To evaluate the change of self-care knowledge of the outpatients with type 2 diabetes having treatment at Yenbai Provincial Hospital of Endocrinology in 2018 after health education. Subjects and methods: Intervention study on the same group of subjects with comparison before and after was conducted. Data were collected by directly interviewing 108 people with type 2 diabetes for outpatient examination and treatment at Yenbai Provincial Hospital of Endocrinology from January to April, 2018 with self-assessment questionnaires of diabetes self-care. Direct consultation was taken in small groups of 2 - 4, the content of the consultation is based on the American Diabetes Association''s self-care recommendation (2017) and guidelines for the diagnosis and treatment of type 2 diabetes by the Ministry of Health (2017). Results: Before the intervention, the rate of patients with self-care knowledge was 19.4%. After the intervention, the rate of patients with self-care knowledge rose up to 91.7%. The average knowledge score was 17.3 ± 3.6 before the intervention and up to 25.2 ± 2.8 of a total of 30 points after one-month intervention.
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CHANGING SELF-CARE KNOWLEDGE OF THE OUTPATIENTS
WITH TYPE 2 DIABETES HAVING TREATMENT AT
YENBAI PROVINCAL HOSPITAL OF ENDOCRINOLOGY
IN 2018 AFTER HEALTH INTERVENTION
Vu Thi Huong Nhai 1 ; Vu Van Thanh 2
SUMMARY
Objectives: To evaluate the change of self-care knowledge of the outpatients with type 2
diabetes having treatment at Yenbai Provincial Hospital of Endocrinology in 2018 after health
education Subjects and methods: Intervention study on the same group of subjects with
comparison before and after was conducted Data were collected by directly interviewing 108
people with type 2 diabetes for outpatient examination and treatment at Yenbai Provincial
Hospital of Endocrinology from January to April, 2018 with self-assessment questionnaires of
diabetes self-care Direct consultation was taken in small groups of 2 - 4, the content of the
consultation is based on the American Diabetes Association's self-care recommendation (2017)
and guidelines for the diagnosis and treatment of type 2 diabetes by the Ministry of Health
(2017) Results: Before the intervention, the rate of patients with self-care knowledge was
19.4% After the intervention, the rate of patients with self-care knowledge rose up to 91.7%
The average knowledge score was 17.3 ± 3.6 before the intervention and up to 25.2 ± 2.8 of a
total of 30 points after one-month intervention Conclusion: Self-care knowledge of the
outpatients with type 2 diabetes having treatment at in Yenbai Provincial Hospital of
Endocrinology was improved significantly after health education
* Keywords: Type 2 diabetes; Knowledge; Self-care; Yenbai province
INTRODUCTION
Diabetes is the chronic disease which
does not commonly spread and rapidly
increase worldwide in the 21st century [8]
According to the report of the International
Diabetes Federation (IDF) in 2017, there
are about 425 million people with diabetes
in the world, equivalent to every 11 adults
who have 1 people with this disease and
more than 212 million people (50%) suffer
from diabetes without being diagnosed
[9] Vietnam is one of the four countries in
Southeast Asia with the highest incidence
of diabetes with about 3.5 million adults (20 - 79 years old), but up to 54% are undiagnosed, 85% are only detected to have the disease when they have a dangerous complication [9] Diabetes is a major burden for individuals, families and the whole society One more person dies every 8 seconds and every 30 seconds a person is amputated because of diabetes [9] Most countries have to spend 5 - 20%
of total health expenditure on diabetes [9]
1 Yenbai Medical College
2 Namdinh University of Nursing
Corresponding author: Vu Van Thanh (vuthanhdhdd@gmail.com)
Date received: 20/07/2019
Date accepted: 26/08/2019
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Studies have shown that patients play
a key role in disease management and
a reasonable educational intervention
program will contribute to improve
self-care knowledge for patients and will help
to manage disease better [13] However,
in fact, during daily medical examination,
health education is less focused [11]
Deficiencies in self-care knowledge lead
to improper behavior reduce treatment
effectiveness; contribute to increase
complications, increase treatment cost,
increase disability and death rates [12] In
Vietnam, there have been a number of
intervention studies in patients with type 2
diabetes, but there have not been many
intervention studies in the field of nursing
about the self-care knowledge of patients
According to the report of Yenbai
Provincial Hospital of Endocrinology, up
to April 2018, the whole province had
1,955 people with type 2 diabetes, who
were undergoing outpatient treatment at
the hospital and the number of diabetic
patients was increasing rapidly [2] Yenbai
