The effects of a comprehensive self-management program promoting self-efficacy on compliance and glycemic control for type 2 diabetic patients in community health centers

Abstract

Since type 2 diabetes should be self-managed during life, it is critical for nurse to help participants motivate, comply by themselves, and sustain it considering their individual situation. A variety of programs were attempted to do this, but they included only a part of the domains of self-management and a part of the self-efficacy sources, when they were organized. In addition, the already developed programs haven''t been adopted easily by hands-on staff, because it took a little longer time to operate the programs or they have simplicity in approaching methods, and operating them are time-consuming for the number of staffs. So, in this study, a whole range of 8 self-management domains; diet management, exercise management, medication management, self-testing of blood glucose, complication or foot management, stress management, time management, and general health management, were set as a goal to practice them, and 4 sources of self-efficacy; enactive mastery experience, vicarious experience, verbal persuasion, and physiological and affective states, were adopted as strategies to promote self-efficacy. Besides, group or small group education and individual education or counseling and telephone counseling was applied as methods. A comprehensive self-management program promoting self-efficacy was developed by synthesizing all above.Therefore, The purpose of this study is to apply the comprehensive self-management program promoting self-efficacy for type 2 diabetic patients in community health centers and to evaluate the effects of the program on self-management compliance and glycemic control. Two community health centers, which volunteered to participate the study, were settled by lot for an intervention group and a control group, respectively. Then, the 47 total participants took part in the intervention group(n=25) and the control group(n=22) according to their affiliated community health centers. As measurement tools, first, physical check-up were used for body mass index and waist-to-hip circumference ratio out of diseases-related characteristics and second, physiological measurement were adopted for HbA1c, and postprandial 2hours blood glucose, Third, an well-organized questionnaire was used for self-management compliance, self-efficacy, knowledge, and participants-related characteristics. The study period was from March 15, 2010 to November 7, 2010. The comprehensive self-management program promoting self-efficacy was applied to the intervention group for 8 weeks after pre-test, and to the control group only on a request basis for 8 weeks after post-test. Homogeneity between the two groups was analyzed with Chi-square test, Fisher''s exact test, Wilcoxon rank sum test, and independent t-test. The hypotheses were tested with independent t-test. As a result of the hypothesis testing, ''The intervention group participating in a comprehensive self-management program promoting self-efficacy will show higher level of self-management compliance, self-efficacy, and knowledge than the control group'' and ''The level of HbA1c in the intervention group will be lower compared to the control group'' were supported. A hypothesis, ''The level of post prandial 2hours blood glucose in the intervention group will be lower compared to the control group'' was not supported.In conclusion, this comprehensive self-management program promoting self-efficacy for type 2 diabetic patients was verified as a program to improve self-management compliance, self-efficacy, diabetic knowledge, and to decrease HbA1c and postprandial 2hours blood glucose. From now on, self-management compliance wasn''t high, reinforcement of the program like mapping out a specific plan to let participants comply self-management by themselves should be needed.