Diabetes empowerment scores among type 2 diabetes mellitus patients and its correlated factors: A cross-sectional study in a primary care setting in Malaysia
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摘要
BACKGROUND There are limited studies on diabetes empowerment among type 2 diabetes patients, particularly in the primary care setting.AIM To assess the diabetes empowerment scores and its correlated factors among type2 diabetes patients in a primary care clinic in Malaysia.METHODS This is a cross sectional study involving 322 patients with type 2 diabetes mellitus(DM) followed up in a primary care clinic. Systematic sampling method was used for patient recruitment. The Diabetes Empowerment Scale(DES) questionnaire was used to measure patient empowerment. It consists of three domains:(1)Managing the psychosocial aspect of diabetes(9 items);(2) Assessing dissatisfaction and readiness to change(9 items); and(3) Setting and achieving diabetes goal(10 items). A score was considered high if it ranged from 100 to 140.Data analysis was performed using SPSS version 25 and multiple linear regressions was used to identify the predictors of total diabetes empowerment scores.RESULTS The median age of the study population was 55 years old. 56% were male and the mean duration of diabetes was 4 years. The total median score of the DES was 110 [interquartile range(IQR) = 10]. The median scores of the three subscales were 40 with(IQR = 4) for "Managing the psychosocial aspect of diabetes"; 36 with(IQR = 3) for "Assessing dissatisfaction and readiness to change"; and 34 with(IQR = 5) for "Setting and achieving diabetes goal". According to multiple linear regressions, factors that had significant correlation with higher empowerment scores among type 2 diabetes patients included an above secondary education level(P < 0.001), diabetes education exposure(P = 0.003),lack of ischemic heart disease(P = 0.017), and lower glycated hemoglobin(HbA1 c) levels(P < 0.001).CONCLUSION Diabetes empowerment scores were high among type 2 diabetes patients in this study population. Predictors for high empowerment scores included above secondary education level, diabetes education exposure, lack of ischemic heart disease status and lower HbA1 c.
BACKGROUND There are limited studies on diabetes empowerment among type 2 diabetes patients, particularly in the primary care setting.AIM To assess the diabetes empowerment scores and its correlated factors among type2 diabetes patients in a primary care clinic in Malaysia.METHODS This is a cross sectional study involving 322 patients with type 2 diabetes mellitus(DM) followed up in a primary care clinic. Systematic sampling method was used for patient recruitment. The Diabetes Empowerment Scale(DES) questionnaire was used to measure patient empowerment. It consists of three domains:(1)Managing the psychosocial aspect of diabetes(9 items);(2) Assessing dissatisfaction and readiness to change(9 items); and(3) Setting and achieving diabetes goal(10 items). A score was considered high if it ranged from 100 to 140.Data analysis was performed using SPSS version 25 and multiple linear regressions was used to identify the predictors of total diabetes empowerment scores.RESULTS The median age of the study population was 55 years old. 56% were male and the mean duration of diabetes was 4 years. The total median score of the DES was 110 [interquartile range(IQR) = 10]. The median scores of the three subscales were 40 with(IQR = 4) for "Managing the psychosocial aspect of diabetes"; 36 with(IQR = 3) for "Assessing dissatisfaction and readiness to change"; and 34 with(IQR = 5) for "Setting and achieving diabetes goal". According to multiple linear regressions, factors that had significant correlation with higher empowerment scores among type 2 diabetes patients included an above secondary education level(P < 0.001), diabetes education exposure(P = 0.003),lack of ischemic heart disease(P = 0.017), and lower glycated hemoglobin(HbA1 c) levels(P < 0.001).CONCLUSION Diabetes empowerment scores were high among type 2 diabetes patients in this study population. Predictors for high empowerment scores included above secondary education level, diabetes education exposure, lack of ischemic heart disease status and lower HbA1 c.
BACKGROUND There are limited studies on diabetes empowerment among type 2 diabetes patients, particularly in the primary care setting.AIM To assess the diabetes empowerment scores and its correlated factors among type2 diabetes patients in a primary care clinic in Malaysia.METHODS This is a cross sectional study involving 322 patients with type 2 diabetes mellitus(DM) followed up in a primary care clinic. Systematic sampling method was used for patient recruitment. The Diabetes Empowerment Scale(DES) questionnaire was used to measure patient empowerment. It consists of three domains:(1)Managing the psychosocial aspect of diabetes(9 items);(2) Assessing dissatisfaction and readiness to change(9 items); and(3) Setting and achieving diabetes goal(10 items). A score was considered high if it ranged from 100 to 140.Data analysis was performed using SPSS version 25 and multiple linear regressions was used to identify the predictors of total diabetes empowerment scores.RESULTS The median age of the study population was 55 years old. 56% were male and the mean duration of diabetes was 4 years. The total median score of the DES was 110 [interquartile range(IQR) = 10]. The median scores of the three subscales were 40 with(IQR = 4) for "Managing the psychosocial aspect of diabetes"; 36 with(IQR = 3) for "Assessing dissatisfaction and readiness to change"; and 34 with(IQR = 5) for "Setting and achieving diabetes goal". According to multiple linear regressions, factors that had significant correlation with higher empowerment scores among type 2 diabetes patients included an above secondary education level(P < 0.001), diabetes education exposure(P = 0.003),lack of ischemic heart disease(P = 0.017), and lower glycated hemoglobin(HbA1 c) levels(P < 0.001).CONCLUSION Diabetes empowerment scores were high among type 2 diabetes patients in this study population. Predictors for high empowerment scores included above secondary education level, diabetes education exposure, lack of ischemic heart disease status and lower HbA1 c.
引文
1 International Diabetes Federation.Diabetes atlas-7th Edition.Available from:http://www.diabetesatlas.org
2 World Health Organization.Global Report on Diabetes.2016.Available from:http://apps.who.int/iris/bitstream/10665/204871/1/9789241565257_eng.pdf?ua=1
3 Ministry of Health Malaysia.National Health and Morbidity Survey 2015.Available from:http://www.iku.gov.my/images/IKU/Document/REPORT/nhmsreport2015vol2.pdf
4 Ministry of Health Malaysia.National Health and Morbidity Survey,2015,NCD risk factors.Available from:http://www.mpoc.org.my/upload/Pn%20Zalma%20National%20Health%20and%20Morbidity%20Survey%20NCD%20Risk%20Factors.pdf
5 Cooper H,Booth K,Gill G.A trial of empowerment-based education in type 2 diabetes--global rather than glycaemic benefits.Diabetes Res Clin Pract 2008;82:165-171[PMID:18804887 DOI:10.1016/j.diabres.2008.07.013]
6 Funnell MM,Anderson RM,Arnold MS,Barr PA,Donnelly M,Johnson PD,Taylor-Moon D,White NH.Empowerment:an idea whose time has come in diabetes education.Diabetes Educ 1991;17:37-41[PMID:1986902 DOI:10.1177/014572179101700108]
7 Hernandez-Tejada MA,Campbell JA,Walker RJ,Smalls BL,Davis KS,Egede LE.Diabetes empowerment,medication adherence and self-care behaviors in adults with type 2 diabetes.Diabetes Technol Ther 2012;14:630-634[PMID:22524548 DOI:10.1089/dia.2011.0287]
8 Heinrich E,Schaper NC,de Vries NK.Self-management interventions for type 2 diabetes:a systematic review.2010.Available from:https://www.ncbi.nlm.nih.gov/books/NBK79914/
9 Tol A,Alhani F,Shojaeazadeh D,Sharifirad G,Moazam N.An empowering approach to promote the quality of life and self-management among type 2 diabetic patients.J Educ Health Promot 2015;4:13[PMID:25861658 DOI:10.4103/2277-9531.154022]
10 Liu MY,Tai YK,Hung WW,Hsieh MC,Wang RH.[Relationships between emotional distress,empowerment perception and self-care behavior and quality of life in patients with type 2 diabetes].Hu Li Za Zhi 2010;57:49-60[PMID:20401867]
11 Malay Mail.Malaysia's population stood at 32.6 million in Q4.2018.Available from:https://www.malaymail.com/news/malaysia/2019/02/12/malaysias-population-stood-at-32.6-million-in-q4-2018/
12 Social Research Methods.Types of Reliability.2019.Available from:https://socialresearchmethods.net/kb/reltypes.php/
13 Lance CE,Butts MM,Michels LC.The Sources of Four Commonly Reported Cutoff Criteria:What Did They Really Say?Organ Res Methods 2006;9:202-220[DOI:10.1177/1094428105284919]
14 Anderson RM,Funnell MM,Fitzgerald JT,Marrero DG.The Diabetes Empowerment Scale:a measure of psychosocial self-efficacy.Diabetes Care 2000;23:739-743[PMID:10840988 DOI:10.2337/diacare.23.6.739]
15 Gilpin EA,Pierce JP,Farkas AJ.Duration of smoking abstinence and success in quitting.J Natl Cancer Inst 1997;89:572-576[PMID:9106646 DOI:10.1093/jnci/89.8.572]
16 WHO Expert Consultation.Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies.Lancet 2004;363:157-163[PMID:14726171 DOI:10.1016/S0140-6736(03)15268-3]
17 Noshad S,Afarideh M,Heidari B,Mechanick JI,Esteghamati A.Diabetes Care in Iran:Where We Stand and Where We Are Headed.Ann Glob Health 2015;81:839-850[PMID:27108151 DOI:10.1016/j.aogh.2015.10.003]
18 Tol A,Baghbanian A,Sharifirad G,Shojaeizadeh D,Eslami A,Alhani F,Tehrani MM.Assessment of diabetic distress and disease related factors in patients with type 2 diabetes in Isfahan:A way to tailor an effective intervention planning in Isfahan-Iran.J Diabetes Metab Disord 2012;11:20[PMID:23497508DOI:10.1186/2251-6581-11-20]
19 D'Souza MS,Karkada SN,Hanrahan NP,Venkatesaperumal R,Amirtharaj A.Do Perceptions of Empowerment Affect Glycemic Control and Self-Care Among Adults with Type 2 Diabetes?Glob JHealth Sci 2015;7:80-90[PMID:26156908 DOI:10.5539/gjhs.v7n5p80]
20 DeWalt DA,Davis TC,Wallace AS,Seligman HK,Bryant-Shilliday B,Arnold CL,Freburger J,Schillinger D.Goal setting in diabetes self-management:taking the baby steps to success.Patient Educ Couns 2009;77:218-223[PMID:19359123 DOI:10.1016/j.pec.2009.03.012]
21 Funnell MM,Brown TL,Childs BP,Haas LB,Hosey GM,Jensen B,Maryniuk M,Peyrot M,Piette JD,Reader D,Siminerio LM,Weinger K,Weiss MA.National Standards for diabetes self-management education.Diabetes Care 2011;34 Suppl 1:S89-S96[PMID:21193633 DOI:10.2337/dc11-S089]
22 Agency for Healthcare Research Quality.Population Health:Behavioral and Social Science Insights:Understanding the Relationship Between Education and Health.2015..Available from:https://www.diabetes.org.uk/professionals/resources/resources-to-improve-your-clinical-practice/diabetes-self-management-education/
23 Diabetes UK.Diabetes self-management education.Available from:https://www.diabetes.org.uk/professionals/resources/resources-to-improve-your-clinical-practice/diabetes-self-management-education
24 Brooks AD.Patient-Centered Care in Type 2 Diabetes Mellitus.2016.Available from:https://www.accp.com/docs/bookstore/acsap/a16b1_sample.pdf/
25 World Health Organization.Model of Integrated Care for Patients with Type 2 Diabetes.A Guide for Health Care Professionals(Clinical Management Guidelines).2018.Available from:https://www.hse.ie/eng/about/who/cspd/ncps/diabetes/moc/model-of-integrated-care-type-2-diabetes-2018.pdf/
26 Ministry of Health Malaysia.National diabetes registry report 2009-2012.Available from:https://www.mendeley.com/catalogue/national-diabetes-registry-report/
2 World Health Organization.Global Report on Diabetes.2016.Available from:http://apps.who.int/iris/bitstream/10665/204871/1/9789241565257_eng.pdf?ua=1
3 Ministry of Health Malaysia.National Health and Morbidity Survey 2015.Available from:http://www.iku.gov.my/images/IKU/Document/REPORT/nhmsreport2015vol2.pdf
4 Ministry of Health Malaysia.National Health and Morbidity Survey,2015,NCD risk factors.Available from:http://www.mpoc.org.my/upload/Pn%20Zalma%20National%20Health%20and%20Morbidity%20Survey%20NCD%20Risk%20Factors.pdf
5 Cooper H,Booth K,Gill G.A trial of empowerment-based education in type 2 diabetes--global rather than glycaemic benefits.Diabetes Res Clin Pract 2008;82:165-171[PMID:18804887 DOI:10.1016/j.diabres.2008.07.013]
6 Funnell MM,Anderson RM,Arnold MS,Barr PA,Donnelly M,Johnson PD,Taylor-Moon D,White NH.Empowerment:an idea whose time has come in diabetes education.Diabetes Educ 1991;17:37-41[PMID:1986902 DOI:10.1177/014572179101700108]
7 Hernandez-Tejada MA,Campbell JA,Walker RJ,Smalls BL,Davis KS,Egede LE.Diabetes empowerment,medication adherence and self-care behaviors in adults with type 2 diabetes.Diabetes Technol Ther 2012;14:630-634[PMID:22524548 DOI:10.1089/dia.2011.0287]
8 Heinrich E,Schaper NC,de Vries NK.Self-management interventions for type 2 diabetes:a systematic review.2010.Available from:https://www.ncbi.nlm.nih.gov/books/NBK79914/
9 Tol A,Alhani F,Shojaeazadeh D,Sharifirad G,Moazam N.An empowering approach to promote the quality of life and self-management among type 2 diabetic patients.J Educ Health Promot 2015;4:13[PMID:25861658 DOI:10.4103/2277-9531.154022]
10 Liu MY,Tai YK,Hung WW,Hsieh MC,Wang RH.[Relationships between emotional distress,empowerment perception and self-care behavior and quality of life in patients with type 2 diabetes].Hu Li Za Zhi 2010;57:49-60[PMID:20401867]
11 Malay Mail.Malaysia's population stood at 32.6 million in Q4.2018.Available from:https://www.malaymail.com/news/malaysia/2019/02/12/malaysias-population-stood-at-32.6-million-in-q4-2018/
12 Social Research Methods.Types of Reliability.2019.Available from:https://socialresearchmethods.net/kb/reltypes.php/
13 Lance CE,Butts MM,Michels LC.The Sources of Four Commonly Reported Cutoff Criteria:What Did They Really Say?Organ Res Methods 2006;9:202-220[DOI:10.1177/1094428105284919]
14 Anderson RM,Funnell MM,Fitzgerald JT,Marrero DG.The Diabetes Empowerment Scale:a measure of psychosocial self-efficacy.Diabetes Care 2000;23:739-743[PMID:10840988 DOI:10.2337/diacare.23.6.739]
15 Gilpin EA,Pierce JP,Farkas AJ.Duration of smoking abstinence and success in quitting.J Natl Cancer Inst 1997;89:572-576[PMID:9106646 DOI:10.1093/jnci/89.8.572]
16 WHO Expert Consultation.Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies.Lancet 2004;363:157-163[PMID:14726171 DOI:10.1016/S0140-6736(03)15268-3]
17 Noshad S,Afarideh M,Heidari B,Mechanick JI,Esteghamati A.Diabetes Care in Iran:Where We Stand and Where We Are Headed.Ann Glob Health 2015;81:839-850[PMID:27108151 DOI:10.1016/j.aogh.2015.10.003]
18 Tol A,Baghbanian A,Sharifirad G,Shojaeizadeh D,Eslami A,Alhani F,Tehrani MM.Assessment of diabetic distress and disease related factors in patients with type 2 diabetes in Isfahan:A way to tailor an effective intervention planning in Isfahan-Iran.J Diabetes Metab Disord 2012;11:20[PMID:23497508DOI:10.1186/2251-6581-11-20]
19 D'Souza MS,Karkada SN,Hanrahan NP,Venkatesaperumal R,Amirtharaj A.Do Perceptions of Empowerment Affect Glycemic Control and Self-Care Among Adults with Type 2 Diabetes?Glob JHealth Sci 2015;7:80-90[PMID:26156908 DOI:10.5539/gjhs.v7n5p80]
20 DeWalt DA,Davis TC,Wallace AS,Seligman HK,Bryant-Shilliday B,Arnold CL,Freburger J,Schillinger D.Goal setting in diabetes self-management:taking the baby steps to success.Patient Educ Couns 2009;77:218-223[PMID:19359123 DOI:10.1016/j.pec.2009.03.012]
21 Funnell MM,Brown TL,Childs BP,Haas LB,Hosey GM,Jensen B,Maryniuk M,Peyrot M,Piette JD,Reader D,Siminerio LM,Weinger K,Weiss MA.National Standards for diabetes self-management education.Diabetes Care 2011;34 Suppl 1:S89-S96[PMID:21193633 DOI:10.2337/dc11-S089]
22 Agency for Healthcare Research Quality.Population Health:Behavioral and Social Science Insights:Understanding the Relationship Between Education and Health.2015..Available from:https://www.diabetes.org.uk/professionals/resources/resources-to-improve-your-clinical-practice/diabetes-self-management-education/
23 Diabetes UK.Diabetes self-management education.Available from:https://www.diabetes.org.uk/professionals/resources/resources-to-improve-your-clinical-practice/diabetes-self-management-education
24 Brooks AD.Patient-Centered Care in Type 2 Diabetes Mellitus.2016.Available from:https://www.accp.com/docs/bookstore/acsap/a16b1_sample.pdf/
25 World Health Organization.Model of Integrated Care for Patients with Type 2 Diabetes.A Guide for Health Care Professionals(Clinical Management Guidelines).2018.Available from:https://www.hse.ie/eng/about/who/cspd/ncps/diabetes/moc/model-of-integrated-care-type-2-diabetes-2018.pdf/
26 Ministry of Health Malaysia.National diabetes registry report 2009-2012.Available from:https://www.mendeley.com/catalogue/national-diabetes-registry-report/