Defining Self-Efficacy and Medical Adherence - Assignment Example

Self-efficacy and Medical adherence Introduction This review of literature gives a tabled summary of the of publication, the purpose, sample of participants and instrument for measuring self –efficacy, as well as the findings of each study. The 5 studies had their basis of type 2 diabetes mellitus, whereby 2 of the studies investigated on the effectiveness of self-efficacy programs for diabetes mellitus patients; while two other studies assessed the importance of patient education on self-care, while the last study evaluated on the factors that increased physical activity levels in diabetes mellitus patients (Shu-Fang et al, 2011). Additionally, a summary of the findings of the studies is provided together with a proposed idea to address a gap noted after analysis of the studies. Table1. Comparison of studies: Investigator(s) Purpose/Aim Sample of Participants and Instrument Used to Measure Self-Efficacy Findings Murano, I., Asakawa, Y.,Mizukami, M., Imai, T., Shimizu, K., & Takihara, J. Factors Increasing Physical Activity Levels in Diabetes Mellitus: A Survey of Patients after an Inpatient Diabetes Education Program N=101 type 2 diabetes mellitus patients who had completed an inpatient diabetes education program The levels of physical activity were evaluated with the short Japanese version of the International Physical Activity Questionnaire (IPAQ). Four variables; social support, job presence or absence, the stage of attitude change regarding exercise behaviour and farm work participation, or non-participation; accounted 34% of levels of physical activity in the patients Karakurt , P., & Kasıkçı, M.K. The effect of education given to patients with type 2 diabetes mellitus on self-careijn_2013 170..179 The research population included 100 patients with type 2 diabetes mellitus who met the inclusion criteria. Patients were subjected to a pretest using a patient identification form, Diabetes Self-Care Scale (DSCS) form in Turkish language and metabolic control parameters. A statistically significant difference was found between the mean values of pre-education and post-education DSCS scores with an increase in mean post-education scores. Shu-Fang, V., W., Mei-Chen, L., Shu-Yuan, L., Yu-Ying,. L., Tsae-Jyy, W., & Heng-Hsin, T. Effectiveness of a self-efficacy program for persons with diabetes: A randomized controlled trialnhs_625 335..343 (n = 145), with 72 participants in the intervention group and 73 in the control group. The measurement tools consisted of four structured questionnaires, including demographic characteristics, the Chinese version of the Diabetes Management Self-Efficacy Scale (C-DMSES), the Chinese version of the Perceived Therapeutic Efficacy Scale (C-PTES), and the Chinese version of the Summary of Diabetes Self-Care Activities (SDSCA) scale The scores for efficacy and outcome expectations, and self-care activities had significantly increased in the intervention group at the 3 and 6 month follow-ups, when compared to those of the control group. at the 6 month follow-up. Mishalia, M., Omera, H. & Heymann, A.D. The importance of measuring self-efficacy in patients with diabetes N= 119 patients for 4 recommendations of treatment: exercise, diet, self-monitoring of blood glucose, and oral intake of medication, in correlation with the questionnaire of “resistance to treatment” and Self-Care of Heart Failure Index The higher the resistance to treatment score, the less confident the patient is in his or her ability to adhere with treatment recommendations. Moriyama, M., Nakano, M., Kuroe, Y., Nin, K., Niitani1, M. & Nakaya, T. Efficacy of a self-management education program for people with type 2 diabetes: Results of a 12 month trialjjns_120 51..64 N=65; 42 participants in the control and 23 in the intervention who satisfied the eligibility criteria and agreed to participate in the study. overall QOL scale was used for measuring psychosocial factors while the General Self-efficacy scale was for measuring self- confidence and accomplishment the stages of diet and exercise, self-efficacy,HbA1c,diastolic blood pressure, total cholesterol levels and quality of life were significant upon repeated measures of two-way ANOVA Literature analysis Purpose of studies; similar or different? Some of the aims of the studies were similar while in some studies, the aims and purpose of the studies were varied: ranging from evaluating the effectiveness of self-efficacy program, investigating the factors which lead to increased physical activity in the improvement of glycemia control in diabetes mellitus patients, and investigating the role