INTRODUCTION:

The main types of NCDs are cardiovascular disease, cancers, chronic respiratory diseases and diabetes. NCDs disproportionately affect people in low and middle income countries where more than three quarters of global NCD deaths – 32million – occur (Sinha et al., 2019). India is a populous country of about 1.3 billion. Non-Communicable Diseases (NCDs) contribute to around 5.8 million (60%) of all deaths in India.

Diabetes mellitus is a Chronic, metabolic disease characterized by elevated levels of blood glucose, which

leads over time to serious damage to the heart, bloodvessels, eyes, kidneys and nerves. The three main types of diabetes are Type 1 Diabetes Mellitus (T1DM), Type 2 Diabetes Mellitus (T2DM), and Gestational Diabetes Mellitus (GDM). The most common is type 2 diabetes, usually in adults, which occurs when the body becomes resistant to insulin or doesn’t make enough insulin. About 422 million people worldwide have diabetes, particularly in low and middle income countries (Ahlqvist et al., 2019). Patients with diabetes are expected to perform daily self-management activities to help avoid diabetes related morbidity & mortality. Self-management is a cornerstone of diabetes care, and it is believed that improving patients self-efficacy is a critical pathway to improved self-management (Atlanta, Self-Efficacy (SE) has a prominent role in diabetes self – management and predicts its outcome. In their study Didarloo et al. reported that self-efficacy explained 11.4% of variance regarding diabetes self-care and 31.3% variance of diabetes self-care behavioural intention (Didarloo, 2016). Diabetes self-care requires the patient to make many dietary and lifestyle modifications supplemented with the supportive role of healthcare staff for maintaining a higher level of self-confidence leading to a successful behavior change.(Shrivastava, et al., 2013). Self-efficacy impacts adherence to treatment and therefore plays a role in the clinical outcome. The practical implication is that assessment self-efficacy in people with diabetes may be a first step in the development of individually tailored interventions. (Mishalia et al., 2010)

NEED AND SIGNIFICANCE OF THE STUDY:

Individuals living with diabetes should adhere to physicians’ prescribed treatment regimens (Arifulla et al., 2014). However, findings from studies have shown that many patients fail to adhere to treatment recommendations. Consequently, many people with diabetes face acute and chronic complications (Amado et al., 2015). Diabetes mellitus is a chronic disease that can affect all aspects of life. Diabetes being a chronic illness, it is important that the patients be self-sufficient in managing diabetes which in turn would help in improving the quality of life and postponing complications. Thus it is very important to study the self-efficacy of diabetic patients towards diabetes self-management.

Reasons for undertaking the current study:

· The growing global burden of diabetes mellitus makes research in diabetes a priority.

· Adherence to complex diabetes treatment regimen is not satisfactory and rate of complications higher among the diabetes. Self-management of diabetes is priority research area recommended by different diabetes organizations and self-care is closely associated with self-management of diabetes. Dearth of research findings in terms of diabetes self-efficacy in Tamilnadu.

· Interest and motivation of the research.

PROBLEM STATEMENT:

A descriptive study to determine the perceived self-efficacy towards diabetes self-management among patients with type 2 diabetes mellitus from a selected hospital of Madurai district.

OBJECTIVES:

1. To assess the perceived self-efficacy towards diabetes self-management among patients with type II diabetes mellitus.

2. To determine the association between selected demographic variables & clinical variables and perceived self-efficacy towards diabetes self-management among patients with type II diabetes mellitus.

3. To determine the relationship between blood sugar values and perceived self-efficacy towards diabetes self-management in patients with type II diabetes mellitus.

HYPOTHESIS:

1. These will be a significant association between selected variables and perceived self-efficacy towards diabetes self-management among patients with type IIdiabetes mellitus.

2. These will be a significant association between selected clinical variables and perceived self-efficacy towards self-management among patients with type II diabetes mellitus.

3. There will be a significant relationship between blood sugar values perceived self-efficacy towards diabetes self-management of patients with type II diabetes mellitus.

OPERATIONAL DEFINITIONS:

Perceived self-efficacy towards diabetes self-management:

Perceived self-efficacy towards diabetes self-management refers to type 2 diabetic patient’s confidence in his or her capacity to organize and execute course of action related to treatment and control of diabetes mellitus in terms of management of social and emotional, aspects of diabetes, food related aspects of diabetes, communication with health professional and planning, management of low blood sugar, management of diabetes related to exercise, blood glucose and prevention, integration of knowledge and day to day care, and management of insulin as measured by the Diabetes Self Efficacy Questionnaire (DSEQ).

Patients with Type II Diabetes Mellitus:

In this study, patients with type 2 diabetic mellitus refers to patients of both genders who are diagnosed to have type 2 diabetic mellitus for more than a month by the physician and attending the OutPatient Department (OPD) of Saravana Multispecialty Hospital. Henceforth type II diabetes mellitus will be referred as T2DM.

