The Effect of Mandala Coloring in Type-2 Diabetes Patients

The Effect of Mandala Coloring on Perceived Stress and Anxiety Levels in Type-2 Diabetes Patients: Randomized Controlled Study

THIS RESEARCH was planned to examine the effect of mandala painting on the perceived stress and anxiety levels of type-2 diabetic patients.

Study Overview

• Status: Completed
• Conditions: Type-2 Diabetic Patients; Mandala Painting
• Intervention / Treatment: Behavioral: mandala painting

Detailed Description

Diabetes is a frequently encountered chronic metabolic disease characterized by increased plasma glucose levels as a result of inadequate insulin secretion and/or increased insulin resistance. The most common type of diabetes is type-2 diabetes, accounting for approximately 90% of all cases. Type 2 diabetes is more common in middle and older ages, but today it is also seen in children and young adults due to negative changes in lifestyle habits.

Diabetes is typically a manageable disease through lifestyle changes and treatment. However, diabetes care can create additional stress for people with diabetes due to the never-ending demands of maintaining nutritional and physical health, exercising, monitoring blood sugar, regular monitoring, and managing fears about the reality of symptoms and complications. As a result, they experience feelings of depression, anxiety, and stress, which affects their health and overall quality of life. Patients with diabetes have significantly higher levels of anxiety and depression than the general population. The coexistence of diabetes and anxiety and stress results in poor glycemic control and self-management, increases the risk of diabetes complications, and reduces overall quality of life and life expectancy. Therefore, prevention, early recognition and treatment of these conditions are necessary to achieve optimal goals in the management and overall quality of life of patients.

A holistic approach should be adopted when planning the care practices of patients during this difficult period, and non-pharmacological practices should be planned, especially those that will allow the patient to perform daily life activities with minimum energy and maximum function. Mandala painting, one of the non-pharmacological practices, is an art therapy technique that can provide psychological support and healing. This circular art has traditionally been used for meditation in various Eastern cultures and is a symbol of psychological wholeness. Mandala coloring is a safe and accessible activity that does not require any special skills and can be used as a complementary strategy to support mental health. It is stated in the literature that painting mandalas improves psychological symptoms and relaxes the person. The artistic perspective of nursing is to understand the individual's needs, sources of worry, anxiety and stress, and then to develop practices that will increase his self-confidence and resilience by increasing his level of capability and competence. For this reason, this study was planned to examine the effect of mandala painting on the perceived stress and anxiety levels of Type-2 diabetic patients.

• Study Type: Interventional
• Enrollment (Actual): 92
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Elazıg, Turkey
    • Firat University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Being between the ages of 18 and 65

  • Having been diagnosed with Type-2 diabetes for at least 6 months
  • Being an inpatient in the endocrine clinic for at least 7 days
  • Not having a physical problem that would prevent painting mandalas (vision, hearing, etc.)

Exclusion Criteria:

• Not being able to use his hands actively
• Having a communication problem
• Having a learning problem

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Experimental:mandala painting; Patients in this group will be subjected to mandala painting.	Behavioral: mandala painting; Patients in this group will be subjected to mandala painting.
No Intervention: Control; Patients in this group will not be subjected to mandala painting.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Perceived Stress Scale	The Perceived Stress Scale was developed by Cohen, Kamarck and Mermelstein in 1983 to determine the level of stress that threatens human health. Turkish validity and reliability were determined by Eskin et al. (2013). The scale is a 5-point Likert type scale and consists of 14 items. As the scores obtained from the scale increase, the level of stress perceived by the person also increases. PSS scores vary between 0 and 56, with 0-35 points indicating normal stress level and 35-56 points indicating that the individual is under stress.	after 7 days
State-Trait Anxiety Scale	The State-Trait Anxiety Scale was developed by Spielberger et al. (1970). The validity and reliability of the scale in Turkey was determined by Öner and Le Compte (1983). The scale consists of two parts: State Anxiety Scale and Trait Anxiety Scale. The first 20 items evaluate situational anxiety, and the last 20 items evaluate trait anxiety. In this study, the scores obtained from the Scale, which is the first 20 items to evaluate situation-related anxiety, range between 20 and 80. Higher scores indicate higher levels of anxiety.	after 7 days

Collaborators and Investigators

• Sponsor: Ataturk University

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2023
• Primary Completion (Actual): May 25, 2024
• Study Completion (Actual): December 1, 2024

Study Registration Dates

• First Submitted: October 5, 2023
• First Submitted That Met QC Criteria: October 5, 2023
• First Posted (Actual): October 11, 2023

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: February 12, 2025
• Last Verified: February 1, 2025

More Information

Terms related to this study

• Other Study ID Numbers: 2023/ 12 - 41

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No