported on knowledge, 39 studies (n = 8323) on physical activity, 99 studies (n = 17,178) on HbA1c and 24 studies (n = 5147) on quality of life outcomes. Meta-regression analyses demonstrated that skills-related attributes had an estimated effect suggesting improvement in knowledge (SMD [standardized mean difference] increase of 0.80; P = 0.025) and that information-related attributes had an estimated effect suggesting improvement in quality of life (SMD increase of 0.96; P = 0.405). Skill- and information-related attributes did not have an estimated effect suggesting improvement in physical activity or in HbA1c.

CONCLUSIONS

The study findings demonstrate that the skills and information related attributes contribute to different outcomes for people with T2D. This study provides, for the first time, preliminary evidence for differential association of the individual DSME attributes with different levels of outcome.

Preferences for pharmacist services to enhance medication management among people with diabetes in Indonesia: A discrete choice experiment

OBJECTIVES

To elicit patients' preferences for pharmacist services that can enhance medication management among people with diabetes in Indonesia.

METHODS

A discrete choice experiment (DCE) among 833 respondents with diabetes in 57 community health centers (CHCs) and three hospitals in Surabaya, Indonesia. Consultation was the baseline service. Four attributes of consultation and two attributes of additional services were used in the DCE profiles based on literature and expert opinion. The DCE choice sets generated were partially balanced and partially without overlap. Random effect logistic regression was used in the analysis.

RESULTS

Respondents preferred a shorter duration of consultation and flexible access to the pharmacist offering the consultation. A private consultation room and lower copayment (fee) for services were also preferred. Respondents with experience in getting medication information from pharmacists, preferred to make an appointment for the consultation. Total monthly income and experience with pharmacist services influenced preferences for copayments.

CONCLUSION

Differences in patients' preferences identified in the study provide information on pharmacist services that meet patients' expectations and contribute to improve medication management among people with diabetes.

PRACTICE IMPLICATION

This study provides insight into evaluating and designing pharmacist services in accordance with the preferences of people with diabetes in Indonesia.

Self-management Education Program: The Case of Glycemic Control of Type 2 Diabetes

Objectives

Self-management education (SME) is recognized globally as a tool that enables patients to achieve optimal glucose control. While factors influencing the effectiveness of self-management interventions have been studied extensively, the impact of program length on clinical endpoints of patients diagnosed with diabetes is underdeveloped. This paper synthesized information from the existing literature to understand the effect of program length on glycated hemoglobin (HbA_1C) in adults with type 2 diabetes mellitus.

Methods

We searched Web of Science, PubMed, Scopus, MEDLINE, EMBASE, PsychINFO, and the Cochrane Central Register of Controlled Trials to identify relevant English language publications on diabetes self-management education published between January 2000 and April 2019.

Results

The review included 25 randomized controlled trials, with 64.0% reporting significant changes in HbA_1C. The studies classified as long-term (lasting one year and above) were associated with the greatest number of interventions achieving statistically significant (87.5% significant vs. 12.5% non-significant) differences in changes in HbA_1C between the intervention and the control subjects, recording an overall between-group HbA_1C mean difference of 0.6±0.3% (range = 0.2–1.2).

Conclusions

Our findings suggest that program length may change the effectiveness of educational interventions. Achieving sustained improvements in patients’ HbA_1C levels will require long-term, ongoing SME, and support.

Theater Performing Arts (TPA): Community Empowerment to Improve Blood Glucose Control Behavior in Yogyakarta

BACKGROUND

Poor self-management behavior is one of the causes of the high number of patients with type 2 diabetes mellitus (T2DM) in Indonesia.

OBJECTIVES

The aim of this study was to measure the effectiveness of TPA-based community empowerment as a form of education in improving the blood glucose control practices of patients with T2DM in Yogyakarta.

METHODS

This study used quantitative methods with a quasi-experimental non-equivalent pre-posttest control group design. The subjects of this study were "Prolanis member" patients with T2DM in the four primary health care centers in Sleman, Yogyakarta, Indonesia. Purposive sampling was done at four primary care in Sleman, Yogyakarta, Indonesia. From 138 T2DM patients, only 102 were eligible to become respondents. The questionnaires were adapted to the recommendations of endocrine experts' associations to measure the level of T2DM patients' knowledge, attitude and practices. Intervention was done for three months, from October to December 2019. Measurements were made before and after the TPA.

RESULTS

Attitude and behavior scores showed a significant increase (P < 0.05) after TPA intervention. Meanwhile, the average score of knowledge after the TPA intervention showed no significant increase (P > 0.05). Good self-management behavior in patients with T2DM was observed in Sleman Regency. Education through TPA based community empowerment should be considered as an appropriate intervention to improve DM management practice. Patients can receive material that is delivered easily because of the relaxed and pleasant environment during TPA.

CONCLUSIONS

TPA-based community empowerment can create a relaxed and pleasant environment to improve blood glucose control practices in patients with T2DM.

Family Functional-based Coaching Program on Healthy Behavior for Glycemic Control among Indonesian Communities: A Quasi-experimental Study

OBJECTIVES

This study sought to examine the impact of a family functional-based coaching program on improving the perceived family functioning practice and clinical outcomes among patients with glycemic uncontrolled type 2 diabetes mellitus (T2DM) in the Indonesian community.

METHODS

We applied a quasi-experimental study, pretest, and posttest design with a non-equivalent control group. Sixty pairs of T2DM patient-caretaker dyads were recruited and assigned to either an intervention or control group. The Family Function Questionnaire (FFQ) was used to assess the perception of family functioning practices by T2DM patients of their caretakers to support their diabetes self-management. The clinical outcomes were measured using clinical outcome devices and laboratory tests. These measurements were conducted and compared at a baseline and 12 weeks after completing the program.

RESULTS

Patients who received the family functional-based coaching program saw significant improvement in perception of family function practice, compared to the control group who received usual care. The findings also showed a positive decline glycated hemoglobin and total cholesterol levels after receiving the 12-week program. However, no significant difference was found in body mass index.

CONCLUSIONS

It can be concluded that a family functional-based coaching program is feasible to implement among uncontrolled T2DM in a large scale study.

A Diabetes Self-Management Education/Support (DSME/S) Program in Reference to the Biological, Psychological and Social Aspects of a Patient with Type 2 Diabetes Mellitus: A Systematic Review

Introduction: Various efforts have been made to improve the self-care management of patients with type 2 diabetes mellitus (T2DM). One of them is by using a Diabetes Self-Management Education and Support (DSME/S) program. DSME/S produces positive effects in relation to patient behavior and health status. This is a systematic review of randomized controlled trials published where the aim was to evaluate the impact of the DSME/S program in term of biological. psychological and social aspects.Methods: The articles were searched for using the PRISMA approach from within Scopus, Sage Journal, ProQuest, Google Scholar and PubMed to identify the relevant English publications on DSME over the last 5 years (2013-2018). In total, 15 studies met the inclusion criteria.Results: The articles included at least one result that covered the biological, psychological, and social aspects that are more general and relevant for T2DM patients who received the DSME program. DSME had a positive impact on T2DM, namely the reduction of HbA1c, blood glucose, LDL, cholesterol, blood pressure, weight, waist circumference, decreased distress, anxiety and increased self-efficacy and self-empowerment.Conclusion: It can increase the social and family support, improve self-management motivation, increase knowledge and improve the behavior of T2DM patients. The findings of our review showed that DSME has a positive impact on the biological, psychological and social aspects of type 2 diabetes mellitus.