Extended Abstract
Introduction
Diabetes mellitus is a chronic disease necessitating long-term lifestyle modifications and medical care. Poor diabetes control culminates in sustained hyperglycemia, which exhibits a strong correlation with the development of chronic complications in these patients. Consequently, significant attention is currently directed toward investment in diabetes control. Nevertheless, it is crucial to acknowledge that routine educational programs for individuals with diabetes do not necessarily result in successful diabetes management or improved metabolic control. Hence, empowerment has been considered an educational approach for patients. The principal distinction between empowerment-based educational programs and traditional educational programs lies in the fact that the former functions more as a facilitator for patients and healthcare providers rather than being merely a technique or strategy.
One effective method for empowering patients with chronic conditions is the implementation of a family-centered empowerment model. The family, as the most fundamental unit of society, is responsible for providing correct and appropriate healthcare to the patient and their surrounding individuals.
This study was conducted to compare the effects of patient-centered and family-centered empowerment model-based training on perceived self-efficacy and fasting blood glucose in patients with type 2 diabetes.
Methods
This quasi-experimental study was conducted on 120 patients with type 2 diabetes. The patients were non-randomly assigned to three groups of 40: A control group, a family-centered empowerment group, and a patient-centered empowerment group.
The inclusion criteria included a definitive diagnosis of type 2 diabetes, possession of a health center record, the willingness of the patient and one family member to participate in the study (for the family-centered empowerment group), being at least 18 years of age (for the family-centered empowerment group), absence of specific mental illnesses, having an active rural household record (for the patient) in the health information software (NAB) system, an age range of 30 to 70 years (considering the minimum age of 30 in the national screening program), and a body mass index (BMI) of less than 40.
For data collection, the standardized Perceived Self-Efficacy Questionnaire for middle-aged diabetic patients was utilized. The questions of the questionnaire comprised 17 items across 5 domains: Nutrition, physical activity, self-monitoring of blood glucose, foot care, and smoking. These questions were scored using a 5-point Likert scale (strongly agree=5, agree=4, no idea=3, disagree=2, and strongly disagree=1). The total score ranged from 17 to 85, with higher scores indicating greater self-efficacy.
Other instruments employed in the present study encompassed a patient sheet for recording information related to clinical tests of patients with type 2 diabetes and demographic characteristic questions covering age, gender, education, occupation, marital status, history of diabetes, and family history of the disease.
In this study, a pre-test and post-test design was employed so that patients in the control group did not receive training from the researcher and only received the routine training provided by the health center. The empowerment model-based training for the patient-centered and family-centered groups was designed and implemented in four domains: Medication regimen, nutrition, physical activity and exercise, and foot care. This training was based on the model stages (threat perception, problem-solving, educational participation, and evaluation) and Sadeghi et al.’s study. The first stage (threat perception) initially involved group training 45-60 minute sessions held on two separate days in 6-8 people groups in order to sensitize and raise patients’ level of awareness. Following a one-week interval, the second phase (problem-solving) was conducted through group discussion sessions, with 6-8 people groups held in two 45-60 minute sessions. During these sessions, patients, under the supervision of a researcher specializing in health education and health promotion, discussed their problems and strategies for resolving them. Subsequently, the researcher provided a practical demonstration of these strategies. These two phases were implemented for patients in both the patient-centered and family-centered groups by the same trainer. The third phase (educational participation) was exclusively implemented for the family-centered group. Patients were asked to instruct an active family member on the learned information during a session (with an approximate duration of 30-45 minutes). If they required assistance or guidance in this instruction, the researcher provided it. Ultimately, in the fourth stage (evaluation), both process evaluation and final evaluation were implemented. Process evaluation was carried out by the researcher throughout the intervention in all sessions.
After obtaining the necessary permits and collecting samples from eligible patients, and upon completion of the questionnaires, information regarding fasting blood glucose (fasting for at least 8 hours) was gathered for all patients at the health center (using a glucometer) by the local health worker(s). The final evaluation was also conducted in person after 3 months following the intervention, using the same method. After 3 months, fasting blood glucose tests were repeated for all patients, and the Perceived Self-Efficacy Questionnaire was completed again by the patients in the presence of the health worker(s) or the researcher.
Results
The mean and standard deviation of fasting blood glucose in the patient-centered and family-centered groups were 157.30 ± 43.50 and 162.75 ± 52.74, respectively, at the pre-test, and 132.98 ± 34.96 and 145.36 ± 36.38, respectively, at the post-test. Fasting blood glucose levels decreased in all three groups after the intervention; however, this difference was not statistically significant between the groups at either the pre-test or the post-test.
The mean difference, standard error, and significance level of fasting blood glucose between the patient-centered and family-centered groups were 5.45, 10.38, and 0.859, respectively, at the pre-test, and 12.67, 7.78, and 0.238, respectively, at the post-test, indicating no statistically significant difference between the groups.
No statistically significant difference was observed in the self-efficacy scores of diabetic patients between the study groups at the pre-test. However, at the post-test, the self-efficacy status of the patients exhibited a statistically significant difference (P<0.002).
Before the intervention, none of the groups had a statistically significant difference from each other. However, the self-efficacy score in the post-test of the patient-centered group showed a statistically significant increase compared to the family-centered group (P<0.023) and the control group (P<0.003). Pairwise comparisons of the groups demonstrated that the self-efficacy of the patient-centered group in the post-test had a statistically significant increase compared to both the family-centered group (P<0.023) and the control group (P<0.001).
Conclusion
Based on the findings of the current study, a statistically significant increase was observed in patients' self-efficacy scores across the family-centered and patient-centered groups following the implementation of interventions. Notably, the intervention demonstrated a greater efficacy in the family-centered group compared to the patient-centered group.
Ethical Statement
The current study was approved by the Research Ethics Committee of Golestan University of Medical Sciences (IR.GOUMS.REC.1402.323).
Funding
This article has been extracted from Ali Maghsoudlou’s Ph.D dissertation in Medicine at the International Campus of Golestan University of Medical Sciences and was conducted with the student’s personal funding.
Conflicts of Interest
No conflicts of interest.
Acknowledgement
We would like to thank all healthcare experts and health workers for their cooperation and coordination with patients.
Key Message: An intervention aimed at enhancing self-efficacy in patients with type 2 diabetes mellitus is effective in conducting more appropriate self-care behaviors and fostering effective peer support programs.