Determining the impact of a self-care educational program designed based on the Peplau theory on adherence to treatment and self-care in elderly patients with diabetes
DOI:
https://doi.org/10.17533/udea.iee.v43n1e05Keywords:
Diabetes Mellitus, self care, treatment adherence and compliance, aged, control groupsAbstract
Objective. To examine the impact of a self-care program designed using Peplau's theory on adherence and self-care in elderly diabetic patients.
Methods. This semi-experimental study involved 102 elderly diabetic patients from a diabetes clinic in Hormoz, Iran, in 2023. Participants were randomly allocated to either the control group (n=51) or the intervention group (n=51). Before and two weeks after the intervention, participants completed a demographic information questionnaire, the Modanloo Adherence to Treatment Questionnaire for Patients with Chronic Illness, and the Summary of Diabetes Self-Care Activities Scale. The intervention group received a self-care educational program based on Peplau's therapeutic communication theory, delivered in three phases: orientation, working, and termination. The program focused on key diabetes self-care factors including diet, medication adherence, physical activity, blood sugar monitoring, and foot care. Educational sessions were conducted in small groups or individually in the clinic’s education room. The control group received routine educational content provided by the diabetes clinic.
Results. The findings showed that the difference between the pre-post mean scores was significantly higher in the intervention group compared with the control group in the total self-care score, as well as in its dimensions: diet, blood sugar regulation, and foot care (p<0.001). On the other hand, in terms of adherence, no significant difference was observed in the mean difference between groups for the total score (p=0.307), although a statistical difference was found in the dimensions of willingness to participate in treatment (p=0.035) and ability to adapt (p<0.001).
Conclusion. The self-care educational program based on Peplau's theory improved the self-care and two dimensions of the adherence: willingness to participate in treatment and ability to adapt in diabetic patients.
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References
1. Mokhberi A, Nedae fard A, Sahaf R. Barriers and facilitators of Iranian elderly in use of ATM machines: a qualitative research in the way of cultural probes. Iranian Journal of Ageing. 2013; 8(3):17-24.
2. UNESCO. World population ageing 1950-2050. UNESCO, New York; 2002.
3. Sargazi M, Salehi SH, Naji A. Health promoting behaviors of elderly people admitted to hospital in Zahedan in 1389. Journal of Zabol University of Medical Sciences and Health Services 2012; 4(2):73-83.
4. Comer-HaGans D, Austin S, Ramamonjiarivelo Z, Sherman LD. Preventative diabetes self-care management prac-tices among individuals with diabetes and mental health stress. Journal of Affective Disorders. 2022; 298(Pt B):24-34.
5. Iglay K, Hannachi H, Joseph Howie P, Xu J, Li X, Engel SS, et al. Prevalence and co-prevalence of comorbidities among patients with type 2 diabetes mellitus. Current Medical Research and Opinion. 2016; 32(7):1243-52.
6. Fotouhi F, Rezvan F, Hashemi H, Javaherforoushzadeh A, Mahbod M, Yekta A, et al. High prevalence of diabetes in elderly of Iran: an urgent public health issue. Journal of Diabetes & Metabolic Disorders. 2022; 21(1):777-84.
7. Rahimian-Boogar E, Mohajeri-Tehrani MR. Risk factors associated with depression in type 2 diabetics. KAUMS Journal (FEYZ). 2012; 16(3):261-72.
8. American Association of Diabetes Educators. An effective model of diabetes care and education: revising the AA-DE7 Self-Care Behaviors®. The Diabetes Educator. 2020; 46(2):139-60.
9. Wong S, Chen E, Smith H, Griva K. Assessing the mechanisms contributing to self-care behaviours in young and usual-onset diabetes. Annals of Family Medicine. 2022; 20(Suppl 1):3101.
10. Takemura M, Mitsui K, Itotani R, Ishitoko M, Suzuki S, Matsumoto M, et al. Relationships between repeated in-struction on inhalation therapy, medication adherence, and health status in chronic obstructive pulmonary dis-ease. International Journal of Chronic Obstructive Pulmonary Disease. 2011; 6:97-104.
11. Haynes RB, McDonald HP, Garg AX. Helping patients follow prescribed treatment: clinical applications. Journal of the American Medical Association. 2002; 288(22):2880-3.
12. Lee WC, Balu S, Cobden D, Joshi AV. Medication adherence and the associated health-economic impact among patients with type 2 diabetes mellitus converting to insulin pen therapy: an analysis of third-party claims da-ta. Clinical Therapeutics. 2006; 28(6):1712-25.
