The effects of self-efficacy enhancing program on foot self-care behaviour of older adults with diabetes: A randomised controlled trial in elderly care facility, Peninsular Malaysia

Siti Khuzaimah Ahmad Sharoni, Hejar Abdul Rahman, Halimatus Sakdiah Minhat, Sazlina Shariff-Ghazali, Mohd Hanafi Azman Ong, Siti Khuzaimah Ahmad Sharoni, Hejar Abdul Rahman, Halimatus Sakdiah Minhat, Sazlina Shariff-Ghazali, Mohd Hanafi Azman Ong

Abstract

Background: Self-care behaviour is essential in preventing diabetes foot problems. This study aimed to evaluate the effectiveness of health education programs based on the self-efficacy theory on foot self-care behaviour for older adults with diabetes.

Methods: A randomised controlled trial was conducted for 12 weeks among older adults with diabetes in elderly care facility in Peninsular Malaysia. Six elderly care facility were randomly allocated by an independent person into two groups (intervention and control). The intervention group (three elderly care facility) received a health education program on foot self-care behaviour while the control group (three elderly care facility) received standard care. Participants were assessed at baseline, and at week-4 and week-12 follow-ups. The primary outcome was foot-self-care behaviour. Foot care self-efficacy (efficacy expectation), foot care outcome expectation, knowledge of foot care and quality of life were the secondary outcomes. Data were analysed with Mixed Design Analysis of Variance using the Statistical Package for the Social Sciences version 22.0.

Results: 184 respondents were recruited but only 76 met the selection criteria and were included in the analysis. Foot self-care behaviour, foot care self-efficacy (efficacy expectation), foot care outcome expectation and knowledge of foot care improved in the intervention group compared to the control group (p < 0.05). However, some of these improvements did not significantly differ compared to the control group for QoL physical symptoms and QoL psychosocial functioning (p > 0.05).

Conclusion: The self-efficacy enhancing program improved foot self-care behaviour with respect to the delivered program. It is expected that in the future, the self-efficacy theory can be incorporated into diabetes education to enhance foot self-care behaviour for elderly with diabetes living in other institutional care facilities.

Trial registration: Australian New Zealand Clinical Trial Registry ACTRN12616000210471.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Flow chart of enrolment, allocation,…
Fig 1. Flow chart of enrolment, allocation, follow up and analysis of the self-efficacy enhancing program on foot self-care behaviour of older adults with diabetes.
Fig 2
Fig 2
(a)—(f). The linear plot of the time effects for each variable across two groups.