is a mountainous province with many
ethnic minorities living, the incidence of
disease is not similar to the ones studied
Therefore, the aims of this study was: To
evaluate the change of self-care knowledge
of the outpatients with type 2 diabetes
having treatment at Yenbai Provincial
Hospital of Endocrinology in 2018 after
being trained about health
SUBJECTS AND METHODS
1 Subjects
- Selection criteria: Patients aged 18
and older were diagnosed with type 2
diabetes within one year of the time of
data collection; being on outpatient
treatment at Yenbai Provincial Hospital of Endocrinology for at least 1 month (there has been enough minimum experience to assess before intervention); capable of receiving and answering questions; agreed
to participate in the study
- Exclusion criteria: Patients with serious complications must go to the inpatient hospital; patients did not fully participate
in health assessment and education programs in this study
* Time and place of study:
- Data collection time: From January to April 2018
- Research location: Outpatient Department of Yenbai Provincial Hospital
of Endocrinology
2 Methods
* Research design:
Health education intervention studies had compared before and after on a research group
* Samples and sampling methods:
- Sample size:
Applying the formula for calculating sample size for intervention research is as follows:
2
2
0 1
n
=
−
In which, n: The number of research subjects; Z (1-α) = 1.65 and Z (1-β) = 1.29; p0: The rate of patients with self-care knowledge before intervention was 0.374 according to Nguyen Vu Huyen Anh (2016) in Dienbien [1]; p1: The proportion
of patients with knowledge after the intervention was 0.524 From that calculation, n = 93
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- Sampling method: Convenient sample
selection Select all patients diagnosed
with type 2 diabetes who were receiving
outpatient treatment at Outpatient
Department, Yenbai Provincial Hospital of
Endocrinology to response the sampling
criteria, during the period from 01 - 2018
to 04 - 2018; the research team selected
108 people who agreed and fully
participated in the post-health education
assessment Thus, the sample size was
determined to be 108
* The method of data collection:
- Data collection tool:
The data collection toolkit was based
on the Diabetes Self-Care Knowledge
Questionnaire toolkit (DSCKQ) 30 after
obtaining the author's permission and
referring to the translation used in the
study of Nguyen Vu Huyen Anh at
Dienbien in 2016 [1] The toolkit was
examined, revised and evaluated by three
experts in the field of diabetes Then
investigate more than 30 patients who
response the sampling criteria to correct
the toolkit The result of the toolkit had a
CVI of 0.83; Cronbach's Alpha coefficient
was 0.81
- Scale and evaluation:
Each correct answer is 1 point Each
answer is incorrect or does not know the
answer is 0 points The maximum total
score is 30 points The total score is
presented as a percentage (%) Self-care
knowledge will be divided into 2 levels:
- Knowledge gained: When reaching
21 points or more on a total of 30 points
(correct answer ≥ 70% of the total score)
- Knowledge does not gained: When
correct answer < 70% of the total score
- Steps to collect data:
+ Step 1: Training for 3 collaborators are 3 lecturers of the Nursing Department, Yenbai Medical College about the purpose, content, and method of investigation + Step 2: Conducting surveys and assessing the self-care knowledge of the research subjects by direct interview method through the prepared questionnaires while the patients wait for the test results with time about 25 to 30 minutes
+ Step 3: Conduct counseling and health education for the study subjects under the intervention program Interview appointments again after 1 month
+ Step 4: The patients who had received calling before 2 days to remind their appointment for the second interview Investigate the self-care knowledge of the research subjects after 1 month of educational intervention (T2) by questionnaire and how to perform like the first interview
* Program of intervention:
- Intervention content:
Health education program about knowledge of self-care for people with type 2 diabetes, using communication materials and leaflets developed by researchers based on professional documents Guidelines for diagnosis and treatment of type 2 diabetes issued together with No 3319/QD-BYT at July 19, 2017 of the Minister of Health and ISTEP-D program in the period of 2017 - 2018 (Intensive training program on diabetes)
- How to intervene:
Hand out communication materials and leaflets for research subjects to read before consulting 10 - 15 minutes; health counseling and education on self-care knowledge for people with type 2 diabetes
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caused by researchers; answering questions
about the intervention contents of the
research subjects
* Methods of data analysis:
Data were cleaned, entered and
analyzed using SPSS 18.00 software