of patient education n in enhancement of self management ability] and behavior as well as self-care (Karakurt et al, 2012) Is the research current? An analysis of the research literature shows that the research is current. The time span ranges from 2009 to 2014.This review of self-efficacy and medical adherence of diabetes includes 5 research studies. Each of the journals has different authors: No author appears to have contributed in writing more than one journal (Moriyam, 2009). The following is an in-depth analysis based on the details of each journal; starting with the most recent, as is presented in the table above. Name of journal; where published 1. Murano, I., Asakawa, Y.,Mizukami, M., Imai, T., Shimizu, K., & Takihara, J. (2014). Factors Increasing Physical Activity Levels in Diabetes Mellitus: A Survey of Patients after an Inpatient Diabetes Education Program. Journal of Physical Therapy Science, 26 (6), 695-9. Sample size adequacy Subjects eligible for this study were recruited from type 2 diabetes mellitus patients receiving outpatient treatment at Endocrinology department kin Kyodo General Hospital. Those patients who had participated in education program for diabetes inpatients more than 6 months prior to the study; without any altered lifestyle habits and not in subjection to marked physical activity restrictions (Murano et al, 2014). Purpose and method description was given to each subject and the survey conducted after the signing of consent forms by the participants. The protocol of the study underwent approval by the Ethics Committee. Among 115 outpatients meeting the selection criteria with positive consent, 14 were excluded from the study and the remaining number of subjects that were cooperative was 101(87.8%) Type of participants The participants had the following characteristics: Ethnicity-Chinese, Age between 50-72years,53 male and 48 female; Body Mass Index-20-30kg per square meter; Body pain was present in 44 participants and absent in 57; presence of exercise behavior-60 present, 41 absent; marital status-83 married and 18 single; mean number of household members(1-5); those with an occupation-50 while those without-51 ( Murano et al, 2014). Instruments A questionnaire that listed psychosocial and physical factors and conducted consenting survey of subjects through interview and mailing methods were used. The levels of physical activity were evaluated with the short Japanese version of the International Physical Activity Questionnaire (IPAQ).glycaemia control was assessed with the haemoglobin A1c (HbA1c) value. Physical and psychosocial factors were assessed through the inquiry of patient characteristics (Murano et al, 2014) Main item of investigation The survey assessed the levels of physical activity basing on the questionnaire of the International Physical Activity (IPAQ) and another questionnaire that lists psychosocial and physical factors (Murano et al, 2014) 2. 2. Karakurt , P., & Kasıkçı, M.K. (2012). The effect of education given to patients with type 2 diabetes mellitus on self-care: Blackwell publishing. International Journal of Nursing Practice, 18 (2), 170-9. Sample size adequacy The population under research included type 2 diabetes mellitus patients who applied to the outpatient clinics of the internal medicine in blocks A and B of Erzincan state Hospital and met the eligibility criteria. The study included 119 patients meeting the eligibility criteria and that volunteered for random research. (Karakurt et al, 2012)The study was complete with 100 patients since 8 patients moved to a different city; 1 of the patient was hospitalized while10 withdrew from the scheduled education. Type of patients The selection criteria of the study group considered the following patient characteristics: Turkish, being literate, residence in central Erzincan, without serious complications, open to cooperation and communication, without a psychiatric illness history, outpatient and a volunteer in participating in the research (Karakurt et al, 2012) Instruments The use of a patient identification form shows information about the patient’s characteristics: gender, age, education status and disease-related information. Additionally, the form of metabolic control parameters includes variables like lipids, high and low-density lipoprotein, HbA1c, blood pressure, waist circumference and body mass index. Arterial blood pressure of the type 2 diabetes patients was recorded using 12 by 35cm sleeved measurement device of blood pressure for adults. Moreover, the diabetes self-care scale (DSCS) was used to measure the efficacy of self-care activities (Karakurt et al, 2012). Main item