An intervention to improve self-care among people with diabetes mellitus: A quasi-experimental study

Abstract

Abstract Background An increased self-efficacy promotes better diabetes self-care behaviours, which help in achieving glycemic targets among patients with diabetes mellitus. Methods A quasi-experimental study was conducted among patients with T2DM living in rural areas of Punjab, North India. A total of 283 in the intervention and 291 in the control arms were participated at baseline, and a total of 242 in the intervention and 237 in the control arms at endline assessments. Summary of diabetes self-care activities and diabetes management self-efficacy questionnaires were used at baseline and endline (after 6 months) surveys. Outcomes were net changes in proportion of population having diabetes self-management self-efficacy, overall diabetes self-care activities (health dietary habits, physical activity, adequate foot care, medication adherence and blood glucose monitoring) and net mean change in HbA1c. Data were analysed using per protocol analysis principle. Difference in difference analysis (DiD) using Generalized Estimating Equation model was done to adjust for confounders. p < 0.05 was considered as significant. Results There was a significant net increase in participants proportion (39%; 95% CI: 25% -52%, p < 0.001) on diabetes management self-efficacy scale. At the baseline assessment for overall self-care behaviours, only 4% of participants in the intervention arm were in the action stage and 12% were in the preparation stage; however, at the post intervention assessment, this proportion increased to 24% for action stage and 67% for preparation stage. There was a significant net increase in participants proportion (49%, 95%CI 37% -60%, p < 0.001) engaged in optimal diabetes self-care. There was a significant net decrease in mean HbA1c (-1.06%; 95%CI: -1.62 - -0.50, p < 0.001) at post intervention phase. Conclusions Diabetes self-care intervention was successful in promoting self-efficacy and self-care practices among patients with T2DM of rural areas. Key messages • Self-efficacy theory-based diabetes self-care intervention successfully improves the diabetes related self-care practices. • There is a need for a structured diabetes self-care management education programme to improve the ability of patients with T2DM who live in rural areas.