References

    1. International Diabetes Federation (IDF). IDF Diabetes Atlas, 6 ed. 2013. [cited 2015 November 7]. Available from: .
    1. Litwak L, Goh SY, Hussein Z, Malek R, Prusty V, Khamseh ME. Prevalence of diabetes complications in people with type 2 diabetes mellitus and its association with baseline characteristics in the multinational A1chieve study. Diabetology & Metabolic Syndrome. 2013;5:57 doi:
    1. Maddux JE. Self-efficacy, adaptation, and adjustment: Theory, research and application. New York: Plenum Press; 1995.
    1. Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J. Self management approaches for people with chronic conditions: a review. Patient Education and Counselling. 2002;48:177–87.
    1. International Working Group on the Diabetic Foot. International consensus on the diabetic foot. 2014. [2016 March 28]. Available from: .
    1. Standards of medical care in diabetes; Microvascular complications and foot care. Diabetes Care. 2015;38:S56–S58. doi:
    1. Clinical Practice Guidelines Management of type 2 Diabetes Mellitus, 5 ed. Ministry of Health Malaysia; 2015. [2016March 28]. Available from: .
    1. Suhl E. Diabetes self-management education for older adults: general principles and practical application. Diabetes Care. 2006;19:234–40.
    1. Satoko N, Nozomi O, Masayuki M, Keigo S, Kenji O, Kimiko T, et al. Health-related Quality of Life (HRQOL) decreases independently of chronic conditions and geriatric syndromes in older adults with diabetes: The Fujiwara-kyo Study. Journal Epidemiology. 2014;24:259–66. doi:
    1. Bandura A. Self-efficacy In Ramachaudran V. S. (Ed.), Encyclopedia of human behavior (Vol. 4, pp. 71–81). New York: Academic Press; (Reprinted in H. Friedman [Ed.], Encyclopedia of mental health. San Diego: Academic Press, 1998. 1994. [2016 March 28]. Available from: .
    1. Bandura A. Self-efficacy: the exercise of control. New York; W. H. Freeman and Company; 1997.
    1. Lenz ER, Shortridge-Baggett LM. Self-efficacy in nursing: research and measurement perspectives. New York: Springer Publishing Company; 2002.
    1. Adam J, Folds L. Depression, self-efficacy, and adherence in patients with type 2 diabetes. The Journal for Nurse Practitioners. 2014;10:646–52. doi:
    1. Ministry of Health Guideline Group New Zealand. RapidE: Chronic care a systematic review of the literature on health behaviour change for chronic care. 2011. [2015August 25]. Available from: .
    1. Bandura A. Social cognitive theory. Annals of Child Development. 1989;6:1–85.
    1. Bandura A. Health promotion by social cognitive means. Health education & behavior: the official publication of the society for public health education. 2004;31:143–64. doi:
    1. Borges W, Ostwald S. Behaviors with Pies Sanos. Western Journal of Nursing Research. 2008;30:325–41. doi:
    1. Fan L, Sidani S, Cooper-Brathwaite A, Metcalfe K. Feasibility, acceptability and effects of a foot self-care educational intervention on minor foot problems in adult patients with diabetes at low risk foot ulceration: a pilot study. Canadian Journal of Diabetes. 2013;37:195–201. doi:
    1. Seyyedrasooli A, Parvan K, Valizadeh L, Rahmani A, Zare M, Izadi T. Self-efficacy in foot-care and effect of training: a single-blinded randomized controlled clinical trial. International Journal of Community Based Nursing and Midwifery. 2015;3:141–9.
    1. Dorresteijn JAN, Kriegsman DMW, Assendelft WJJ, Valk GD. Patient education for preventing diabetic foot ulceration. Cochrane Database of Systematic Reviews. 2014; 12:CD001488 doi:
    1. Fernando ME, Seneviratne RM, Tan YM, Lazzarini PA, Sangla KS, Cunningham M, et al. Intensive versus conventional glycaemic control for treating diabetic foot ulcers. Cochrane Database of Systematic Reviews. 2016;1: CD010764 doi:
    1. Institute for Public Health (IPH) 2015. National Health and Morbidity Survey 2015 (NHMS 2015). Vol. II: Non-Communicable Diseases, Risk Factors & Other Health Problems; 2015 [2016 April 7]. Available from:
    1. Ooi CCP, Loke SC, Zaiton A, Zaitun Y. Cross-sectional study of older adults with type 2 diabetes mellitus in two rural public primary healthcare facilities in Malaysia. Medical Journal of Malaysia. 2011;66:108–12.
