Effectiveness of Pocket diary on Knowledge and Practices of Self-insulin administration among diabetic individuals

 

Mrs. Smita Sunil Gawade

Sadhu Vaswani College of Nursing, 10-10/1, Koregaon Park Road, Pune-411001.

 

ABSTRACT:

Diabetes mellitus is a silent disease and is not recognized as one of the fastest growing threats to public health in almost all countries of the world. Diabetes has emerged as a major health care problem in India.1 Diabetes can be treated and its consequences can be avoided or delayed with diet, physical activity, medication as oral hypoglycemic agent and Insulin administration and regular screening. Multiple daily doses of insulin need to be injected to achieve glycemic control, which has been shown to be an essential condition to prevent acute and chronic complications of this disease mellitus. The most used instrument among the several available in the market to inject insulin is the disposable syringe. 2 Many research studies have assessed factor hindering self-insulin administration among diabetic individuals and identified that most of the diabetic individuals suffering with pain, bleeding at the site of injection and they are unaware about of vial temperature, rotation of injection site. They skipped insulin due to workload, travelling couldn’t afford new syringe, pen and needles. 3 So researcher felt to assess the effectiveness of pocket diary on knowledge and practices of self-insulin administration among diabetic individuals. A quasi experimental research design and purposive sample technique used. Sample size was 30. Structured questionaries’ to assess knowledge and self-insulin administration procedure checklist was prepared for data collection. Researcher prepared self-explanatory pocket diary to teach steps of insulin administration, injection site care, complications, management of diabetes and disposal of insulin syringe. Pre-test conducted to assess knowledge and practices. Pocket diaries were used to explain safe self-insulin administration practices and post-test was conducted. Study findings shows that the, in pre-test of knowledge assessment of self-insulin administration 60% individuals had average knowledge, 27% individuals had poor knowledge, 13% individuals had good knowledge and in post-test 93% individuals had good knowledge, 7% individuals had average knowledge. In pre-test of practice assessment of self-insulin administration 67% individuals had good practices, 30% individuals had average practices, 3% individuals had poor practices and in post-test 100% individuals had good practices. Finding of the study will be helpful to create awareness related to self-insulin administration knowledge and practices on large scale by use of modern educational technology.

 

 

 

INTRODUCTION:

Diabetes mellitus is a silent disease and is not recognized as one of the fastest growing threats to public health in almost all countries of the world. It is also called the ''disease of prosperity''. Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Diabetes has emerged as a major health care problem in India.

According to Atlas published by the International Diabetes Federation (IDF) there were an estimated 40 million persons with diabetes in India 2007 and the number predicted to rise to almost 70 million people by 2025.

 

The need to use exogenous insulin to maintain good metabolic control has been increasingly acknowledged as a therapeutic option for diabetes mellitus type 2 (DM2) in addition to being a classical indication for diabetes mellitus type 1 (DM1). Multiple daily doses of insulin need to be injected into the subcutaneous tissue to achieve glycemic control, which has been shown to be an essential condition to prevent acute and chronic complications of this disease.⁽²⁾

 

The most used instrument among the several available in the India market to inject insulin into the subcutaneous tissue is the disposable syringe due to its low cost, easy access, health.

 

Professional’s familiarity with its use and also because it is freely distributed by government institutions.

 

For glycemic control done through insulin therapy with disposable syringes to be effective, several things need to be learned. Among them is the administration technique, considered one of the factors influencing the effectiveness of insulin inadequate and unsafe practices in the administration of insulin can interfere in the metabolic control and consequently lead to the development of DM chronic complications. Due to the increased number of people with DM using insulin in recent years, more emphasis should be given to the standardization and improvement of insulin administration technique, focusing on properly teaching this technique so that people become aware of their responsibility and make less mistakes during insulin administration. Even though some studies have focused on the many variables related to the self-insulin administration, there is a need to introduce the process of insulin self-administration with disposable syringes or pens in the current context of health policies that is in the Family Health Strategy (FHS) context. Because the FHS aims to reorganize the delivery of primary health care and ensure that individuals with DM receive integral, equitable care with case-resolution ability, interventions in health should be developed with an adequate knowledge of people's context so to favor the establishment of goals and practices that effectively meet the needs of populations. Based on the above, this study aimed to identify the most common incorrect and correct procedures in the insulin self-administration technique with disposable syringes and pens, and the use of pocket manual importance to relate the findings to socio- demographic variables and identify the professional responsible for providing instructions on how to self- administer insulin. The therapeutic success of insulin does not depend only on its type and dose prescribed but also on how it is administered. Thus, the recommendations provided by the ADA(American Diabetic Association) on the preparation and administration of insulin involving consecutive stages can contribute, when properly followed, to safe practice and achieving treatment goals and preventing or delaying acute and chronic complications due to poor metabolic control. For that, health professionals also need to make a detailed evaluation of visual, motor or neurological deficits of patients before providing them the sequential steps of this technique.⁽⁴⁾

 

MATERIAL AND METHOD:

1.     Research approach: Quantitative

2.     Research design: Quasi experimental

3.     Study setting: The setting of this study is selected hospital.

4.     Sample Technique: purposive sampling technique.

5.     Sample size: 30

6.     Variables of the study:

·       Dependent Variable: the practices of pocket diary uses by diabetic individual while self -insulin administration.

·       Independent Variable: the self-insulin administrator.

7.     Tool: The present study aims at assessing the effectiveness of pocket diary on knowledge and practices of self-insulin administration. Total 30 individuals are selected for study. The evaluation questionnaire consists 3 section. Section A: Demographic data (age, sex, education, occupation, income, duration of diabetes, duration of self-insulin administration, type of insulin etc.) Section B: Multiple choice questions to assess knowledge related self-insulin administration. Section C: Checklist to assess the practices of self-insulin administration.