Use appropriate algorithms to validate
values before and after intervention
RESULTS AND DISCUSSION
1 General characteristics of the
subjects
Among 108 research subjects of type 2
diabetes, aged from 19 to 86 years old,
the average age was 59.4 ± 12.2 Most of
them were in the age group of 60 years
old or older, accounting for 51.8% This
result was similar to the research results
of Nguyen Thi Thu Thao with the average age of the study subjects was 57.1 ± 12.8 [5] In our study, the proportion of women (61.1%) was higher than that of men (38.9%) The majority of research subjects were Kinh people, 75% of the remaining were ethnic minorities; in which, Dao people accounted for 11.1% This was entirely consistent with the proportion of ethnic groups in Yenbai province according to the results of the Yenbai population and housing census in 2009 [3] The subjects
of study mainly lived in rural areas accounting for 64.8% Research subjects with lower secondary education accounted for the highest percentage of 30.6% and there were 9.3% illiterate Thus, type 2 diabetes people who had a low education level accounted for high rate
2 The change of self-care knowledge after health education
Table 1: The change of knowledge points of self-care after health education
The average points (mean ± SD)
The lowest points (min)
The highest points
After intervention 25.2 ± 2.8 16 30 < 0.001
Research results showed that the reality of self-care knowledge level of the research subjects was still very low The general knowledge score before the intervention ranged from 8 to 25 out of 30 points The average score was 17.3 ± 3.6 The rate of patients with self-care knowledge was low, accounting for 19.4%
Figure 1: The change in the level of general knowledge about self-care of the research
subject after health education
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This result was lower than the research
result of Nguyen Vu Huyen Anh in Dienbien
in 2016 with 37.4% having standard
knowledge This difference may be due
to: The proportion of illiterate study subjects
in our study was much higher (9.3%) and
mainly lived in rural areas (64.8%) compared
to research of Nguyen Vu Huyen Anh
Therefore, it is possible to affect the ability
to access self-care knowledge for type 2
diabetes patients According to the study
by Adibe et al, the longer time the patients
suffer from diabetes, the higher the level
of self-care knowledge they have [6] In
our study, only those with type 2 diabetes
who were diagnosed with the disease
within 1 year were selected and in the
study by Nguyen Vu Huyen Anh, but the
proportion of study subjects with time
≤ 1 year only accounted for 11.7% [1]
However, there was a significant change
in point of self-care knowledge of people with type 2 diabetes after health education The rate of research subjects with standard knowledge had increased remarkably from 19.4% to 91.7%; scores ranged from
16 to 30 points, the average score reached 25.2 ± 2.8 out of 30 points (the difference was statistically significant with p < 0.001) This result was consistent with Pereira's research, which also indicated that the educational program is used as an effective intervention tool in disease control, self-care management and a significant improvement in self-care knowledge after intervention [12] In Vietnam, we have not found any researches on assessing the change of self-care knowledge of type 2 diabetes after education intervention have been published Therefore, we can not compare the level of changing knowledge among regions across the country
Table 2: The proportion of research subjects with correct knowledge about physical
activity, diet, prevention of complications, and blood sugar self-monitoring before and after health education
Content
Before intervention (%)
After intervention (%)
Physical activity
The relationship between frequency of blood sugar level
Understanding the frequency of physical activity 93.5 96.3 Understanding the intensity of physical activity 43.5 78.7 Diet
Should have a snack before going to bed 24.1 75.9 Classify food according to blood sugar index 54.6 82.4
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Prevention of complications
Need to take care of the feet carefully 83.3 91.7 Should use soft socks, have good elasticity 71.3 80.6
Self-monitoring of blood sugar
Not only health workers can check blood sugar and blood
Frequency of self-monitoring of blood sugar 26.9 74.1
According to the recommendation of the
American Diabetes Association in 2017
and the Ministry of Health's Guidelines for
Diet for Diabetes 2015, the diet plays a
very important and indispensable role in
managing diabetes In our study, the
knowledge of patients' diet was limited
Before the intervention, only 24.1% of the
study subjects knew that there should be
an extra meal before going to bed to
prevent hypotension during the night
Percentage of subjects who could identified
and classified foods according to the blood