of investigation This research was done as a pre test-post test experiment of a single group in determining effect of education on patient’s self care. Patients were subjected towards pre-test with an identification form for patients, DSCS scale and metabolic control parameters. (Karakurt et al, 2012) 3. Shu-Fang, V., W., Mei-Chen, L., Shu-Yuan, L., Yu-Ying,. L., Tsae-Jyy, W., & Heng- Hsin, T. (2011). effectiveness of a self efficacy program for persons with diabetes: A randomized control trial. Nurs Health Sci, 13 (3), 335-43. doi: 10.1111/j.1442-2018.2011.00625.x. Types of participants Eligibility Criteria for individuals to take part in the study was if they were aged more than 30 years, had an oral regimen of medication, satisfied type 2 diabetes clinical criteria, understood and spoke Taiwanese or Japanese, and in possession of a telephone in their place of residence with the ability to effectively use it. The exclusion criterion was if the individuals had major complications which would interfere with self-care, for instance severe stroke, kidney analysis, visual or cognitive impairment (Shu Fang et al, 2011). Sample size A power analysis of statistics was used in the calculation of the required sample size. The design of repeated measures in this study consisted of two groups, 69 participants each, in a total of 139 participants. Each of the participants was measured thrice. The standard deviation between participants was 18.78, while within participants was 16.26; achieving 87% power upon a F-test at a significant level of 5%. A multistage method of sampling was chosen for a total of 140 participants with 70, in each group.173 persons met the inclusion criteria and 158 of them agreed to participate. Finally, they were 73 and 72 in the intervention and control groups respectively (Shu Fang et al, 2011). Instruments The measurement tools comprised of four structured questionnaires with the inclusion of demographic characteristics, Chinese version of Diabetes self-efficacy scale(C-DMSES), Perceived therapeutic scale of efficacy(C-PTES) and a scale on summary of Diabetes self-care activities (SDSCA) (Shu Fang et al, 2011). Main item of investigation The participants underwent pre-tests to establish a base, and post tests were performed 3, and 6, months after collection of baseline data. Participants in the intervention group were given a standard education program and additional self-efficacy program (Shu Fang et al, 2011). 4. 4. Mishalia, M., Omera, H. & Heymann, A.D. (2010). The importance of measuring self efficacy in patients with diabetes. Cary, NC: Oxford University Press Instruments Self-efficacy questionnaires underwent measurement against four treatment recommendations: self monitoring, blood glucose, oral medication intake, diet and physical activity. These questionnaires assessed the degree of competency of participants in following treatment recommendations in different situations such as exercising. For each item, a Likert scale of five-point was used by the participants to indicate their level of confidence and ability to follow the treatment recommendation (Mishalia et al, 2010). Type of participants Patients were recruited by 80 health care workers including social workers, dieticians and psychologists working in diabetic cared clinics that are community-based in Israel. All diabetic patients were eligible for inclusion. The exclusion criteria, was the inability of patients to fill the questionnaire as a result of the difficulty in language or visualizing. All patients were approached by known health professionals who sought their consent and upon agreeing to participate, signed the consent forms (Mishalia et al, 2010). Sample size adequacy A total of 119 patients; 67 women, 52 men participated in the study and the mean age was 57.45 years (Mishalia et al, 2010). Main item of investigation This study was designed to assess the relationship between low self efficacy in self-care treatment recommendations and decreased adherence to each specific recommendation. The self-efficacy measurements were done in 119 patients for 4 recommendations of treatment: exercise, diet, self-monitoring of blood glucose, and oral intake of medication, in correlation with the questionnaire of “resistance to treatment” (Mishalia et al, 2010). 5. Moriyama, M., Nakano, M., Kuroe, Y., Nin, K., Niitani1, M. & Nakaya, T. (2009). Efficacy of a self-management education program for people with type 2 diabetes: Results of a 12 month trial: Japan Journal of Nursing Science, 6(1), 51- 63. DOI: 10.1111/j.1742-7924.2009.00120.x ns Type of participants This program enrolled outpatient type 2 diabetes patients who had consulted physicians in two hospitals, with less than 200 beds, and consented the participation in the study. The inclusion or exclusion criteria were: Japanese, not pregnant, no bar on age, sex or treatment regimen, not cognitively impaired and without a diagnosis of a psychiatric disorder that includes severe depression, cardiac disorder, renal failure, diabetic gangrene (Moriyama et al, 2009). Instruments The points and indicators of evaluation were based on opinions and clinical guidelines of specialist physicians. The blood pressure, weight, abdominal circumference, Hb1Ac and fasting blood glucose were measured before and each month after the intervention. Moreover, total cholesterol and serum triglyceride levels underwent measurement before and three months after intervention. Measurement of the psychological indicators was conducted using two items in the overall QOL scale and the General Self-efficacy scale for measuring self- confidence and accomplishment. In evaluating the psychological state, the participants determined their preparatory state in respect to their exercise habits and dietary control before and every month after intervention: maintenance- 1point, action-2 points, preparation-3 points, contemplation-4 points, pre-contemplation-5 points. Additionally, the participants evaluated their degree of attaining their goal for exercise and diet with 0-100 points. The higher the scores in terms of points, the higher the achievement level of their goals (Moriyama et al, 2009). Sample size adequacy Of participants that were referred by attending physicians 25 in the control and 50 in the intervention group satisfied the eligibility criteria and agreed to participate in the study. Finally, the intervention group comprised of 42 participants while the control group had 23 participants that were included in the set of analysis. The completion rate of the program was thus 84.0% ( Moriyama et al, 2009). Main item of investigation A 12-month education program on self-management for type-2 diabetes was conducted based on a 6-month previous program and its efficacy was examined. A randomized controlled trial was done on type 2 diabetes outpatients meeting the inclusion criteria and those who gave consent for participation. These patients were randomly divided into intervention and control group which followed normal clinical practise. The group under intervention received monthly interviews of less than 30 minutes based on the program and calls from the educating nurse throughout the year (Moriyama et al, 2009). Overall quality of the studies One of the studies revealed that a program on self-efficacy was effective and acceptable, short term in self-management of type 2 diabetes patients (Karakurt et al, 2012). Another study proved that interventions such as promoting exercise behavior, social support and practical utilization of the living environments may deem effective in aiding to improve the control of glycemia.(Isamu et al,2014)The complication prevention behaviors depicted a high rate of implementation in the group under intervention (Shu Fang et al, 2011). The overall program evaluation was high and the participants recognized the high need for the program. Moreover, the higher the score of resistance to treatment, the less confident the patient in adhering to treatment recommendations. However, this pattern was absent in medical intake adherence (Mishalia et al, 2010). In summary, Four variables; social support, job presence or absence, the stage of attitude change regarding exercise behaviour and farm work participation, or non-participation; accounted 34% of levels of physical activity in the patients Scores for outcome and efficacy expectations, and self-care activities increased in the group under intervention at three and six month follow-ups in comparison to the control group. A small proportion of participants in intervention group than the control group, were hospitalized or visited the emergency room during the follow-ups. The correlation between diet and physical activity with self-efficacy was 0.67 and 0.5, respectively. The implication is that the higher the treatment score resistance, the less confident is the patient in adherence ability with treatment recommendations and finally the stages of diet and exercise, self-efficacy,HbA1c,diastolic blood pressure, total cholesterol levels and quality of life were significant upon repeated measures of two-way ANOVA. For changes over time, the intervention group only showed significant differences through Friedman test and thus the prevention behaviors of complications showed high rate of implementation in the group under