13. Larsson IE, Sahlsten MJM, Segersten K, Plos KAE. Patients' perceptions of nurses' behaviour that influence pa-tient participation in nursing care: a critical incident study. Nursing Research and Practice. 2011; 2011:534060.
14. Meleis AI. Theoretical Nursing: Development and Progress. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2011.
15. Penckofer SM, Ferrans C, Mumby P, Byrn M, Emanuele MA, Harrison P, et al. A psychoeducational intervention (SWEEP) for depressed women with diabetes. Annals of Behavioral Medicine. 2012; 44(2):192–206.
16. Alishahi B, Hemmati Maslakpak M, Sheikhi S, Moradi Y. Effects of Peplau’s theory of interpersonal relations on stress of hemodialysis patients. Nursing and Midwifery Journal. 2017; 15(1):1-9.
17. Seyed Fatemi N, Rafii F, Hajizadeh E, Modanloo M. Psychometric properties of the adherence questionnaire in pa-tients with chronic disease: A mixed method study. Koomesh. 2018; 20(2):179-91.
18. Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care activities measure: Results from 7 studies and a revised scale. Diabetes Care. 2000 ;23(7):943-50.
19. Fernandes S, Naidu S. Promoting participation in self-care management among patients with diabetes mellitus: An application of Peplau's theory of interpersonal relationships. International Journal of Nursing Education. 2017; 9(4):129.
20. Khiyali Z, Ghasemi A, Toghroli R, Ziapour A, Shahabi N, Dehghan A, Yari A. The effect of peer group on self-care behaviors and glycemic index in elders with type II diabetes. Journal of Education and Health Promotion. 2021; 10(1):197.
21. Hooshmandja M, Mohammadi A, Esteghamti A, Aliabadi K, Nili M. Effect of mobile learning (application) on self-care behaviors and blood glucose of type 2 diabetic patients. Journal of Diabetes & Metabolic Disorders. 2019; 18(2):307-13.
22. Hailu FB, Moen A, Hjortdahl P. Diabetes self-management education (DSME) - Effect on knowledge, self-care be-havior, and self-efficacy among type 2 diabetes patients: A systematic review. Diabetes Metabolism Syndrome Obesity. 2019; 12:2489-99.
23. Lee SK, Shin DH, Kim YH, Lee KS. Effect of diabetes education through pattern management on self-care and self-efficacy in patients with type 2 diabetes. International Journal of Environmental Research and Public Health. 2019; 16(18):346.
24. LoBiondo-Wood G, Haber J. Nursing Research E-book: Methods and Critical Appraisal for Evidence-Based Prac-tice. 9th ed. St. Louis: Elsevier Health Sciences; 2021.
25. Shojaeezadeh D, Tol A, Sharifirad G, Alhani F. Effect of education program based on empowerment model in pro-moting self-care among type 2 diabetic patients in Isfahan. Razi Journal of Medical Sciences. 2013; 20(107):18-31.
26. Fathidokht H, Mansour-Ghanaei R, Darvishpour A, Maroufizadeh S. The effect of communication using Peplau's theory on satisfaction with nursing care in hospitalized older adults in cardiac intensive care unit: A quasi-experimental study. Journal of Education and Health Promotion. 2023; 12:426.
27. Ferreira GRS, Viana LRdC, Pimenta CJL, Silva CRRd, Costa TFd, Oliveira JdS, Costa KNdFM. Self-care of elderly people with diabetes mellitus and the nurse-patient interpersonal relationship. Revista Brasileira de Enfermagem. 2021; 75(01):e20201257.
28. Borhaninejad V, Shati M, Bhalla D, Iranpour A, Fadayevatan R. A population-based survey to determine association of perceived social support and self-efficacy with self-care among elderly with diabetes mellitus (Kerman City, Iran). The International Journal of Aging and Human Development. 2017; 85(4):504-17.
29. RobatSarpooshi D, Mahdizadeh M, Alizadeh Siuki H, Haddadi M, Robatsarpooshi H, Peyman N. The relationship between health literacy level and self-care behaviors in patients with diabetes. Patient Related Outcome Measures. 2020; 11:129-35.
30. Tanharo D, Ghods R, Pourrahimi M, Abdi M, Aghaei S, Vali N. Adherence to treatment in diabetic patients and its affecting factors. Pajouhan Scientific Journal. 2018; 17(1):37-44.
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