8.     Ethical Consideration: Ethical committee approval is obtained from the Sadhu Vaswani College of Nursing

 

RESULTS:

Pre-test and post-test knowledge wise distribution of patient in study group.                                                      N= 30

Knowledge score	Pre-test		Post- test
	No. of individual	%	No. of individual	%
Poor (score 1-6)	8	27%	0	0%
Average (7-12)	18	60%	2	7%
Good (13-17)	4	13%	28	93%
Total	30	100%	30	100%

 

Above table shows that, out of 30 subjects in pre-test to assess the effectiveness of pocket diary on self-insulin administration of knowledge.

 

In pre-test 18 (60%) of them had average knowledge (score 7-12), 8(27%) individuals had poor knowledge about self-insulin administration (score 1-6), and 4 (13%) of them had good knowledge (score 13-17).

 

In post-test, majority 28(93%) of them had good knowledge regarding self- insulin administration (score 13-17) and 2 (7%) of them had average knowledge (score 7-12).

 

This indicates that there is marked improvement in knowledge among diabetic individuals regarding self-insulin administration.

 

Bar diagram showing pre- test and post- test knowledge wise distribution of pocket diary on self-insulin administration.

 

Comparison of pre and post- test knowledge score of pocket diary on self-insulin administration.                                     N=30

Parameter	Pre-test	Post-test	t	df	p-value
Knowledge score	Mean ∓ SD (n=30)	Mean∓ SD (n=30)	11	29	0.000
	8.7 ∓ 2.902	15.33∓1.971

 

Above table shows that pre-test and post-test score of them were compared for effectiveness of the pocket diary of self-insulin administration on knowledge among diabetes individuals. Average knowledge score in pre-test was 8.7 which increased to 15.33 in post-test. The knowledge score increased significantly after using pocket diary on self- insulin administration. Paired t-test is applied, ‘t’ value was found to be 11 at 29 degree of freedom. Corresponding p-value was small (of order of 0.000, less than 0.0001).

 

The pocket diary is highly effective in improving the knowledge among the diabetes individual.

 

Pre-test and post-test practice wise distribution of patient in study group.                                                                                       N= 30

Practice score	Pre-test		Post- test
	No. of individual	%	No. of individual	%
Poor practice (1-7)	1	3.00%	0	0%
Average practice (8-14)	9	30.00%	0	0%
Good practice (15-22)	20	67%	30	100%
Total	30	100%	30	100%

 

Above table shows that, out of 30 subjects pre-test to assess the effectiveness of pocket diary on self-insulin administration of practices.

 

20(67%) individuals had good practices about self-insulin administration (score 15-22), 9 (30.00%) of them had average practices (score 8-14), and 1(3.00%) of them had poor practices (score 1-7).

 

In post- test, all 30 (100%) of had good practice regarding self- insulin administration.

 

This indicates that there is marked improvement in practices among diabetic individuals regarding self-insulin administration.

 

Bar diagram showing pre-test post-test practice wise distribution of pocket diary on self-insulin administration.

 

Comparison of pre and post- test practices score of pocket diary on self-insulin administration.                                                      N=30

Parameter	Pre-test	Post-test	t	df	p-value
Practice score	Mean ∓ SD (n=30)	Mean∓ SD (n=30)	7	29	0.000
	16.23∓4.15	21.8∓0.7611

 

Above table shows that pre-test and post-test score of them were compared for effectiveness of pocket diary on self-insulin administration practices. Average practice score in pre-test was 16.23 which increased to 21.8 in post- test. The practice score increased significantly after using pocket diary on self-insulin administration. Paired t-test is applied, ‘t’ value was found to be7 at 29 degree of freedom. Corresponding p-value was small (of order of 0.000, less than 0.0001).

 

The pocket diary is highly effective in improving the practices among the diabetes individuals.

 

DISCUSSION:

Diabetes mellitus is a silent disease and is not recognized as one of the fastest growing threats to public health in almost all countries of the world. It is also called the ''disease of prosperity''. Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from, factors affecting the quality and quantity of defects in insulin secretion, insulin action, or both. Diabetes has emerged as a major health care problem in India.

 

It is our moral responsibility to increase their knowledge and practices of self-insulin administration with the help of modern educational technology which will help to retain and enlighten this knowledge to others.

 

Present study also proved that pocket diary on self-insulin administration is highly effective on knowledge and self-reported practices of insulin administration among diabetes individuals.

 

RECOMMENDATIONS:

Following recommendations can be made on the basis of following findings. It is recommended that a similar study can be replicated

1.     On a large sample with different demographic characteristics.

2.     A study can be conducted to find out the effectiveness of health teaching program on diabetic individuals regarding prevention of complication of self-insulin administration.

3.     A comparative study can be done with urban and rural setting.

4.     The study may be done with various information, education and communication technology.

5.     The survey can be conducted to find out wrong practices of self-insulin administration.

 

REFERENCES:

1.     Gao Y.( 2017), Publication trends of research on diabetes mellitus and T- Cells. Available at:https://journals.plos.org>plosone>article

2.     The Hindu, “50.8 Million will have Diabetes in India”. Available at: https://www.thehindu.com

3.     Insulin administration Diabetes Care American Diabetes Association Available at: Care. Diabetes journal.org.

4.     Gawade S. et,all,(2017), “A Descriptive study to assess the factors hindering self-insulin administration among diabetic individuals of Pune city.” Asian Journal of Nursing Education and Research. 9(2):April-June,2019.

 

Received on 13.04.2020          Modified on 23.04.2020

Accepted on 01.05.2020     © AandV Publications all right reserved