intervention. Proposal Title of proposal Extension of education programs of researches to be conducted over longer periods of time with the inclusion of smaller sample groups and increase of awareness about the issue. Introduction According to the studies analyzed, significant limitations emanate out of most of the studies, including: indirect as opposed to direct measurement of treatment cooperation of patients, choosing of study participants by their own health care providers and might not be representative of the whole population that are in need of treatment with low self efficacy (Mishalia et al, 2010). Randomized control trial has the limitation of unreliability of participants hence their data may not be obtained. The other limitation is that participants were only followed-up for a short time of 6 months. This length of study wasn’t sufficient in examining lasting effects of a self efficacy education program (Karakurt et al, 2012). Longer follow-up studies are thus needed to determine the sustenance of benefits over the disease life course. The idea that I am proposing is the extension of education research programs on a similar case over a long time, and in a manner that includes a smaller sample group, and increasing the awareness about this issue (Moriyama et al, 2009). Sample size A smaller sample size of between 50 and 70 participants should be used for ease of follow-up activities. A random sampling should be conducted to ensure that the final participants are representative of the total population under study (Moriyama et al, 2009). Type of participants Eligibility Criteria for individuals to take part in the study will be if they age more than 30 years, have an oral regimen of medication, satisfied type 2 diabetes clinical criteria, and in possession of a telephone in their place of residence with the ability to effectively use it (Shu Fang et al, 2011). The exclusion criterion will be if the individuals had major complications which would interfere with self-care, for instance, severe stroke, kidney analysis, visual or cognitive impairment. Instruments used The instruments to be used in the study include: structured questionnaires, diabetes self efficacy sales and metabolic control parameters (Karakurt et al). Importance of study This study is important in establishing the effect of a long term intervention in diabetic or glycemic control. Due to the representation of a smaller sample size, the program is effective over a long follow-up period (Mishalia et al, 2010). Conclusion In conclusion, Self-efficacy impacts on treatment adherence and, thus plays a crucial role in clinical outcome. The implication practically is that, evaluation of self-efficacy in diabetic patients may aid in developing individually tailored interventions. The results showed that patient education enhances self-management ability and self-care in the improvement of glycemia control. Moreover, physical activity is directly proportional to glycemia control. The difference of pre-education and post-education scores on the diabetes scales was highly significant, which shows that education awarded to patients had a positive impact on the self-care activities. A difference of statistical significance was achieved between pre-education and post-education mean values, with increased post-education mean DSCS scores. These results demonstrate the effectiveness of educating patients in the improvement of their metabolic control variables and self care. References Karakurt , P., & Kasıkçı, M.K. (2012). The effect of education given to patients with type 2 diabetes mellitus on self-care: Blackwell publishing. International Journal of Nursing Practice, 18 (2), 170-9. Mishalia, M., Omera, H. & Heymann, A.D. (2010). The importance of measuring self efficacy in patients with diabetes. Cary, NC: Oxford University Press Moriyama, M., Nakano, M., Kuroe, Y., Nin, K., Niitani1, M. & Nakaya, T. (2009). Efficacy of a self-management education program for people with type 2 diabetes: Results of a 12 month trial: Japan Journal of Nursing Science, 6(1), 51- 63. DOI: 10.1111/j.1742- 7924.2009.00120.x Murano, I., Asakawa, Y.,Mizukami, M., Imai, T., Shimizu, K., & Takihara, J. (2014). Factors Increasing Physical Activity Levels in Diabetes Mellitus: A Survey of Patients after an Inpatient Diabetes Education Program. Journal of Physical Therapy Science, 26 (6), 695-9. Shu-Fang, V., W., Mei-Chen, L., Shu-Yuan, L., Yu-Ying,. L., Tsae-Jyy, W., & Heng- Hsin, T. (2011). effectiveness of a self efficacy program for persons with diabetes: A randomized control trial. Nurs Health Sci, 13 (3), 335-43. doi: 10.1111/j.1442- 2018.2011.00625.x. Read More