CONCEPTUAL FRAMEWORK:

The conceptual framework for the current study is adapted from Bandura’s self-efficacy theory (Bandura, 1995; Shortridge-Bagget & Vander Bijil, 1996) as implemented in a study by D” souza et al., (2017) in Oman which assessed the relationship between self-efficacy and self-care behaviours among adults with type II diabetes mellitus. The current conceptual framework is named as “Adapted Self-Efficacy Model for Patients with Type II Diabetes Mellitus.”

RESEARCH METHODOLOGY:

Schematic Representation of Research Methodology

Research Approach :Quantitative Approach

Research Design :Descriptive Cross-sectional Research Design

Setting - Selected Hospital of Madurai District

Setting of the study :Patients with Type II Diabetes mellitus attending out patient department (OPD)

Sample: Patients with Type II Diabetes mellitus attending OPD and who fulfilled the inclusion criteria

Sample size and Sampling Technique-80; Convenient sampling technique

Tools and Technique -Structured interview schedule on sociodemographic & clinical variables, DSEQ technique – Interview & chart analysis

Content validity: 7 experts

Reliability of DSEQ --- Cronbbach’s Alpha r = 0.86

Pilot study-10% of the total sample size, study was found feasible, practical.

Ethical clearance obtained. Permission from hospital obtained. Data collection period 6 weeks. Informed consent obtained.

Each interview lasted 30-45mints.

Data analysis : Descriptive Statistics, Frequency, Percentage, Mean, Standard deviation, Inferential Statistics, Chi-square

VARIABLES:

Main Study Variable: Perceived self-efficacy towards diabetes self-management.

DESCRIPTION OF THE TOOL:

Section A: Structured interview schedule on socio demographic variables. This included the socio demographic characteristics of patients with type II diabetes mellitus like age, gender, marital status, educational qualification, income and occupation.

Section B: Structured interview schedule on Clinical Variable:

This consisted of clinical variables like duration of illness, number of medications taken currently, previous hospitalization, adherence to regular exercise, adherence to regular checkup, adherence to the dietary restrictions, presence of comorbidity(Hypertension, heart disease, kidney disease or any other). Interview technique was used to collect the data regarding socio demographic and clinical variables.

Section C: Biochemical Variables:

Using chart analysis, patient’s recent values of fasting blood sugar postprandial blood sugar and random blood sugar values were recorded.

Section D: Diabetes Self Efficacy Questionnaire (DSEQ):

The self-efficacy towards diabetes self-management was measured using the DSEQ. Diabetes self-efficacy questionnaire was revised for evaluation of a community diabetes program. originally developed for use in western populations to assess the confidence of diabetes patients in their ability to manage their diet, blood sugar, and physical exercise. The items were developed based on the literature and the experience of a number of experienced diabetes educators. The DSEQ consists of questions that answered on a six-point likert scale ranging from never to always. Items are scored using a 6 point scale with 0 as never and 5 as always.

INTERPRETATION OF DSEQ:

The total score were interpreted to:

Mild perceived self-efficacy score - 0 - 145

Moderate perceived self-efficacy score - 146 - 218

High perceived self-efficacy score - 219 – 290

DATA COLLECTION PROCEDURE:

Ethical clearance was obtained from ethical committee of Sacred heart nursing college. Formal permission was obtained from the management of Saravana Multispeciality Hospital. Duration of the data collection period was six weeks. Descriptive cross- sectional design was adopted to do the study. The total sample size was 80 patients with type II diabetes mellitus who were selected using convenient sampling technique. The data was collected from Monday to Saturday between 8am to 4pm. Each week approximately 10-15 patients were interviewed. Interview was conducted in the OPD of Saravana Multispeciality Hospital in a separate room. Once the sample was collected the researcher introduced herself to the patient. A written informed consent was obtained from each patient after giving assurance on the maintenance of confidentiality and anonymity. The data regarding socio demographic variables, clinical variables, and perceived self-efficacy was collected by interview technique. The recent fasting blood sugar value, postprandial blood sugar value and random blood sugar values were collected from patients chart. Each patient was interviewed individually. Interview lasted approximately for 30 to 45 minutes. The data was collected without causing hindrance to patient care activity. The researcher thanked the patient at the end of data collection. Each weeks for 6 days approximately 10-15 patients interviewed by the researcher.

DATA ANALYSIS AND INTERPRETATION:

Distribution of patients with T2DM according to the demographic characteristics:

Samples distributed were that a little less than half of the (48.75%) belong to the age group of 31-50 years. Males (55%) were little high in number than the females (45%)A little over half of them (53.75%) were Hindu by religion. Out of 80, 47 of them (58.75%) were literates and the others (41.25%) were illiterates. Majority (60%) of them were married and majority (62.50%) of them hailed from nuclear family. There were equal number of patients in both the employed and unemployed category. Majority of the sample (77.50%) hailed from urban areas.

Mean and standard deviation of overall and domain wise perceived self-efficacy towards diabetes self-management:

Bio chemical variables	Mean	Standard Deviation	Minimum	Maximum	Range
Fasting Blood Sugar	178.75	33.37	112	290	178
Postprandial Blood Sugar	217.05	37.26	126	310	184
Random Blood sugar	189.90	32.97	140	280	140

Portrays that the mean fasting blood sugar value was 178.75+33.37; mean postprandial blood sugar was 217.05+37.26; and the mean random blood sugar was 189.90+32.97.

Distribution of patients with T2DM according to the level of perceived self-efficacy towards diabetes self-management:

portrays that out of 80 samples, 45(56.25%) of them had low self-efficacy towards diabetes self-management and none of them had high self-efficacy (0.00%) towards diabetes self-management.

Mean and standard deviation of overall and domain wise perceived self-efficacy towards diabetes self-management depicts the mean and standard deviation of the overall and domain wise perceived self-efficacy towards diabetes self-management. Since the number of items is different in each domain, it is difficult to interpret with the mean scores. So the mean scores were converted in to mean percentage score for easy and clear interpretation. The domain wise mean and standard deviation is as follows: managing social, emotional and food related aspects of diabetes (42.61±6.16), communicating with health professionals and planning (22.50±3.80) and managing low blood sugars (10.90±3.27), managing diabetes related to exercise, blood glucose and prevention (30.13±6.28), integrating knowledge and day to day care (2.34±4.13) and managing insulin (20.32±2.07). Mean and standard deviation for the overall perceived self-efficacy toward diabetes self-management was (153.00±9.49).

The percentage mean score in decreasing order for the different domains are managing insulin (67.73%), communicating with health care professionals and planning (56.25%), integrating knowledge and day to day care (54.68%), managing low blood sugars (54.50%), managing social, emotional and food related aspects of diabetes (50.13%), and managing diabetes related exercise, blood glucose and prevention (46.35%). The overall mean percentage score was 52.75%.

S. No.	Correlation Variables	Number of samples	Pearson correlation ‘r’value	‘p’ value
1.	Perceived self efficacy Vs FBS	80	-0.12	0.28 (NS)
2.	Perceived self efficacy Vs PPBS	80	-0.14	0.21 (NS)
3.	Perceived self efficacy Vs RBS	80	-0.21	0.04**

Correlation between the perceived self-efficacy towards self-management and blood sugar values of patients with T2DM.

There is a statistically significant negative relationship between perceived self-efficacy and random blood sugar values (r= -0.21- p = 0.04*). There exists a negative relationship between perceived self-efficacy and FBS (r = -0.12); and PPBS (r = -0.14) but it was not statistically significant at 0.05 level of significance

RECOMMENDATIONS:

On the basis of present study, the following recommendations made for further studies

· A study can be undertaken to determine the relationship between self-efficacy and self-management behaviours among T2DM patients.

· A similar study can be undertaken to determine the significant predictors of self-efficacy in T2DM patients.

CONCLUSION:

The present study findings revealed that the perceived self-efficacy was ranging from low to moderate and none had high self-efficacy towards diabetes self-management. There is a wide scope for enhancing nursing practice in this chosen area. Diabetes self-efficacy has a strong influence on diabetes self-management which improves adherence to the therapeutic regimen and thereby delaying the rate of complications. Management of client with diabetes includes restoring and maintaining blood glucose levels to near normal as possible by balancing the diet, exercise, and the use of oral hypoglycaemic agents or insulin. The treatment of diabetes is highly individualized, and it depends on type of diabetes, complications, and presence of other active medical problems, age and general health at the time of diagnosis. Diabetes can be managed with proper care, clear understanding of the problem, proper treatment and regular follow up.

REFERENCES:

1. Sinha etal (2019) Identification of publicity Data available from floo research 7; 245 Doi; 10.21276/aimdel 2019.5 ATZ

2. Ahlquist.B, Misra.M, Karuna.L (2018) Current glycemic status and Diabetes related complications among TYPE 2 Diabetes related complications among Type 2 DM Patients in India. Data from journal of Association of Physician India 61 (suppl) 12;15 http; doi; ISSN/0004-57

3. Didarloo etal (2016) Prediction of self-management behaviour among Iranian women with Type 2 DM Med J 14(2); 86 doi; 10.4/03/2016-2082. I7600 A doi; I04239/wjd.vio.16-34

4. Shrivasta etal (2013) Role of selfcare in management of Diabetes mellitus, Journal of Diabetes and metabolic disorders 12.14.http// www.jdmd online .com/content/12/1/14

5. Mishalini etal (2011) The importance of measuring self-efficacy in patients with Diabetes Fam pract 28(I) 82-87 doi; 10/1093/fampra/cmq086

6. Arifulla. M, Johan. L, Sareedharan, Mutfappallymyil. J and Basha. S (2014) Patients adherence to Antidiabetic medications in a hospital, Journal of medical science 21(1) 44-49 www.ncbi.nlm.gov/pupmed/2463661

7. Amado et al 2015) Early detection and treatment of Type 2 DM to reduce cardio vascular mortality and morbidity Diabetes care Aug 38(8); I449-55 doi; 10.2337 /dc 14-2459

8. Bandura G guide for constructing self-efficacy http./www.yearbook2017.psg.fr/4diyz-bandura-guide-for-con-

Received on 17.02.2022 Modified on 10.04.2022

Int. J. of Advances in Nur. Management. 2022; 10(3):163-167.

DOI: 10.52711/2454-2652.2022.00042