The Evaluation of the Effects of Implementing Tailored Care Program on Patients with Diabetes in Indonesia

Tahapan Penelitian : Complete
Mitra Pelaksana:
National Taipei University of Nursing and Health Sciences
No Registry
Tanggal Input Registry : 14-11-2021

After three months following enrolment, physiological outcomes (HbA1c, body mass index, blood pressure, triglyceride, blood glucose, triglyceride glucose index and cholesterol levels), self-management outcomes (eating behaviour, physical activities, medication adherence, self-monitoring and diabetes knowledge) were evaluated.
After three months following enrolment quality of life, diabetes-related distress, diabetes self-care activity and risk assessment for diabetes complication were evaluated.
The Evaluation of the Effects of Implementing Tailored Care Program on Patients with Diabetes in Indonesia
The Evaluation of the Effects of Implementing Tailored Care Program on Patients with Diabetes in Indonesia
The main study was a randomized controlled trial (RCT) to test and evaluate the tailored care for patients with diabetes in Indonesia. Design A single-blinded repeated measure RCT with two group pre-test and post-test design was used to test a tailored care intervention program for patients with diabetes in Indonesia. This design is particularly relevant where a new intervention as a tailored care program was compared to a routine treatment or a comparative intervention. Design for RCT is the gold standard to minimize bias through the process of random assignment and blinding. Moreover, the RCT as an intervention design was selected to test the effectiveness of the tailored care intervention. The intervention program is set at helping the participants acquire physiological outcomes, self-management, self-care activity, risk assessment for diabetes complications and psychosocial outcomes in three months of data collection after the intervention program. The main goals of the study were focused on after receiving three months tailored care program participant showed significant improvements from pre to post-intervention programs in improving the physiological outcomes (HbA1c, body mass index, blood pressure, triglyceride, blood glucose, triglyceride glucose index and cholesterol levels), diabetes self-management, self-care activity, risk assessment for diabetes complication, quality of life and diabetes-related distress. Randomization Lists of names of potential respondents who perform health checks routinely in primary health cares, have complete laboratory data especially HbA1c from September-December, are collected then randomized using a computer (Excel program) to avoid selection bias. After randomization, respondents were divided into two groups, intervention and control groups. Each address of respondent was also collected so, they could be tracked in each area where they lived. Furthermore, the researcher went to each respondent's house for inviting participant candidate to participate in the study. All respondents agreed to participate in the study because they would receive free medical tests such as blood sugar level, blood pressure, weight, height, cholesterol and triglycerides every month during the visit or follow up activity. Blinding In this study, all participants are blind to the allocation. It avoids those elements that have potentially influenced the outcomes from allocations. Participants were also blinded as to their group assignment to avoid their expectations for that treatment. It has been confirmed that there was no communication between participants in the intervention and the control group. The participants in control groups in this study receive d routine care from staff in a clinical setting. On the other hand, the intervention group received a tailored care program in the community setting. Preparation before tailored care program for diabetes implemented 1. Apperception related to all processes and procedures to be carried out in the study with two research assistants. 2. Research assistants attended an apperception about how to use the tailored care and practice skills for managing groups. 3. After apperception, facilitators were supported to deliver the intervention Application of the tailored care program for diabetes 1. Brief deducted teaching Firstly, it is necessary to hold a lay seminar attended by patients with diabetes. This seminar was filled with speakers who are experts in their fields such as a nurse, a doctor, and a nutritionist. The lay seminar contains ways for patients to perform self-management to maintain their blood glucose still stable while at home. 2. Assessment for self-management level and risk of cardiovascular disease (CVD) among patients After didactic teaching was completed, the nurse conducts an assessment to determine the level of patient self-management, how many the percentages of patients’ risk of complication. The risk report was personalized to describe individual complication risk then patients with a high risk of complications treated by the sub-specialist physicians. Patients were divided into groups for brainstorming the difficulties on glycaemic target and specific target behaviour. 3. Brainstorming among patients to share their difficulty on glycaemic targets and specific target behaviour Programs in the form of support groups between diabetes patients was a good media for patients to share their experiences with each other regarding their lifestyle for blood sugar control. This support group is accompanied by a facilitator to ensure information exchange among patients are still safe and there is no risk of malpractice when patients apply it themselves while at home. 4. Making a list of patients’ needs then rank the priorities The experience they gained from the discussion in the support group became their literature in choosing which invention was the most appropriate to keep their blood glucose stable while at home. 5. Setting a goal and writing action The goal of the patient that wanted to be achieved and the intervention plan that the patient has chosen can be written on a monitoring book that they have. Monitoring books can be read by health workers when patients with diabetes carry out health control routinely every month at primary health care. 6. Follow-up Each report in the monitoring book was valuable data for hospitals or health facilities to determine the most appropriate interventions for patients in the future. 7. Report of goals attempt After three months, participants report their goal attempt, where a goal has been partially achieved or not achieved. Moreover, the outcome evaluation (physical, self-management, psychosocial, self-care activity, risk assessment for diabetes complication) was also evaluated.

Inclusion Criteria:

The selection criteria for inclusion were more than 20 age years old at the time of recruitment, Asian- from ethnic of Indonesia, willing to participate in the trial, had a mobile device and lived with family members, 20 years old was considered as a mature age and has the authority to make their own decisions. Patients who live with their families make the researcher easier to follow up or call their family to reminder respondents to follow the process of study.

Exclusion Criteria:

The selection criteria for exclusion were having a history or diagnosis of ischemic heart disease, transient ischemic attack (TIA) or peripheral vascular disease, enduring mental health problems, terminal stages of a condition, cannot consent for themselves were not considered suitable for the trial and exclude.