sugar index to be used appropriately
54.6% and knew to maintain regular time,
time between meals (53.7%) also increased
significantly after intervention were 82.4%
and 80.6% This result was consistent
with the research result of Vu Thi Tuyet
Mai at Kiengiang General Hospital in
2014 [4]
Knowledge of self-monitoring of blood sugar of research subjects was very limited Only 22.2% knew not only health workers can check blood sugar, blood pressure of patients and 26.9% knew the frequency of self-monitoring of blood sugar From that situation, we put this knowledge into the content of educational intervention; in which, emphasizing the role of patients themselves in monitoring blood sugar and giving specific instructions on the frequency of self-monitoring of blood sugar After the intervention, the proportion of research subjects with right knowledge on the above content increased to 75.9% and 74.1%
Table 3: The proportion of research subjects with correct knowledge about
medication adherence before and after health education
Content
Before intervention (%)
After intervention (%)
The use of diabetes medication needs to be maintained for a lifetime 85.2 94.4 When you feel well, you still need to take diabetes medicine 86.1 92.6 Drinking alcohol while using of diabetes mellitus drugs is a serious problem 75.9 88.9 Diet and exercise are as important as diabetes medications 63.0 83.3 When you feel well, there is still need for periodic health checkups 96.3 98.1
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After intervention, the percentage of research subject had the right knowledge about medication adherence increased from 83.3% to 98.1%
According to Deepali’s research, 15.8% will stop taking drugs when they feel well, equivalent to our research results before the intervention was 13.9%, but after the intervention this ratio dropped to 7.4% [7]
Table 4: The proportion of research subjects with correct knowledge about the
consequences of uncontrolled blood sugar level before and after health education
Content
Before intervention (%)
After intervention (%)
Symptoms of neurological complications appear in the feet 49.1 82.4
High blood sugar levels can cause eye complications 92.6 97.2 High blood sugar levels can cause cardiovascular and kidney complications 85.2 95.4
The proportion of research subjects
who knew about the consequences of
uncontrolled blood sugar levels increased
significantly; in which, the rate of knowing
the signs of hypoglycemia increased the
highest from 24.1% to 75.0%
Most of the study subjects experienced
symptoms such as trembling, restlessness,
confusion, sweating, but they all did not
know those are signs of hypoglycemia
[10] After the intervention, 75.0% of
the subjects knew the above symptoms
were signs of hypoglycemia (before the
intervention was 24.1%) Thus, in general,
the educational intervention program has
a positive impact on self-care knowledge
of people with type 2 diabetes, creating a
premise for patients to apply knowledge
to practice self-care and change acts in a
positive direction in life Thereby, it is
necessary to widely implement the education
program for all type 2 diabetes patients
CONCLUSION
The self-care knowledge of people with type 2 diabetes in outpatient treatment at Yenbai Provincial Hospital of Endocrinology had been significantly improved after health education: The rate of patients with knowledge about self-care had increased from 19.4% to 91.7% The average score
of knowledge increased from 17.3 ± 3.6 to 25.2 ± 2.8 out of 30 points, the difference was statistically significant with p < 0.001
REFERENCES
1 Nguyen Vu Huyen Anh Assessing
self-care knowledge of type 2 diabetes patients in Dienbien Provincial General Hospital Master's Thesis in Nursing Namdinh University of Nursing 2016
2 Yenbai Hospital of Endocrinology
Report on the implementation of tasks in the first 6 months of 2017 Yenbai October 2017
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3 Electronic Portal of Yenbai Province
Yenbai ethnic groups, at the website
http://www.yenbai.gov.vn/Pages/Cac-dan-toc-Yen-Bai.aspx?l=CacdantocYenBai, accessed
on 28/5/2018 2016
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Tran Thien Trung Knowledge, attitudes and
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2014, 18 (5), pp.136-141
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Minh Assessing the impact of educational
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Diabetes self-care knowledge among type 2
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diabetes atlas seventh edition 1st, ed, Karakas Print, Brussels 2015, 350, pp.362-367
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diabetes atlas eighth edition 1st, ed Belgium, Brussels 2017, pp.9-48
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the disease knowledge of diabetes mellitus patients Revista Latino-Americana de Enfermagem 2012, 20, pp.478-485
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