    1. Malaysian Diabetes Association. Diabetes Malaysia 2013. [2016 April 7]. Available from: .
    1. Letchuman GR, Nazaimoon WMW, Mohamad WBW, Chandran LR, Tee GH, Jamaiyah H, et al. Prevalence of Diabetes in the Malaysian National Health Morbidity Survey III 2006. Medical Journal of Malaysia. 2010;65:173–9.
    1. Mafauzy M, Hussein Z, Chan SP. The status of diabetes control in malaysia: results of DiabCare 2008. Medical Journal of Malaysia. 2011;66:175–81.
    1. National Diabetes Registry. National Diabetes Registry Report 2009–2012 (Vol. 1). Non-Communicable Disease Section, Disease Control Division, Ministry of Health Malaysia. 2013. [2016 April 7]. Available from: .
    1. Abdullah MAH, Abdullah AT. Annual Report of National Orthopaedic Registry Malaysia (NORM) Diabetic Foot. National Orthopaedic Registry Malaysia (NORM) 2009. 2010. [2015 April 14]. Available from: .
    1. Tan MY, Magarey J. Self-care practices of Malaysian adults with diabetes and sub-optimal glycaemic control. Patient Educ Couns. 2008;72:252–67. doi:
    1. Poi PJ, Forsyth DR, Chan D. K. Services for older people in Malaysia: issues and challenges. Age and Aging. 2004;33:444–6.
    1. Abbas MY, Saruwono M. Our “Golden” citizens with “Golden” facilities? Procedia—Social and Behavioral Sciences. 2012;49:127–46. doi:
    1. Wan-Ibrahim WA, Zainab I. Reasons behind the availability of family support of older persons in Malaysia. Middle-East Journal of Scientific Research. 2014;20:1457–60. doi:
    1. Visvanathan R, Zaiton A, Sherina MS, Muhamad YA. The nutritional status of 1081 elderly people residing in publicly funded shelter homes in Peninsular Malaysia. European Journal of Clinical Nutrition. 2005;59:318–24. doi:
    1. Wan-Ibrahim WA, Majid MA, Zainab I. Subjective well-being of older persons at elderly day-care center. Middle-East Journal of Scientific Research. 2014;20:1461–64. doi:
    1. Social Welfare Department Malaysia. Homes for older persons. 2013. [2015 April 19]. Available from: .
    1. The consolidated Standard of Reporting Trials (CONSORT) flow diagram. 2010. [2015 May 23]. Available from: .
    1. Boutron I, Moher D, Altman D, Schulz K, Ravaud P. Extending the CONSORT statement to randomised trials of nonpharmacologic treatment: Explanation and elaboration. Annals of Internal Medicine. 2008a;148:295–309.
    1. Boutron I, Moher D, Altman D, Schulz K, Ravaud P. Methods and processes of the CONSORT group: Example of an extension for trials assessing nonpharmacologic treatments. Annals of Internal Medicine. 2008b;148.
    1. Katz S, Down TD, Cash HR, Grotz RC. Progress in the development of the index of ADL. The Gerontologist. 1970;10:20–30.
    1. Ministry of Health Malaysia. Modul latihan pengendalian kes dementia di peringkat penjagaan kesihatan primer program latihan pengendalian kes dementia. 2007. [2015 April 19]. Available from: .
    1. Aday LA, Cornelius LJ. Designing and conducting health surveys: a comprehensive guide. San Francisco: John Wiley & Sons; 2006.
    1. Chen M, Huang W, Peng Y, Guo J, Chen C, Jong M, et al. Effectiveness of a health promotion programme for farmers and fishermen with type-2 diabetes in Taiwan. Journal of Advanced Nursing. 2011;67:2060–7. doi:
    1. Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348:g1687–g1687. doi:
    1. van der Bijl JJ, Shortridge-Baggett LM. The theory and measurement of the self-efficacy construct. Scholarly Inquiry for Nursing Practice. 2001;15:189–207.
    1. Lawshe CH. A quantitative approach to content validity. Personnel psychology. 1975;28:563–75.
    1. Johnston P, Wilkinson K. Enhancing validity of critical tasks selected for college and university program portfolios. National Forum of Teacher Educational Journal. 2009;19:1–6.
    1. Sharoni SKA, Abdul Rahman H, Minhat HS, Shariff-Ghazali S, Ong MHA. A self-efficacy education programme on foot self-care behaviour among older patients with diabetes in a public long-term care institution, Malaysia: A quasi-experimental pilot study. BMJ Open. 2017;7:e014393 doi:
    1. Chin YF, Huang TT. Development and validation of a diabetes foot self-care behavior scale. The Journal of Nursing Research. 2013;21:19–25. doi:
    1. Sloan HL. Developing and testing the foot care confidence scale to measure self-efficacy in foot care. Dissertation; 1998. [2015 April 19]. Available from: \n.
    1. Resnick B, Zimmerman SI, Orwig D, Furstenberg AL, Magaziner J. Outcome expectations for exercise scale: utility and psychometrics. Journal of Gerontology Social Sciences. 2000;55:S352–6. doi:
    1. Wu SV, Courtney M, Edwards H, Mcdowell J. Psychometric properties of the Chinese version of the perceived therapeutic efficacy scale for type 2 diabetes. Journal Formos Medical Association. 2008;107:232–8.
    1. Pollock RD, Unwin NC, Connolly V. Knowledge and practice of foot care in people with diabetes. Diabetes Research and Clinical Practice. 2004;64:117–22. doi:
    1. Desalu OO, Salawu FK, Jimoh AK, Adekoya AO, Busari OA. Diabetic foot care: self-reported knowledge and practice among patients attending three tertiary hospitals in Nigeria. Ghana Medical Journal. 2011;45:60–65.
    1. Eigenmann C, Skinner T, Colagiuri R. Development and validation of a diabetes knowledge questionnaire. Practical Diabetes International. 2011;28:166–70d. doi:
    1. Vileikyte L, Peyrot M, Bundy C. The development and validation of a neuropathy- and foot ulcer–specific quality of life instrument. Diabetes Care. 2003;26:2549–55.
    1. IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.
    1. Sheridan J, Coakes LS, Clara O. SPSS Version 17.0 for Windows: Analysis without anguish. Australia: John Wiley and Sons Publications; 2010.
    1. Lincoln N, Radford K, Game F, Jeffcoate W. Education for secondary prevention of foot ulcers in people with diabetes: a randomised controlled trial. Diabetologia. 2008;51:1954–61. doi:
    1. Baba M, Duff J, Foley L, Davis W, Davis T. A comparison of two methods of foot health education: The Fremantle diabetes study phase II. Primary Care Diabetes. 2015;9(2):155–62. doi:
    1. International Diabetes Federation. IDF Global Guideline for Managing older people with type 2 diabetes global guideline. 2013. [2015 April 19]. Available from:
    1. Fan L, Sidani S, Cooper-Brathwaite A, Metcalfe K. Improving foot self care knowledge, self-efficacy, and behaviors in patients with type 2 diabetes at low risk for foot ulceration: a pilot study. Clinical Nursing Research. 2014;23(6):627–43. doi:
    1. Williams I, Utz S, Hinton I, Yan G, Jones R, Reid K. Enhancing diabetes self-care among rural African Americans with diabetes: results of a two year culturally tailored intervention. The Diabetes Educator. 2014;40:231–9. doi:
    1. Wu SFV, Lee MC, Liang SY, Lu YY, Wang TJ, Tung HH. Effectiveness of a self-efficacy program for persons with diabetes: A randomized controlled trial. Nursing and Health Sciences. 2011;13:335–43. doi:
    1. Bandura A. Self-efficacy: the exercise of control. New York: W. H. Freeman and Company; 1997.
    1. Waxman R, Woodburn H, Powell M, Woodburn J, Blackburn S, Helliwell P. FOOTSTEP: a randomized controlled trial investigating the clinical and cost effectiveness of a patient self-management program for basic foot care in the elderly. Journal of Clinical Epidemiology. 2003;56:1092–9.
    1. Saleh NM, Shebl A, Hatata E, Refiei M. Impact of educational program about foot care on knowledge and self care practice for diabetic older adult patients. Journal of American Science. 2012;8:1444–52.
    1. Kawamura T, Umemura T, Hotta N. Cognitive impairment in diabetic patients: can diabetic control prevent cognitive decline?. Journal of Diabetes Investigation. 2012;3(5):413–23. doi:
    1. Deakin T, Cade J, Williams R, Greenwood D. Structured patient education: the diabetes X-PERT programme makes a difference. Diabetic Medicine. 2006. 23;944–54. doi:
    1. Netuveli G, Blane D. Quality of life in older ages. British Medical Bulletin. 2008. 85;113–26. doi:
    1. Institute of Medicine (U.S.). Committee on improving quality in long-term care Improving the quality of long-term care. Washington, DC: National Academies Press; 2001. [2017 January 19]. Available from:
    1. Prazeres F, Figueiredo D. Measuring quality of life of old type 2 diabetic patients in primary care in Portugal: a cross-sectional study. Journal of Diabetes & Metabolic Disorders. 2014. 13;6.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren