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ISSN 2723-6927-e ISSN 2723-4339
Effectiveness of Guided
E-Booklet-Based Education on Self Care Behavior and Blood Sugar in Hospital X
Bandung
Asriyanti1*, Dewi Prabawati2,
Wilhelmus3
Sekolah Tinggi Ilmu Kesehatan Sint Carolus, Jakarta, Indonesia1*23
Email: ayanti750@gmail.com*
ABSTRACT
Diabetes
mellitus is a metabolic disorder requiring patients to manage and stabilize
their condition to prevent complications. Education using e-booklets can
facilitate information access and blood sugar control. This study aimed to
evaluate the effectiveness of e-booklet-based education on self-care behavior
and blood sugar levels in diabetes mellitus patients. Conducted from June to
August 2023 at X Hospital's internist clinic in Bandung, the research employed
a quasi-experimental pre-test and post-test design with a control group. The
study involved 126 respondents, with 63 in the intervention group and 63 in the
control group, selected through purposive sampling. The intervention lasted 4
weeks, covering 8 materials with ongoing monitoring and active participation.
Self-care behavior and random blood sugar levels were measured at the beginning
and end of the study using the Summary Diabetes Self-Care Activity (SDSCA)
questionnaire and blood glucose tests. The Wilcoxon test revealed significant
differences in self-care behavior and blood sugar levels before and after the
intervention (p < 0.05). The Mann-Whitney test showed significant
differences between the intervention and control groups (p < 0.05).
Multivariate analysis indicated that age, gender, education, disease duration,
and e-booklet-based education accounted for 22.2% of the variance in self-care
behavior and 30.6% in blood sugar levels. E-booklet-based education effectively
improves self-care behavior and blood sugar control. The study recommends
ongoing development and supervision to establish healthy habits and prevent
complications.
Keywords: Blood
Sugar, Diabetes Mellitus, E-booklet based education, Self-Care Behavior
INTRODUCTION
Diabetes mellitus is a group of
metabolic diseases characterized by an increase in blood sugar levels caused by
impaired insulin secretion, impaired insulin work or both (Emerson Edwards,
2021). The population of diabetes sufferers increases continuously every year
and is one of the non-communicable diseases that contributes to quite a large
death rate from 2000 to 2019 (SDGs Sustainable Development Goals, 2022). Based on CDC data
(2022), the incidence of diabetes in the United States is 37.3 million (11.3%
of the US population), of which 28.7 million were diagnosed, including 28.5
million adults. According to data from the International Diabetes Federation
(IDF), Indonesia is the country with the fifth largest number of diabetes
sufferers in the world. There are 19.5 million Indonesians aged 20-79 years who
suffer from this disease in 2021 (IDF Diabetes Atlas 10th Edition, 2021).
According to the Basic Health
Research report (2018), the prevalence of diabetes in Indonesia is 10.9%, with
West Java contributing 1.7% based on doctor's diagnosis for ages > 15 years
(Smeltzer, 2010). Type 2 diabetes has no definitive cure; management involves a
balanced diet, physical activity, medication consumption, and stress management
(ADA, 2023). Hyperglycemia, or high blood glucose levels, can be caused by beta
cell insufficiency, inadequate nutrition, lack of activity, or inadequate
medication consumption (Coapstead & Banasik, 2013).
Unstructured
interviews with nurses at Hospital Patients also admitted that they were lazy
about following recommendations because the information was uninteresting or
forgotten (Syahrul et al., 2022). Self-care, as a form of responsibility for
one's own health, is important to prevent diabetes complications and must be
developed independently by the patient (Alligood, 2017; Shrivastava et al.,
2013).
The American Association
of Diabetes Educators(AADE) has established
AADE7 Self care behaviors as a reference for patient care and self-management
education for diabetes patients (AADE, 2014). AADE7 self care consists of
healthy eating, being active, monitoring, taking medication, problem solving,
healthy coping, reducing risk. These 7 components are based on research
conducted by Prabawati & Silalahi (2021). The results showed that self-care
education is an effective program in improving the self-care behavior of
diabetes mellitus patients and their blood glucose control. Effective self-care
for diabetes patients has a very important role in controlling diabetes
mellitus (Prabawati et al., 2021). The role of nurses in health efforts, namely
promotion, is very necessary, in order to help patients improve their health
and prevent complications.
Research
shows that digital technology can increase preventive interventions,
flexibility in time and cost, and improve nursing practice (Mamt et al., 2021).
E-books, as a low-cost medium that is easily accessible via smartphones, enable
learning anytime and anywhere (Ishak, 2018). Research also shows that web and
application-based education is effective in increasing knowledge and blood
sugar control in type 2 diabetes patients (Min MSN, nd), and that social media
such as WhatsApp has more impact on self-care behavior than lectures and
booklets (Fitria et al. , 2021). With a simple and
interactive format, the e-booklet helps patients understand and apply self-care
independently. Based on the Self Care Deficit Theory by Dorothea Orem,
educational support is important to prevent self care deficits and support effective
self care (Alligood, 2017).
Based on researchers' observations, many
diabetes sufferers do not understand how to manage their health condition,
ignoring medication and diet. RS X Bandung has provided diabetes education
through leaflets, lectures, radio and social media, but community participation
is still low. The current education refers to 5 pillars, while the program to
be tested refers to 7 pillars. This study aims to evaluate the effectiveness of
guided e-booklet-based education on self-care behavior and blood sugar levels of
diabetes patients at RS X Bandung. With the increasing number of diabetes
sufferers and the need for long-term care, this study focuses on the effect of
guided e-booklets, compared with existing educational methods, in improving
self-care behavior and controlling blood sugar. This research uses a
quasi-experiment design with pretest and posttest in the intervention and
control groups, and is expected to provide benefits for patients, hospitals,
educational institutions, and nurses, by improving the quality of education and
reducing the risk of diabetes complications.
RESEARCH METHODS
This study aims to evaluate the effect of e-booklet-based education on
self-care behavior and blood glucose levels in diabetes mellitus patients, by
considering confounding variables such as age, education level, duration of
diabetes, and information about DM. The research design used was a
quasi-experiment pretest-posttest with a control group, where the intervention
group received e-booklet-based education and the control group received
standard education. The effectiveness of the treatment was assessed by
comparing the pretest and posttest scores between the intervention group and
the control group. The study population consisted of 126 diabetes mellitus
patients at Hospital X, and samples were taken using a purposive sampling
technique, consisting of 63 patients per group. The research was conducted at
the Internal Medicine Clinic, RS Data collection tools include the SDSCA
questionnaire, potential data collection tools, observation sheets, cellphones
to access the e-booklet, glucometer, and the e-booklet itself. The data
collection process includes preparation, implementation with a pretest, provision
of educational material, and posttest after 4 weeks. Data analysis techniques
include data processing by editing, coding, processing, and cleaning, as well
as univariate, bivariate, and multivariate analysis using multiple linear
regression and ordinal logistic regression to evaluate the relationship between
variables. Classic assumption tests such as residual normality,
heteroscedasticity, multicollinearity, linearity and autocorrelation were also
carried out to ensure the quality of the regression model.
RESULTS AND
DISCUSSION
A.
Univariate Analysis of
Descriptive Statistics
This descriptive statistical analysis describes
characteristics including age, gender, education level, length of time
suffering from DM, information about DM, and dependent variables which include
self-care behavior and blood sugar at any time.
1. Frequency Distribution of
Respondents Based on Age
Table 1. Frequency
Distribution of Respondents Based on Age
Intervention Group and
Control Group
|
Age |
Intervention
Group |
Control
Group |
||
|
|
Total
Patients |
Total
Patients |
||
|
|
N |
% |
N |
% |
|
26-35
Years |
2 |
3.2 |
3 |
4.8 |
|
36-45
Years |
4 |
6.3 |
6 |
9.5 |
|
46-55
Years |
19 |
30.2 |
11 |
17.5 |
|
56-65
Years |
23 |
36.5 |
21 |
33.3 |
|
>65
Years |
15 |
23.8 |
22 |
34.9 |
|
Total |
63 |
100 |
63 |
100 |
(Source: Primary Data,
2023)
The age characteristics of
respondents showed that in the intervention group, the majority were aged 56-65
years (36.5%), while the control group was dominated by those aged >65 years
(34.9%), indicating that the late elderly and seniors were at higher risk of
developing diabetes mellitus compared to the age category. other. According to
Ningrum et al. (2019), diabetes mellitus generally occurs over the age of 30
years with an increased risk at the age of 40-60 years due to increased insulin
retention. Fahd Akram et al. (2020) added that those aged >40 years have a
higher risk of developing diabetes, while a survey in Bali by Suastika (2009)
showed that the prevalence of DM in the elderly was three times higher than in
the younger age group, associated with a decrease in insulin sensitivity and
glucose metabolism function. The International Diabetes Federation (IDF) (2020)
reported that in 2019, there were 463 million people aged 20-79 years who had
diabetes, equivalent to 9.3% of the population of that age, with prevalence
expected to increase with age, especially in the Arab region -Africa and the
West Pacific.
2.
Frequency Distribution
Based on Gender
Table
2. Frequency Distribution Based on Gender
|
Gender |
Intervention Group |
Control Group |
Amount |
|||
|
N |
% |
N |
% |
N |
% |
|
|
Man |
29 |
46% |
29 |
46% |
58 |
46% |
|
Woman |
34 |
54% |
34 |
54% |
68 |
54% |
|
Amount |
63 |
100% |
63 |
100% |
126 |
100% |
(Source: Primary Data, 2023)
The gender characteristics
of the respondents showed that in the intervention and control groups, the
number of female respondents was greater than male, with 34 respondents (54%)
each. This finding is consistent with research by Prabawati & Natalia
(2020) which reported that the majority of respondents were female (82.7%), as
well as Fitriah (2009) who identified women as having a higher risk of diabetes
mellitus than men, related to factors such as increased mass index. body,
monthly cycle syndrome, and hormonal imbalance. In addition, research by Khan
et al (2020) states that women have poor glycemic control and higher
lipoprotein sensitivity to hormones than men. Even though women more often
experience diabetes, they tend to have better self-care management than men,
with women being more concerned about their health and trying to optimally
self-care for their disease (Ningrum et al., 2019).
3.
Frequency Distribution of
Respondents based on Education Level
Table
3. Frequency Distribution Based on Education Level
|
Level
of education |
Intervention
Group |
Control
Group |
Amount |
|||
|
N |
% |
N |
% |
N |
% |
|
|
elementary
school |
- |
|
2 |
3.2% |
2 |
1.6% |
|
JUNIOR
HIGH SCHOOL |
6 |
9.5% |
3 |
4.8% |
9 |
7.1% |
|
SENIOR
HIGH SCHOOL |
25 |
39.7% |
19 |
30.2% |
44 |
35% |
|
PT |
32 |
50.8% |
39 |
61.9% |
71 |
56.3% |
|
Amount |
63 |
100% |
63 |
100% |
126 |
100% |
(Source: Primary Data, 2023)
Based on the data, there
were more respondents with a tertiary education level than others, namely 71
people (56.3%). In the intervention group, there were 32 respondents (50.8%)
with a tertiary education level, while in the control group, there were 39 respondents
(61.9%). This shows that the majority of respondents in this study have a good
level of formal education. The level of education is an indicator that someone
has taken formal education, but does not always reflect mastery of a field of
knowledge. Good education often results in positive behaviour, including
receiving information regarding self-care management of diabetes mellitus.
Patients with higher education generally have a better understanding of
self-care management of diabetes mellitus and more often seek information about
their disease through various media compared to those with low education
(Ningrum et al., 2019).
4.
Frequency Distribution of
Respondents Based on Length of Suffering from DM
Table
4. Frequency Distribution Based on Length of Suffering from DM
|
Suffering
from DM for a long time |
Intervention Group |
Control Group |
Amount |
|||
|
|
N |
% |
N |
% |
N |
% |
|
<
5 Years |
25 |
39.7% |
29 |
46% |
54 |
42.8% |
|
|
38 |
60.3% |
34 |
54% |
72 |
57.2% |
|
Amount |
63 |
100% |
63 |
100% |
126 |
100% |
(Source: Primary data, 2023)
The characteristics of the duration of suffering from
diabetes mellitus (DM) show that in the intervention group and control group,
more respondents suffered from DM for ≥ 5 years, namely 38 respondents
(60.3%) and 34 respondents (54%), respectively. Long-term diabetes mellitus is
often accompanied by microvascular and macrovascular complications. Apart from
that, long suffering from diabetes mellitus affects itmaintenancediabetes self-management, because
sufferers with old diagnoses generally have a better understanding of the
importance of diabetes self-management and are more active in seeking
information related to diabetes care. Sufferers who have experienced this
disease for a long time tend to be better able to accept and manage their
disease, as well as adapting new lifestyles in their daily lives (Ningrum et
al., 2019).
5.
Frequency Distribution of
Respondents Based on the opportunity to get information about DM
Table
5. Frequency Distribution Based on Information About DM
|
Information
about DM |
Intervention Group |
Control Group |
Amount |
|||
|
|
N |
% |
N |
% |
N |
% |
|
Once |
56 |
88.9% |
59 |
93.7% |
115 |
47.6% |
|
Never |
7 |
11.1% |
4 |
6.3% |
11 |
52.4% |
|
Amount |
63 |
100% |
63 |
100% |
126 |
100% |
(Source: Primary Data, 2023)
Based on the table above,
it can be seen that in the intervention and control groups, 56 respondents
(88.9%) and 59 respondents (93.7%) respectively had received information about
diabetes mellitus (DM). The majority of respondents got information through
health workers, such as doctors, nurses and nutritionists, through direct
explanations, doctor's notes and leaflets from hospitals. Knowledge about DM is
important in the concept of self-care because it allows individuals to evaluate
and carry out necessary interventions to prevent long-term complications.
Research by Hailu et al. (2019) supports that information about diabetes can
improve self-care management, reduce the risk of complications, and increase
patients' ability to care for themselves.
6.
Frequency Distribution of
Respondents Based on Self-care Behavior of DM Patients Before and After
E-Booklet-based Educational Intervention
Table
6. Frequency Distribution of Respondents Based on Self-care Behavior of DM
Patients Before and After E-Booklet Based Educational Intervention
|
Self-care behaviorDM patients |
Intervention Group |
Control Group |
||||||
|
Pre |
Post |
Pre |
Post |
|||||
|
N |
% |
N |
% |
N |
% |
N |
% |
|
|
Self-careGood |
42 |
66.7% |
61 |
96.8% |
46 |
73% |
43 |
68.3% |
|
Self-careNot good |
21 |
33.3% |
2 |
3.2% |
17 |
27% |
20 |
31.7% |
|
Amount |
63 |
100% |
63 |
100% |
63 |
100% |
63 |
100% |
(Source: Primary Data, 2023)
Based on the data above,
before the e-booklet-based educational intervention, self-care behavior in the
intervention and control groups was mostly in the good category, respectively
42 respondents (66.7%) and 46 respondents (73%). After 4 weeks of intervention,
the intervention group showed a significant increase in self-care behavior,
from 42 respondents to 61 respondents (96.8%), while the control group
experienced a decrease, from 46 respondents (73%) to 43 respondents (68.3%). Self-care
behavior includes the management of diabetes mellitus, including treatment and
prevention of complications, which has an impact on controlling blood sugar
levels and preventing complications (AADE7, 2014). E-booklet-based education is
designed to influence individuals in managing diabetes through electronic
media, as described by Notoadmojo (2012), and is recognized by the ADA as
important for improving blood glucose levels and reducing complications. The
self-care theory by D. Orem (2017) also supports the importance of self-care to
maintain health. In this study, respondents who were given the e-booklet
intervention did not experience hyperglycemia or hypoglycemia, indicating the
effectiveness of the self-care management taught.
7.
Frequency Distribution of
Respondents Based on Blood Sugar Before and After E-Booklet Based Educational
Intervention
Table
7. Frequency Distribution of Respondents Based on Blood Sugar Before and After
E-Booklet Based Educational Intervention
|
When blood sugar |
Intervention Group |
Control Group |
||||||
|
Pre |
Post |
Pre |
Post |
|||||
|
N |
% |
N |
% |
N |
% |
N |
% |
|
|
Normal |
38 |
60.3% |
58 |
92.1% |
43 |
68.3% |
27 |
42.9% |
|
Diabetes |
25 |
39.7% |
5 |
7.9% |
20 |
31.7% |
36 |
57.1%% |
|
Amount |
63 |
100% |
63 |
100% |
63 |
100% |
63 |
100% |
(Source: Primary Data, 2023)
Based on the table above,
before e-booklet-based education, blood sugar levels in the intervention and
control groups were mostly in the normal category, respectively 38 respondents
(60.3%) and 43 respondents (68.3%). After e-booklet-based education, blood
sugar in the intervention group increased to 58 respondents (92.1%), while the
control group experienced a decrease, with 36 respondents (57.1%) being in the
diabetes category. Temporary blood sugar, which measures blood glucose levels
without fasting (Perkeni, 2021), showed significant changes in the intervention
group after receiving e-booklet-based education. This shows the great impact of
the intervention in glycemic control. This education includes components of
AADE7 self-care behaviors, such as healthy eating, physical exercise, blood
sugar monitoring, foot care, pharmacological therapy, and problem solving.
Research by Ji Min et al. (2020) shows that DSMEs using SMS and applications
are effective in controlling blood sugar levels, proving that interactive
educational methods such as e-booklets are better in controlling blood glucose.
Interactive education helps patients control blood sugar levels and prevent
complications.
B.
Bivariate Analysis
Bivariate analysis in this
study was carried out to determine differences in self-care behavior of DM
patients, blood sugar levels before and after being given an E-Booklet-based
educational intervention and to determine differences in self-care behavior of
DM patients, blood sugar levels between the intervention group and the control
group.
1.
Differences in self-care
behavior of DM patients and blood sugar levels before and after intervention in
the intervention group
Table
8. Differences in Self-care Behavior of DM Patients Before and After E-Booklet
Based Educational Intervention
|
Self-care behaviorDM patient |
Before Intervention |
After Intervention |
p
value |
||
|
N |
% |
N |
% |
||
|
Self-careGood |
42 |
66.7% |
61 |
96.8% |
0,000 |
|
Self-carenot good |
21 |
33.3% |
2 |
3.2% |
|
|
Amount |
63 |
100% |
63 |
100% |
|
(Source: Primary Data, 2023)
Based on the table above,
the difference in self-care behavior of DM patients before and after the
e-booklet-based educational intervention shows a value of p = 0.000, which
means there is a significant difference (p < 0.05) in the self-care behavior
of DM patients before and after the intervention. Self-care behavior is an
individual's responsibility for their health and involves managing diabetes
mellitus through treatment and prevention of complications, with the aim of
controlling blood sugar levels and improving quality of life (Alligood, 2017;
AADE7, 2014). Guided e-booklet-based education, which covers seven important
components in self-care behaviors, namely healthy eating, exercise, monitoring
glucose levels and feet, pharmacological therapy, problem solving, healthy
coping, and risk reduction, is designed to influence individuals through
electronic media (Notoadmojo, 2012). This research confirms that education
using e-booklets, which involves interactive learning via video and audio,
improves patient understanding and self-care behavior, in accordance with
research by Min MSN (2020) and Fitri et al (2018), which shows that interactive
media such as e-booklets -booklets and WhatsApp Groups are more effective in
increasing knowledge and self-care behavior than traditional methods.
Respondents of good age and education, as well as access to e-booklet-based
education, demonstrated positive changes in diet, exercise, and stress
management, and reported that concise, easy-to-understand educational material,
as well as motivational support, increased their enthusiasm for maintaining
health and blood sugar stability. This proves that providing e-booklet-based
education can make DM patients carry out good self-care behavior, thereby
helping DM patients to prevent long-term complications from occurring.
Table
9. Differences in Blood Sugar Levels Before and After E-Booklet Based
Educational Intervention
|
When
blood sugar |
Before Intervention |
After Intervention |
p
value |
||
|
N |
% |
N |
% |
||
|
Normal |
38 |
60.3% |
58 |
92.1% |
0,000 |
|
Abnormal |
25 |
39.7% |
5 |
7.9% |
|
|
Amount |
63 |
100% |
63 |
100% |
|
(Source: Primary Data, 2023)
Based on the table above,
the difference in blood sugar before and after the e-booklet-based educational
intervention shows a value of p = 0.000 (p < 0.05), which means there is a
significant difference in blood sugar levels before and after the intervention.
Temporary blood sugar, which is the blood glucose level without fasting
(Perkeni, 2021), in the intervention group increased from 60.3% to 92.1%,
indicating a large impact of the e-booklet-based educational intervention in
glycemic control. Education that includes the components of AADE7 self-care
behaviors—such as healthy eating, physical exercise, blood sugar monitoring,
and pharmacological therapy—can help keep blood sugar under control, thereby
preventing long-term complications. This finding is in line with research by Ji
Min et al. (2020), which shows the effectiveness of SMS-based DSME and
applications in controlling blood sugar levels. In contrast, research by
Prabawati & Silalahi (2021) found no difference in blood glucose levels
when using booklet education, but this research proves that e-booklets are more
effective in controlling blood sugar than other methods. Interactive and
interesting e-booklet-based education has been proven to help patients control
blood sugar levels and prevent diabetes complications.
2.
Differences in Self-care
Behavior of DM Patients and Current Blood Sugar Levels in the Intervention
Group and Control Group
Table
10. Differences in self-care behavior of DM patients in the intervention group
and control group
|
|
Intervention Group |
Control Group |
P
value |
||
|
N |
Mean |
N |
Mean |
||
|
Self-care behavior |
63 |
72.50 |
63 |
54.50 |
0,000 0,000 |
|
When
blood sugar |
63 |
79.00 |
63 |
48.00 |
|
|
Amount |
126 |
|
126 |
|
|
(Source: Primary
Data, 2023)
Based on the table above,
the difference in self-care behavior and blood sugar in diabetes mellitus (DM)
patients between the intervention group and the control group shows a value of
p = 0.000 (p < 0.05), which means that Ha6 is accepted and there is a
significant difference between the two groups. Self care behavior reflects
individual responsibility in managing diabetes mellitus, including treatment
and prevention of complications, with the ultimate goal of controlling blood
sugar levels and preventing long-term complications (Alligood, 2017). There are
seven important components in self-care behaviors, including healthy eating,
exercise, monitoring glucose levels and foot conditions, pharmacological
therapy, problem solving, healthy coping, and risk reduction (AADE7, 2014).
Temporary blood sugar, which is the blood glucose level measured at any time
without fasting (Perkeni, 2021), together with self-care behavior, is used as a
measuring tool in this research. Findings showed significant differences in self-care
behavior and instantaneous blood sugar levels between the intervention and
control groups, indicating the effectiveness of the intervention in improving
diabetes management and glycemic control.
C.
Multivariate Analysis
Multivariate analysis in
this study used the ordinal logistic regression test. Ordinal logistic
regression in this study aims to determine the feasibility of the model, the
magnitude of the contribution given by the independent variables simultaneously
to the dependent variables, the magnitude of the influence of each independent
variable partially on the dependent variables, the magnitude of the influence
of the independent variables simultaneously on the dependent variables. and the
independent variable which has the greatest influence on the dependent
variable.
1.
Feasibility of Model Fit
Table
11. Feasibility test of Fit Model Self-care behavior for DM Patients
|
Test
results |
-2
Log Likelihood |
Sig. |
|
Intercept Only |
91,773 |
|
|
Finals |
60,186 |
0.001 |
(Source: Primary Data, 2023)
Based on table 5.5.1.1 of
the feasibility of model fit on the dependent variable self-care behavior of DM
patients, a -2 log likelihood reduction was obtained
from 91,773 to 60,186 after the e-booklet based educational intervention was
carried out. Statistically, it can be concluded that the model with independent
variables (age, gender, education level, duration of suffering from DM,
information about DM and e-booklet-based educational interventions) is good and
suitable to be used to change the self-care behavior of DM patients, but it can
still change because the p value <0.05.
Table
12. Feasibility Test for Temporary Blood Sugar Fit Model
|
Test
results |
-2
Log Likelihood |
Sig. |
|
Intercept Only |
123,298 |
0,000 |
|
Finals |
77,191 |
|
(Source: Primary Data, 2023)
Based on table 5.5.1.2 of the feasibility of the fit model
for the variable blood sugar at any time, a decrease of -2 log likelihood was
obtained from 123,298 to 77,191 after the e-booklet-based educational
intervention was carried out. Statistically it can be concluded that the model
with independent variables (age, gender, education level, duration of suffering
from DM, information about DM and e-booklet based educational interventions) is
good for use for changes in blood sugar levels over time, but can still change
due to the value p < 0.05.
2.
Test the Whole Model
Table
13. Overall Test of Dependent Variable Model
|
Dependent
Variable |
Test results |
|
|
|
Chi-square |
P
value |
|
Self-care behavior |
53,378 |
0.498 |
|
When
blood sugar |
64,776 |
0.161 |
(Source: Primary Data, 2023)
Based on table 13, it
shows that all dependent variables have a p value > 0.05 so the probability
value is significant. So the e-booklet-based education
model cannot reject the null hypothesis, namely that the e-booklet-based
education model is appropriate or compatible with the empirical data.
The e-booklet-based
education model is suitable for use in improving self-care for DM patients.
According to the researchers, this model is suitable and suitable for use
because several things include using e-booklets for DM patients who can easily
access information related to their disease, equipped with interesting
information and videos and pictures making it easier for DM patients to digest
and understand the contents of the material provided. given. In addition,
patients stated that they were greatly helped by the e-booklet provided. This
is supported by previous research conducted by Ishak (2018) that the use of
e-books is an instrument known for its low cost, because it can be accessed
only from a smartphone, can be carried anywhere, making it easier for readers
to learn anywhere, besides that, e-books books can last forever with an
unchanged format.
3.
Pseudo R-Square Test
The Pseudo R-Square test
based on Cox and Snell was carried out to determine the magnitude of the
contribution made by the independent variables (age, gender, education level,
duration of suffering from DM, information about DM and e-booklet-based educational
interventions) simultaneously to changes in self-care behavior. and blood sugar
when DM patients. The Cox and Snell values can be seen in table 14
below:
Table
14. Pseudo R-Square Test of Dependent Variable
|
Dependent
variable |
Cox
and Snell values |
|
Self-care behavior |
0.222 |
|
When
blood sugar |
0.306 |
(Source: Primary Data, 2023)
4. Test
Parameters Estimates
Table
15. Test Parameters Estimate for Independent Variables on Self-care Behavior of
DM Patients
|
Independent
Variable |
Estimate |
P value |
|
Coefficient |
-3,098 |
0.001 |
|
Coefficient |
-2,729 |
0.001 |
|
Control
group |
-2,729 |
0.001 |
|
Intervention
group |
0 |
0.001 |
|
Age1 Age2 Age3 Age4 Age5 |
-1,300 0.029 1,401 0.127 0 |
0.301 0.977 0.149 0.856 |
|
Gender1 Gender2 |
0.104 0 |
0.855 |
|
Education1 Education2 Education3 Education4 |
19,494 1,085 1,186 0 |
- 0.409 0.093 - |
|
Long
suffering from DM1 Suffering
from DM2 for a long time |
-1,186 0 |
0.235 |
|
Information
about DM1 Information
about DM2 |
-0.363 0 |
0.551 - |
(Source: Primary Data,
2023)
The table above shows that
e-booklet-based education has a significant effect on blood sugar with a p
value <0.05, which shows a positive impact on self-care behavior of diabetes
mellitus (DM) patients, while confounding variables such as age, gender,
education level, suffering from DM for a long time, and information about DM
did not show a significant influence on self-care behavior. Field research
revealed that the majority of respondents were aged 56-65 years, an age where
insulin resistance increases which makes them susceptible to DM, consistent
with research by Ningrum (2019) which shows that the risk of DM increases with
age. However, age did not have a significant effect on self-care of DM patients
in this study, in line with Akram et al (2020) who also found that age was not
significantly related to lifestyle compliance in DM patients. Gender,
education, information about DM, and duration of suffering from DM, which
theoretically influence self-care behavior, did not show a significant
influence in this study, supporting the findings of Akram et al (2020) that
these factors do not influence lifestyle adherence in DM patients.
..
Table
16. Test Parameters Estimate for Independent Variables on Temporary Blood Sugar
|
Independent
Variable |
Estimate |
P value |
|
Coefficient |
-3,042 |
0,000 |
|
Coefficient |
-3,085 |
0,000 |
|
Control
group |
-3,085 |
0,000 |
|
Intervention
group |
0 |
0,000 |
|
Age1 Age2 Age3 Age4 Age5 |
0.700 -0.787 -1,048 -0.897 0 |
0.614 0.402 0.143 0.152 |
|
Gender1 Gender2 |
0.687 0 |
0.168 |
|
Education1 Education2 Education3 Education4 |
-19,447 -0.389 -0.506 0 |
- 0.717 0.351 - |
|
Long
suffering from DM1 Suffering
from DM2 for a long time |
0.354 0 |
0.616 |
|
Information
about DM1 Information
about DM2 |
-0.471 0 |
0.496 - |
Table 16 shows that
e-booklet-based education has a significant influence on instantaneous blood
sugar levels with a p value < 0.05, while independent variables such as age,
gender, education level, duration of suffering from DM, and information about
DM do not show a significant influence on instantaneous blood sugar levels with
a p value > 0.05. This research data shows that age, gender, education
level, duration of suffering from DM, and information about DM do not affect
blood sugar levels at any time, in line with research by Boku & Aprilia
(2019) which also found that there was no significant relationship between age
and gender and blood sugar levels of DM patients. Although Ningrum (2019) noted
a higher risk for DM in people over 40 years of age and female, and data from
the Ministry of Health's Pusdatin (2020) showed an increase in DM cases in
women, the results of this study are not consistent with these findings.
Education, which is considered to influence the incidence of DM, as explained
by the Indonesian Ministry of Health's Pusdatin (2020), also did not show a
significant influence in this study. Researchers suggest the need for further
studies with measurements of fasting blood sugar levels or HbA1c and a larger
number of respondents.
5.
Determining the Odd Ratio
Value of Self-care behavior of DM patients and Current Blood Sugar
Based on mathematical
calculations, self-care behavior and blood sugar in diabetes mellitus (DM)
patients showed significant results between the intervention and control
groups. For self-care behavior, the Z value is calculated using the formula Z =
-3.098 + (0 x Group) + (0.127 x age) + (0 x Gender) + (1.085 x Education) + (0
x Length of DM) + (0 x Information about DM). With variable substitution, Z6
becomes 0.42, while Z69 becomes -6.086. The P value is calculated using the
formula P = 1/(1 + e^(-z)), resulting in P6 = 0.4 and
P69 = 0.002. The Odd Ratio is calculated as P/(1-P), with Odd Ratio 6 = 0.67
and Odd Ratio 69 = 0.002, indicating a comparison of 335. This shows that
respondents in the intervention group have a tendency to increase self-care
behavior 335 times greater than those in the group. control. In the case of
instantaneous blood sugar, the Z calculation is carried out using the formula Z
= -3.042 + (0 x Group) + (-0.787 x age) + (0 x Gender) + (-0.389 x Education) +
(0 x DM duration) + (0 x Information about DM). Variable substitution produces
Z6 = -6.968 and Z69 = -5.911. The P value is calculated using the formula P = 1/(1 + e^(-z)), resulting in P6 = 0.99 and P69 = 0.99. The
Odd Ratio is calculated as P/(1-P), with Odd Ratio 6 = 99 and Odd Ratio 69 =
99, indicating a comparison of 1. This indicates that respondents in the
intervention group have a chance of 1 time or 100% better than the control
group in reducing blood levels. when blood sugar. However, transient reductions
in blood sugar may not be completely appropriate for measuring glycemic control
in DM.
6.
Test Parallel Lines
Table
17. Parallel Lines Test Self-care behavior
|
Model |
-2log likelihood |
|
Null Hypothesis |
60,186 |
|
General |
60,186 |
(Source: Primary data, 2023)
The table above shows that
the -2 log likelihood values are the same. This explains that the
e-booklet based educational model used is appropriate or appropriate.
Table
18. Temporary Blood Sugar Parallel Lines Test
|
Model |
-2log likelihood |
|
Null Hypothesis |
77,191 |
|
General |
77,191 |
The table above shows that
the -2 log likelihood values are the same. This explains that the
e-booklet-based education model used is appropriate or suitable.
D.
Research Limitations
Research
Limitations include several important aspects. First, researchers cannot
directly monitor the implementation of respondents' self-care behavior, such as
healthy eating patterns, physical activity, foot monitoring,
handling hyperglycemia and hypoglycemia, and controlling stress. Second, the
time to complete the intervention was delayed in some patients due to illness
and difficulty accessing educational links. Third, measuring blood sugar levels
uses instant blood sugar, which is not recommended compared to HbA1c, which
takes longer. Fourth, education is provided in stages, and not all confounding
variables from self-care behavior are studied. Implications Research shows its
impact on nursing care, nursing education, and nursing research. In nursing
services, this research emphasizes the role of nurses as educators to maintain
the self-care behavior of diabetes patients, as a preventive measure against
complications, and innovation in health education using e-booklets as media.
For nursing education, the results of this study show the effectiveness of
e-booklets in increasing self-care behavior and reducing blood sugar levels, as
well as adding educational methods for diabetes patients. For nursing research,
this study offers evidence of the effectiveness of e-booklets as an educational
intervention and can serve as a basis for evidence-based practice.
CONCLUSION
Based on researchers' observations, many
diabetes sufferers at Hospital X Bandung still do not understand how to manage
their condition, and do not comply with medication and diet. Even though there
are various educational methods such as leaflets, lectures, radio and social
media, public participation is still limited, and existing educational
materials only refer to 5 pillars, while the new program will use 7 pillars.
This study aims to evaluate the effectiveness of guided e-booklet-based
education in improving self-care behavior and controlling blood sugar levels in
diabetes patients at RS X Bandung. Considering the increasing number of
diabetes sufferers and the need for long-term care, this study uses a
quasi-experiment design with pretest and posttest in the intervention and
control groups, and is expected to provide significant benefits for patients,
hospitals, educational institutions and nurses in improving the quality of
education and reduces the risk of diabetes complications.
References
AADE7TM Self-Care Behaviors American
Association of Diabetes Educators (AADE) Position Statement. (2014).
Afriani, L., & Fitria, Y. (2021).
EDUCATIVE: Journal of Educational Science Development of Technology-Based
Learning Media Assisted by Adobe Flash CS6 for Learning during the Covid-19
Pandemic
Aghni, RI (2018).
Functions and Types of Learning Media in Accounting Learning. Indonesian
Journal of Accounting Education
Alligood. (2017). Nursing Theorist.
8th Indonesian Edition. Singapore: Elsevier.
Amalia, A., & Fatonah, S. (2020).
Application of Dragonlearn Online Learning in the Covid-19 Pandemic Era (Case
Study at MI Ma'had Islam Kopeng). ISEJ: Indonesian Science Education Journal
Achsin, A. (1986). Learning Media.
Jakarta: Rineka Cipta
Bare BG., Smeltzer SC (2010). Textbook
of Medical Surgical Nursing. Jakarta :EGC
Baynest, H. W. (2015). Classification, Pathophysiology,
Diagnosis and Management of Diabetes Mellitus. Journal of Diabetes &
Metabolism, 06(05).https://doi.org/10.4172/2155-6156.1000541
Esmaeilpour-BandBoni, M., Gholami-Shilsar, F., &
Khanaki, K. (2021). The Effects of Telephone-Based Telenursing on Glycated
Hemoglobin Among Older Adults With Type 2 Diabetes
Mellitus: A Randomized Controlled Trial. Journal for Nurse Practitioners,
17(3), 305–309. https://doi.org/10.1016/j.nurpra.2020.09.015
Centers
for Disease Control and Prevention. National Diabetes Statistics Report
website.https://www.cdc.gov/diabetes/data/statistics-report/index.html.
Copstead,
Lee Ellen, Jacquelyn L. Banasik. 2013. Pathophysiology. 5th Ed. St. Louis,
Missouri: Elsevier
Emerson Edwards, L. (2021). ADA
Standards of Medical Care in Diabetes-2021.
Ghozali, Imam. 2018. Application of
Multivariate Analysis with the IBM SPSS 25 Program. Diponegoro University
Publishing Agency: Semarang.
Hastono. P. Sutanto & Luknis
Sabri. (2011). Health Statistics. Jakarta: Rajawali Press.
Huether, S. E. & McCance, K. L. (2019). Textbook of
Pathophysiology. 6th Ed. Elsevier.
International Diabetes Federation
(IDF). International Diabetic Federation Diabetic Atlas 10th edition. IDF;
2021.
Ismonah (2008) Analysis of factors
related to self-care management of diabetes mellitus patients in the context of
nursing care. University of Indonesia.
Kumar, Abbas, Aster. (2020). Robbins Textbook of Basic
Pathology. Ed 10. Elsevier.
Karya Kesehatan,
M., Rahmayunia Kartika, I., Wahyuni, A., & Fitra Dewi, N. (2021). Imelda Rahmayunia Kartika: Diabetic
Self-Management Education-Effect on Self-Management Care Diabetic
Self-Management Education-Effect on Self-Management Care of Type-2 Diabetic
Patients (Vol. 4, Issue 2).
Lemone, Priscilla, Karen M Burke,
Gerene Bauldoff. (2016). Medical Surgical Nursing
Textbook: Integumentary Disorders, Endocrine Disorders, Gastrointestinal
Disorders. (Vol.2) (Ed.5). Jakarta: EGC Medical PublisherIDF Diabetes
Atlas 10th edition. (nd).
www.diabetesatlas.org
Mamt, S., Rml, T., & Mcr, P.
(2021). 8 of Digital educational technology for care management of diabetes
mellitus people's feet. In Rev Bras Enferm (Vol. 74, Issue 5).
Min MSN, J. (nd). The Effects of
Diabetes Self-Care Management Education Paired The
Effects of Diabetes Self-Care Management Education Paired with Behavior Change
Support Program Using Mobile Technology with Behavior Change Support Program
Using Mobile Technology in Improving Disease Knowledge, Self-Care Activities,
and Health in Improving Disease Knowledge, Self-Care Activities, and Health
Outcomes in Adult Type II Diabetes Outcomes in Adult Type II Diabetes.
Moini, J. (2016). Anatomy and Physiology for Health
Professionals. In Jones & Bartlett Learning, LLC, an Ascend Learning
Company.
Notoadmojo,
Soekidjo. (2012). Health Education and Behavior. Jakarta: Rineka Cipta
Nurseto, Tejo. (2011). "Creating
Good Learning Media". Journal of Economics & Education, Volume 8,
Number 1
Ohiagu, F.O., Chikezie, P.C., & Chikezie, C.M. (2021).
Pathophysiology of diabetes mellitus complications: Metabolic events and
control. Biomedical Research and Therapy, 8(3), 4243–4257.https://doi.org/10.15419/bmrat.v8i3.663
Parliani, Wahyuningsih, T., Ramadhaniyati (2021). Pocket
book about Diabetes Mellitus. Sukabumi: CV Trace
Paulsen, Herausgegeben Von Friedrich; Waschke, Jens. (2019).
Sobotta's Atlas of Human Anatomy Anatomy: Internal Organs. (Ed 24) . Singapore: ELSEVIER.
Perkeni. (2021). Guidelines for the Management and
Prevention of Adult Type 2 Diabetes Mellitus in Indonesia. PB Perkeni
Potter & Perry. (2009). Nursing
Fundamentals. Edition 7. Book 1. Jakarta: Salemba Medika
Prabawati, D.,
Natalia, L., Stik, S., & Carolus, J. (nd). The Effectiveness Of Self-Care Model On Diabetes Self-Management Behavior.
Basic Health Research (Riskesdas)
(2018). Indonesian Ministry of Health Research and Development Agency in 2018.
http://www.depkes.go.id/resources/download/infoterkini/materi_rakorpop_20
18/Hasil%20Riskesdas%202018.pdf – Accessed December 2022
Sapra A, Bhandari P. Diabetes
Mellitus. [Updated 2021 Sep 18]. In: StatPearls [Internet]. Treasure
Island (FL): StatPearls Publishing; 2022 Jan-.
SDKI, TPP (2017). Indonesian Nursing Diagnosis Standards:
Definition and Diagnostic Indicators.(II). Jakarta: DPP PPNI.
Shrivastava, SRBL, Shrivastava, P.S., & Ramasamy, J. (2013). Role of self-care in management of
diabetes mellitus. In Journal of Diabetes and Metabolic Disorders (Vol. 12,
Issue 1).https://doi.org/10.1186/2251-6581-12-14
Shrivastava,
S.R., Shrivastava, P.S., Ramasamy, J. (2013). Role of Self-Care in Management of Diabetes.
SIKI, TPP (2018). Indonesian Nursing Intervention
Standards: Nursing Definitions and Actions (II). Jakarta: DPP PPNI.
SLKI, TPP (2019). Indonesian Nursing Outcome Standards:
Definition and Criteria for Nursing Outcomes. Jakarta: DPP PPNI.
Sousa, V. D., & Zauszniewski, J. A. (2005). Toward a
Theory of Diabetes Self-Care Management
Susilo,
Wilhelmus Hary; M. Havidz Aima; Fitriana Suprapti. (2014). Advanced
Biostatistics and Research Applications. Jakarta: Trans Info Media
Tafonao, T. (2018). The Role of
Learning Media in Increasing Student Interest in Learning. Journal of
Educational Communication, 2, 110.
Waugh, Grant. (2017). Ross and Wilson Foundations of Anatomy
and Physiology (12th ed.). Singapore: Elsevier.
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