Self-Efficacy Tools in the Management of Diabetes Mellitus - Assignment Example

Self-Efficacy Tools in the Management of Diabetes Mellitus Introduction Persistent hyperglycemia is one of the major predictors for the development of diabetes mellitus. Further if the hyperglycemic condition is not managed it can aggravate diabetic complications like injury to the microvasculature and microvasculature in the form o f retinopathy or neuropathy. Hence achievement of tight glycemic control is of utmost importance for the management of diabetes mellitus. Diabetes mellitus is a metabolic disease where a person shows increased blood sugar levels. Diabetes mellitus is primarily classified into two types which are called Type I or Type II diabetes mellitus (Albisser, Harris, Albisser & Sperlich, 2001) (Spellman, 2009). In Type 1 diabetes mellitus there is an autoimmune destruction of the pancreatic beta cells and insulin is not synthesized in adequate amounts. While in case of Type II diabetes mellitus, the liberated insulin fails to act due to dysfunction of insulin receptor and hence GLUT 4 transporters are not up regulated on the cell membrane from the cytoplasm. Under this condition glucose cannot enter the cells and cannot be used a source of energy, which leads to the breakdown of alternate sources like protein and fats in the cells. Further increased blood glucose creates an increased osmotic gradient and diuresis occurs in the renal tubules and patient offer suffers from hypovolemic shock (Albisser et al., 2001) (Spellman, 2009). Background Although various factors both external and internal contributes to the increased levels of blood glucose in the body, it has been widely accepted that proper self care and life-style modifications do alleviate the complications of both Type I or Type II diabetes mellitus(Albisser et al., 2001) (Spellman, 2009). Psychosocial factors like depression and emotional issues have been correlated with self care behaviors and have shown to negatively impact the glycemic control. Studies have also reflected the associations between emotional condition and self care behaviors that negatively impact HB1Ac levels (Cohen, Shmukler, Ullman, Rivera & Walker, 2010). The associations between the self care activities and diabetic control are measured by regression equations which predict the value of one variable from the value of another and also the way one variable impacts another variable positively or negatively (Michelis et al., 2010). With these guiding principles a group of community clinicians noted an increase in the prevalence of hyperglycemia and other complications of diabetes mellitus. After reviewing the patient history they came to the conclusion that life style factors like eating habits and compliance to medication are amongst the most important factors that is necessary for the management of the disease. These physicians further reviewed the fact that community awareness programs delivered to the patients/subjects in an individualistic manner could improve their life style habits and compliance to medication. In order to adjudicate proper care these physicians developed and implemented a project plan for increasing dietary and medical compliance in the target group which comprised the clients diagnosed with diabetes mellitus. Metric Tool Used For Data Collection The Clinicians used the Self Efficacy Diabetic Tool from the Stanford Patient Education Research Centre (Appendix-1). This tool comprised of a series of questions that measured various aspects of self efficacy and knowledge level of the patients on a 1 to 10 point scale in relation diabetic care. The qualitative aspect of each question rubric is provided in Appendix-2 .Low scores indicated that qualitative score on the particular self efficacy aspect was low and vice versa. The clinicians’ trained the individual patients diagnosed with diabetes through audio-visual and other modalities as an individualistic approach. The self efficacy scores and the blood sugar levels were collected prior to the intervention and after the intervention to judge the efficacy of the tool and also the intervention. To judge the efficacy of the tool and the relevance of the questionnaire method, a regression equation was constructed with the self efficacy variables as the independent variables and the blood sugar level as the dependant variable. An observation of p value with less than 0.05 was considered significant which meant improvement of that particular self efficacy question has impacted the blood sugar levels and the direction also( that is increased it or decreased it) and bias of the observation happening due to chance factors are minimal. To appreciate the level and quality of intervention rendered, a “t test” was undertaken between the two group mean of the self efficacy scores before and after intervention and once again p value with less than 0.05 was considered significant which meant change of that particular self efficacy has taken due to intervention strategy and bias of the observation happening due to chance factors are minimal. Female subjects were excluded from the study to eliminate gender variations. Participants The purposive sampling methodology was used to collect samples at random on a first come first served basis to the clinic that had a minimum blood sugar level of beyond 140mg/dl. 15 subjects were considered for the study and their scores and sugar levels prior and after intervention are provided in Appendix-3(excel 2) Results: Intended Outcome compared to the Actual outcome Fig1: Indicates mean blood sugar level before and after intervention Fig2: Indicates mean self efficacy scores before and after intervention Effectiveness of Intervention As the authors made a review of literature they found that administering intervention approach like these improves efficacy of self efficacy scores by 20% was also confirmed by our study where there was increase of 28% in the efficacy of self efficacy scores. We showed that self efficacy scores significantly improved before and after intervention (Fig 2).Further improvement of scores were significantly related to improved glycemic control (Fig 1). Potential Financial Implications The potential financial implications that were judged was the investments in recruitment of healthcare workers, additional costs of audio-visual support systems and Wi-Fi charges to create the non face to face interface between patient and healthcare workers. Limitations The potential limitations that I noted was the bias in the patients regarding self assessment and hence I feel some sort of blinding was required and the coding of questions could have been done in the reverse pattern to eliminate bias. Future Considerations Self efficacy tools should be encouraged to be used in out patient departments; however the Self efficacy tools should be complemented with diagnostic procedures to judge their efficacy in managing diabetes from a self-oriented approach to reduce any bias in self efficacy questionnaire response. Conclusion It can be inferred that self efficacy tools should be widely accepted for the proper self care and life-style modifications do alleviate the complications of both Type I or Type II diabetes mellitus. Diagnostic procedures should be advocated where there is a doubt in the mind of the clinician regarding the self efficacy response from the client. The question four of the self efficacy scale had the greatest percent change of 25% which meant that the awareness created by intervention motivated the individuals to follow a proper and regular exercise regime. However question 8 had the least percentage change of round 13% which indicated that individuals do not rely on their self abilities for managing diabetes rather they rely on the healthcare support systems. References Albisser, A., Harris, R., Albisser, J., & Sperlich, M. (2001).The impact of initiatives in education, self-management training, and computer-assisted self-care on outcomes in diabetes disease management. Diabetes Technol Ther, 3:571–579. Cohen, H., Shmukler, C., Ullman, R., Rivera, C., & Walker, E. (2010) Measurements of Medication Adherence in Diabetic Patients with Poorly Controlled HbA (1c). Diabet Med, 27:210–216. Michels, M., Coral, M., Sakae, T., Damas, T., & Furlanetto, L. (2010). Questionnaire of Diabetes Self-Care Activities: translation, cross-cultural adaptation and evaluation of psychometric properties. Arq Bras Endocrinol Metabol, 54:644–651. Spellman, C. (2009). Achieving glycemic control: cornerstone in the treatment of patients with multiple metabolic risk factors. J Am Osteopath Assoc, 109(Suppl 5):8–13. Read More