Universitas Advent Indonesia

Universitas Advent Indonesia
SPIRITUAL PERSUASION AND SELF-MANAGEMENT BEHAVIOR AMONG ADULTS WITH TYPE 2 DIABETES IN WEST INDONESIA Universitas Advent Indonesia Fakultas Ilmu Keperawatan Program Studi Diploma Keperawatan Samuel M. Simanjuntak

Problems Compliance among T2DM in Indonesia is poor and learned behaviours change overtime. Too many T2DM received inadequate support to enable them to achieve optimal control of their glucose levels. People with T2DM in Indonesia are not really aware that complications could be prevented.

Problems For many years, majority of diabetes education intervention in Indonesia has been focusing on the physicians consultation with medical explanations on complications as approach. There is no diabetes self-management education with cultural approach on behaviours modification is done yet.

Background: The SAKINAH education intervention is concerned with combining Islam’s health principles and diabetes education to persuade many Indonesian Muslims with type 2 Diabetes to sustain control over their illness-related conditions and complications aside from gaining knowledge, awareness and skills on self-management.

Purpose: The overall purpose of this study is to determine the effects of the spiritual component of SAKINAH on the self-management behavior of adults with type 2 diabetes.

Methods: This study employs the quasi experiment pretest and posttest control group design to determine the effects of SAKINAH on the practice of self-management behaviors among the study group. Change on the criteria of the self-management behaviors and on health status changes.

Methods: The Summary of Diabetes Self-care Activities measure (SDSCA); Physiological measures (fasting blood glucose, body weight, and blood pressure) are used to measure changes in behaviors and physical measures. Data were collected from 91 participants 50.6% from the study group and 48.3% from the control group.

Results: There is no significant difference in the beginning of the SAKINAH intervention in the practice of diabetes self-management of diet, exercise, medication, foot care and smoking in the social support scores and in the values of fasting blood sugar, blood pressures and body weight. Environmental factors have no significant effect on the distribution of practiced behaviors and physical measures at pretest.

Results: The study result support that there is significant difference between groups at posttest in the practice of self-management and physiological measures. There is significant difference between pretest and posttest in study group in the practice of diet, exercise, glucose testing, and foot care; and in the measures of FBS, and systole blood pressure with p< 0.05

Conclusion: The result of this study suggests that social structural health determinant need to be considered in structuring the objectives and strategizing approach of the diabetes education intervention.

SAKINAH as Spiritual Persuasion in Diabetes Self-management
Conceptual map Cognitive/Personal Factor Behavioural Factors SAKINAH as Spiritual Persuasion in Diabetes Self-management The Practice of Diabetes Self-Management: Diet, Exercise, Medication, Glucose testing, Food care, Smoking Physical Improvement: FBS, Blood pressures and Body weight Environmental Factors Education, Family structure, Support system, Duration with DM

Characteristics The total of one hundred twenty seven (127) adults who had been diagnosed with type 2 diabetes (T2DM) were voluntarily consented joining the study from three different diabetes clubs or Persadia (Persatuan Diabetes Indonesia/Indonesian diabetes association). After evaluating their attendance and validity of data, there were 91 participants (71.6 %) being included for the analysis. From the total of 91 data analyzed, there are 46 data (50.6%) from the treatment group and 44 data (48.3%) from the control group.

Age and sex characteristics
Control Treatment Total Count % 56-60 15 34.09 9 19.57 24 26.67 61-65 14 31.82 19 41.30 33 36.67 44 100 46 90 Sex Male 6 13.64 12 26.09 18 20 Female 38 86.36 34 73.91 72 80

Educational Attainment
Education attainment Educational Attainment Control Treatment Total Count % Primary 15 34.09 12 26.09 27 30.00 Secondary 21 47.73 22 47.83 43 47.78 College 6 13.64 8 17.39 14 15.56 Graduate 2 4.55 4 8.70 6.67 44 100 46 90

Duration with Diabetes
Duration with T2DM Duration with Diabetes Control Treatment Total Count % 1-5 11 25 16 34.78 27 30.00 6-10 15 34.09 32.61 30 33.33 11-15 13 29.55 6 13.04 19 21.11 16-20 4 9.09 10 11.11 21-25 3 6.52 3.33 26 < 1 2.27 1.11 44 100 46 90

Family structure Family Structure Control Treatment Total Count %
Alone 5 11.36 9 19.57 14 15.56 With Spouse 11 25.00 12 26.09 23 25.56 Nuclear Family 20 45.45 13 28.26 33 36.67 Nuclear Family with Grand Children 6 13.04 12.22 With Extended Family 1 2.27 2 4.35 3 3.33 Others 4.55 4 8.70 6.67 44 100 46 90

Most frequent help Most Frequent Help Control Treatment Total Count %
Spouse 16 36.36 12 26.09 28 31.11 Family Member 22 50.00 13 28.26 35 38.89 Neighbor 1 2.27 6 13.04 7 7.78 Friend at Work 0.00 2 4.35 2.22 Religious leader 4 8.70 4.44 Health Worker 3 6.82 5 5.56 House Helper 4.55 6.52 Most of them 2.17 1.11 44 100 46 90

Number of closest friends
Control Treatment Total Count % 1-5 29 65.91 63.04 58 64.44 6-10 12 27.27 13 28.26 25 27.78 11-15 2 4.55 4.35 4 4.44 16-20 1 2.27 2.17 2.22 above 21 0.00 1.11 44 100 46 90

Social support distribution
Social support Control treatment pvalue Mean Standard Deviation Informational 31.21 8.94 26.95 6.92 0.040 Interaction 13.82 2.91 12.85 3.74 0.054 Affective 10.06 1.97 9.48 2.76 0.910 Instrumental 17.61 8.63 16.28 8.78 0.164 TOTAL 78.64 20.15 71.48 0.097

Behavioural factors—diabetes self-management: diet
Facilitator Treatment Control Count % None 5 11.3 Physician 37 64.6 36 66.9 Dietitian 1 2.1 Nurse 3 6.5 Some of them 10.8 6.8 Information Never Follow a low fat eating plan 8 17.3 Follow a complex carbohydrate diet 2.2 Reduce the number of calories you eat to lose weight Eat lots of food high in dietary fiber Eat lots (at least 5 servings per day) of fruits and vegetables Eat very few sweets (for example: desserts, non-diet sodas, candy bars) 2 4.5 Other topics Some of the topics 19 41.3 34 77.2

Behavioural factors—diabetes self-management: exercise
Facilitator Treatment Control Count % None 4 9.1 Physician 39 84.7 38 86.4 Dietitian 1 2.1 Nurse 8.6 Some of them 2 2.3 4.5 Information Never Get low level exercise (such as walking) on a daily basis 11 23.9 5 11.3 Exercise continuously for a least 20 minutes at least 3 times a week 9 19.5 3 6.8 Fit exercise into your daily routine Engage in a specific amount, type, duration and level of exercise 4.3 Other topics 6.5 Some of it 20 43.4 32 72.7

Behavioural factors—diabetes self-management: glucose monitoring
Facilitator Treatment Control Count % None 15 32.6 28 63.6 Physician 27 58.6 34.1 Dietitian 2 4.3 Nurse 1 2.2 Some of them Information Never Test blood sugar using a drop of blood from your finger and a color chart 5 10.8 Test blood sugar using a machine to read the results 12 26.1 3 6.8 Test your urine for sugar 4.5 Other topics Some of it 7 15.2 11 25

Behavioural factors—diabetes self-management: medication
TYPE OF MEDICATION Treatment Control Count % None 1 2.1 An insulin shot 1 or 2 times a day 2.2 An insulin shot 3 or more times a day Diabetes pills to control my blood sugar level 39 84.7 88.6 Mix Medication 5 10.8 4 9.1

Practice of Self-management
Test of difference between study variables: before intervention (Pretest) Pretest Practice of Self-management Control treatment pvalue Mean Standard Deviation Diet 4.32 1.47 4.34 1.25 0.913 Exercise 3.32 2.27 3.56 1.43 0.159 Medication 6.02 2.01 5.22 2.38 0.513 Glucose monitor 2.32 1.34 2.97 1.39 0.027 Foot care 4.78 0.96 4.92 0.94 Smoking Yes No 0.975 3 41 1 45

Test of difference between study variables: Before intervention (Pretest)
Physical Variables Control treatment pvalue Mean Standard Deviation Fasting Blood Sugar 179.13 63.48 180.08 64.90 .961 BP Systole 126.81 16.10 127.39 11.24 .490 BP Diastole 81.13 9.93 80.00 6.32 .435 Body Weight 59.06 8.01 59.75 10.06 .657

Environmental factors as predictor to pretest self-management behaviors
Self-management Behaviours Environmental Factors as Significance Predictor Education pvalue Duration of DM Family Structure Social Support Diet 0.69 0.40 0.36 0.53 Exercise 0.35 0.49 0.91 0.65 Medication 0.21 0.10 Glucose monitoring 0.47 0.25 0.88 Foot care 0.73 0.59

After intervention/Posttest
Practice of Self-management Control treatment pvalue Mean Standard Deviatio n Standar d Deviatio n Diet 4.52 1.38 5.70 0.68 <0.001 Exercise 3.30 2.39 4.68 1.21 0.001 Medication 4.84 1.99 4.02 0.74 0.98 Glucose monitor 2.25 1.27 3.52 1.19 Foot care 4.94 6.44 0.63 Smoking Yes No 0.975 3 41 1 45

Physical Variables Control treatment pvalue Mean Standard Deviation Fasting Blood Sugar 193.75 71.45 150.58 46.31 <0.001 BP Systole 128.86 14.81 125.00 12.24 0.260 BP Diastole 83.40 7.75 80.43 5.94 0.061 Body Weight 59.13 8.20 59.10 9.12 0.945

Before intervention (Pretest) and after intervention (Posttest)
Treatment Group Practice of Self-management Pretest Posttest pvalue Mean Standard Deviation Diet 4.34 1.25 5.70 0.68 <0.001 Exercise 3.56 1.43 4.68 1.21 Medication 5.22 2.38 4.02 0.74 0.372 Glucose monitor 2.97 1.39 3.52 1.19 Foot care 4.92 0.94 6.44 0.63 0.010 Smoking Yes No 1.00 1 45