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.
Journal of military pharmaco-medicine no7-2019 CHANGING SELF-CARE KNOWLEDGE OF THE OUTPATIENTS WITH TYPE DIABETES HAVING TREATMENT AT YENBAI PROVINCAL HOSPITAL OF ENDOCRINOLOGY IN 2018 AFTER HEALTH INTERVENTION Vu Thi Huong Nhai1; Vu Van Thanh2 SUMMARY Objectives: To evaluate the change of self-care knowledge of the outpatients with type 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 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 - 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 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 diabetes having treatment at in Yenbai Provincial Hospital of Endocrinology was improved significantly after health education * Keywords: Type 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 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 seconds and every 30 seconds a person is amputated because of diabetes [9] Most countries have to spend - 20% of total health expenditure on diabetes [9] Yenbai Medical College Namdinh University of Nursing Corresponding author: Vu Van Thanh (vuthanhdhdd@gmail.com) Date received: 20/07/2019 Date accepted: 26/08/2019 87 Journal of military pharmaco-medicine no7-2019 Studies have shown that patients play a key role in disease management and a reasonable educational intervention program will contribute to improve selfcare 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 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 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 diabetes having treatment at Yenbai Provincial Hospital of Endocrinology in 2018 after being trained about health SUBJECTS AND METHODS Subjects - Selection criteria: Patients aged 18 and older were diagnosed with type diabetes within one year of the time of data collection; being on outpatient 88 treatment at Yenbai Provincial Hospital of Endocrinology for at least 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 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: Z (1 − α ) n= p (1 − p ) + Z (1 − β ) ( p0 − p1 ) p1 (1 − p1 ) 2 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 selfcare 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 Journal of military pharmaco-medicine no7-2019 - Sampling method: Convenient sample selection Select all patients diagnosed with type 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 point Each answer is incorrect or does not know the answer is points The maximum total score is 30 points The total score is presented as a percentage (%) Self-care knowledge will be divided into 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 collaborators are 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 month + Step 4: The patients who had received calling before days to remind their appointment for the second interview Investigate the self-care knowledge of the research subjects after 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 diabetes, using communication materials and leaflets developed by researchers based on professional documents Guidelines for diagnosis and treatment of type 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 diabetes 89 Journal of military pharmaco-medicine no7-2019 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 General characteristics of the subjects Among 108 research subjects of type 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 diabetes people who had a low education level accounted for high rate 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 (max) Before intervention 17.3 ± 3.6 25 After intervention 25.2 ± 2.8 16 30 p < 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 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 90 Journal of military pharmaco-medicine no7-2019 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 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 diabetes who were diagnosed with the disease within year were selected and in the study by Nguyen Vu Huyen Anh, but the proportion of study subjects with time ≤ year only accounted for 11.7% [1] However, there was a significant change in point of self-care knowledge of people with type 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, selfcare 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 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 Before intervention (%) After intervention (%) The relationship between frequency of blood sugar level monitoring and physical activity 72.2 87.0 Understanding the frequency of physical activity 93.5 96.3 Understanding the intensity of physical activity 43.5 78.7 Should have a snack before going to bed 24.1 75.9 Classify food according to blood sugar index 54.6 82.4 Fulfill the schedule of meals 53.7 80.6 Content Physical activity Diet 91 Journal of military pharmaco-medicine no7-2019 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 Daily dental care is essential 86.1 90.7 Not only health workers can check blood sugar and blood pressure for patients 22.2 75.9 Frequency of self-monitoring of blood sugar 26.9 74.1 Self-monitoring of blood sugar 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 selfmonitoring 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 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 Content 92 Journal of military pharmaco-medicine no7-2019 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 Before intervention (%) After intervention (%) Symptoms of neurological complications appear in the feet 49.1 82.4 Signs of hypoglycemia 24.1 75.0 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 Content 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 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 diabetes patients CONCLUSION The self-care knowledge of people with type 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 Nguyen Vu Huyen Anh Assessing selfcare knowledge of type diabetes patients in Dienbien Provincial General Hospital Master's Thesis in Nursing Namdinh University of Nursing 2016 Yenbai Hospital of Endocrinology Report on the implementation of tasks in the first months of 2017 Yenbai October 2017 93 Journal of military pharmaco-medicine no7-2019 Electronic Portal of Yenbai Province Yenbai ethnic groups, at the website http://www.yenbai.gov.vn/Pages/Cac-dan-tocYen-Bai.aspx?l=CacdantocYenBai, accessed on 28/5/2018 2016 Vu Thi Tuyet Mai, Jane Dimmitt Champion, Tran Thien Trung Knowledge, attitudes and practices on diets of type diabetes Hochiminh City Journal of Medicine Hochiminh 2014, 18 (5), pp.136-141 Nguyen Thi Thu Thao, Nguyen Thanh Minh Assessing the impact of educational communication on knowledge, practical attitudes and control indicators on people with diabetes mellitus Hochiminh City Journal of Medicine Hochiminh 2009, 13 (6), pp.71-78 Adibe M, Aguwa C, Ukwe C et al Diabetes self-care knowledge among type diabetic outpatients in south-eastern Nigeria J Drug Dev Res 2009, (1), pp.85-104 Deepali B.S, Subramanian M, Soumya G et al Knowledge of diabetes, its complications and treatment adherence among diabetic patients International Journal Of Community Medicine And Public Health 2017, (7), pp.2428-2434 94 International Diabetes Federation IDF diabetes atlas seventh edition 1st, ed, Karakas Print, Brussels 2015, 350, pp.362-367 International Diabetes Federation IDF diabetes atlas eighth edition 1st, ed Belgium, Brussels 2017, pp.9-48 10 Jackson I.L, Adibe M.O, Okonta M.J et al Knowledge of self-care among type diabetes patients in two states of Nigeria Pharmacy Practice 2014, 12 (3), p.404 11 Parchman M.L, Flannagan D, Ferrer R.L et al Communication competence, selfcare behaviors and glucose control in patients with type diabetes Patient Education and Counseling 2009, 77, pp.55-59 12 Pereira D.A, Costa N.M, Sousa A.L et al The effect of educational intervention on the disease knowledge of diabetes mellitus patients Revista Latino-Americana de Enfermagem 2012, 20, pp.478-485 13 RamBihariLal S.S, Saurabh S.P Role of self-care in management of diabetes mellitus Journal of Diabetes & Metabolic Disorders 2013, 12 (1), p.14 ... To evaluate the change of self-care knowledge of the outpatients with type diabetes having treatment at Yenbai Provincial Hospital of Endocrinology in 20 18 after being trained about health SUBJECTS... knowledge of people with type diabetes in outpatient treatment at Yenbai Provincial Hospital of Endocrinology had been significantly improved after health education: The rate of patients with knowledge. .. patients with type 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