Impact of Perceived Self Efficacy on Hba1c among Adolescents with Type 1 Diabetes Mellitus

 

Lizzie Raveendran1, Dr. Jeyaseelan M. Devadason2, Dr. Prakash M.Saldanha3

1Principal, Gem Institute of Nursing Education & Research, Coimbatore

2Dean, J.K.K. Sampoorani Ammal College of Nursing, Komarapalayam

3Professor & HOD, Department of Pediatrics, Yenepoya Medical College Hospital, Mangalore

*Corresponding Author Email: lizzie1960cbe@gmail.com

 

ABSTRACT:

Background: Type 1 diabetes mellitus in children is on the increase. It is a chronic, life threatening disease that requires strict adherence to treatment. This means the children should have adequate self efficacy to manage their disease and to lead a near normal life that is free from diabetic related complications

Aim: To assess the level of self efficacy among adolescents with type 1 diabetes and to determine its impact on HbA1c.

Methods: Pretest-posttest control group design was used for the study. The study was conducted in a diabetic clinic in Coimbatore. The population for the study included all the children attending the clinic. The sample size was 65 each in both the experimental and control group. Purposive sampling technique and random allocation of samples to experimental and control group was used. The data was collected using structured demographic questionnaire and self efficacy scale.

Results: the collected data were tabulated and analyzed using descriptive and inferential statistics. The findings showed there is an increase in self efficacy after structured teaching and it had an impact on HbA1c which was markedly decreased.

Conclusion: The structured teaching is effective to improve the self efficacy and it has a positive impact on HbA1c.

 

KEY WORDS: Type 1 diabetes mellitus, Self efficacy, Adolescents, HbA1c, Impact.

 


Type 1 diabetes mellitus among children is on the increase. As reported by the WHO (1) India is the leading country for diabetes with 31.7 million cases in 2000 and the number is expected to rise to 79.4 million by 2030. Gupta (2) has stated that diabetes has emerged as a major health care problem in India. The study by Bhatia and Agarwal (3) showed the incidence of type 1 diabetes is increasing worldwide, especially in younger children. Unfortunately there is little information on the incidence of type 1 diabetes and its management from India. Recent studies have emphasized the importance of strict glycemic control in the prevention and delay of chronic micro vascular complications of diabetes mellitus.

 

Type 1 diabetes is requires series of tasks including blood glucose monitoring, administering insulin, exercising regularly and consuming the right food. Failure to comply with the regimen can cause serious short term and long term complications. Children and adolescents often feel overwhelmed by the complex and time consuming treatment tasks. A study by Tolijamo and Hentinen (4) showed that those who adhered to self care had better glycemic control than those who did not.

 

SIGNIFICANCE OF THE STUDY:

A phenomenological study by Yueh Ling Wang et al (5) discovered four themes of learning as expressed by the adolescents. They are learning to master their disease, learning to find ways to feel comfortable, learning not to be different and learning to not let others worry about them. The present study also concentrates on molding the adolescents to be self reliant. Adolescence is a transition period when the children are trying to be self reliant. Children with any chronic illness can be taught and trained to manage their disease with adequate support and supervision. The present study aims to achieve glycemic control through self care management and thereby prevent the diabetic relate complications.

 

MATERIALS AND METHODS:

Design:

Pretest-posttest control group design was used for the study

 

Setting:

The study was conducted in a diabetic clinic in Coimbatore. On an average 4 to 5 children with diabetes visit the clinic per day

 

Population:

The population for the study included all the children attending the clinic

 

Sample:

A total of 130 children who fulfilled the inclusion criteria were included for the study. They were allotted to the experimental and control group to have 65 in each group.

 

Sampling Technique:

Purposive sampling technique and random allocation of samples to experimental and control group was used.

 

Instruments:

A structured demographic questionnaire and self efficacy scale were used to collect the data.

 

Description of the instrument:

The questionnaire consisted of 4 sections namely demographic data, disease factors, diet and exercise factors and educational factors. There were 19 items in all 4 sections together. The second part of the questionnaire was the self efficacy scale which was developed based on the General Self Efficacy scale by Raif Schwarzer and Matthias Jerusalem in 1995. It is a 4 point scale with 15 items. The content validity was obtained from 5 subject experts and construct validity was done to measure the reliability of the self efficacy scale.

 

Data collection:

Prior permission was obtained from the concerned authorities for the conduct of the study. The adolescents and their parents were explained about the study and their consent was obtained. All the children attending the diabetic clinic were screened and those who fulfilled the inclusion criteria were randomly assigned to the experimental and control groups. The structured questionnaire and the self efficacy scale were administered to all the selected samples. A structured teaching on self care activities on insulin, diet, exercise and blood glucose monitoring was given to all children individually. The self efficacy and HbA1c were checked after 3 months.


 

RESULTS:

Table 1: Frequency and percentage of samples according to demographic date

Sl. No

Variables

Experimental Group (n = 65)

Control Group (n = 65)

Frequency

%

Frequency

%

 

 

 

 

 

 

1

Age of the child

a.       10 – 12 years

b.       13 – 15 years

c.       16 – 19 years

 

27

27

11

 

41.5

41.5

17.0

 

24

32

9

 

37.0

49.2

13.8

2

Sex

a.       Male

b.       Female

 

37

28

 

56.9

43.1

 

33

32

 

50.8

49.2

3

Place of living

a.       Urban

b.       Rural

c.       Semi urban

 

36

15

14

 

55.4

23.1

21.5

 

30

18

17

 

46.1

27.7

26.2

4

Religion

a.       Hindu

b.       Muslim

c.       Christianity

 

43

12

10

 

66.1

18.5

15.4

 

42

11

12

 

64.5

17.0

18.5

5

Number of siblings

a.       One

b.       Two

c.       None

 

43

12

10

 

66.1

18.5

15.4

 

47

12

6

 

72.3

18.5

9.2

6

Family income group

a.       High

b.       Middle

c.       Low

 

19

33

13

 

29.2

50.8

20.0

 

17

41

7

 

26.2

63.0

10.8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Table 1 shows that in experimental group there were equal number of children in10 – 12 years and 13 – 15 years of age (41.5%), majority were males (56.9%), were living in urban areas (55.4%), belonged to Hindu religion (66.1%), had one sibling (66.1%) and belonged to middle income group families (50.8%). In control group majority belonged to 13 – 15 years (49.2%), were males (50.8%), belonged to Hindu religion (64.5%), had one sibling (72.3%) and  belonged to middle income group families (63%).

Table 2: Frequency and percentage of samples according to educational status

Sl. No

Variables

Experimental Group (n = 65)

Control Group (n = 65)

Frequency

%

Frequency

%

1

Educational status

a. Middle school

b. High school

c. Higher secondary

d. Collegiate

 

37

17

6

5

 

56.9

26.2

9.2

7.7

 

32

24

6

3

 

49.2

36.9

9.2

4.6

2

Scholastic performance

a. A grade (81%and above)

b. B grade (6180%)

c. C grade (41 60%)

 

22

27

16

 

33.8

41.5

24.6

 

24

26

15

 

36.9

40.0

23.1

 

The Table 2 shows that most children study in middle school (56.9% and 49.2%) and majority had the scholastic performance to the level of B Grade (41.5% and 40%) in both the groups.

 

Table 3: Frequency and percentage of samples according to disease factors

Sl. No

Variables

Experimental Group (n = 65)

Control Group (n = 65)

Frequency

%

Frequency

%

1

Duration of illness

a.     6 months – 1 year

b.     1 year – 2 years

 

31

34

 

47.8

52.2

 

33

32

 

50.8

49.2

2

No. of insulin injections per day

a.     2

b.     3

c.     4

 

26

9

30

 

40.0

13.8

46.2

 

28

8

29

 

43.1

12.3

44.6

3

Insulin is administered by

a.     Self

b.     Mother

c.     Father

 

46

13

6

 

70.8

20.0

 9.2

 

41

17

7

 

63.1

26.1

10.8

4

Checking blood glucose per day

a.     Once

b.     Twice

c.     Thrice

d.     Nil

 

41

22

1

1

 

63.1

33.9

1.5

1.5

 

40

21

00

4

 

61.5

32.3

00

6.2

5

History of hypoglycemia

a.     More than 10 times

b.     5 – 10 times

c.     Less than 5 times

d.     never

 

3

19

36

7

 

4.6

29.2

55.4

10.8

 

4

15

31

15

 

6.1

23.1

47.7

23.1

6

History of hyperglycemia

a.     5 – 10 times

b.     Less than 5 times

c.     Never

 

1

19

45

 

1.5

29.2

69.3

 

4

20

41

 

6.1

30.8

63.1

7

History of hospitalization for diabetic related problems

a.     Yes

b.     No

 

9

56

 

13.8

86.2

 

5

60

 

7.7

92.3

8

Frequency of medical check up

a.     Once a year

b.     Once in 6 months

c.     Once in 3 months

 

00

00

65

 

00

00

100

 

00

00

65

 

00

00

100

9

Diabetic management considered as difficult

a.    Insulin

b.    Diet

c.    Exercise

d.    Glucose monitoring

 

7

25

27

6

 

10.8

38.5

41.5

9.2

 

10

22

26

7

 

15.4

33.8

40.0

10.8

 

The Table 3 shows that in experimental group most of the children had the illness for 1 – 2 years (52.2%), take 4 injections of insulin per day (46.2%), on their own (70.8%), check blood glucose once a day (63.1%), had history of hypoglycemia less than 5 times (55.4%), have never had hyperglycemia ( 69.3%), never had been hospitalized for diabetic related problems (86.2%), have medical checkup once in 3 months (100%) and considered exercise as difficult management (41.5%).  Whereas in control group most of the children had the illness for 6 months  – 1 year (50.8%), take 4 injections of insulin per day (44.6%), on their own (63.1%), check blood glucose once a day (61.5%), had history of hypoglycemia less than 5 times (47.7%), have never had hyperglycemia ( 63.1%), never had been hospitalized for diabetic related problems (92.3%), have medical checkup once in 3 months (100%) and considered exercise as difficult management (40%). 

 

Table 4: Frequency and percentage of samples according to diet and exercise

Sl. No

Variables

Experimental Group (n = 65)

Control Group (n = 65)

Frequency

%

Frequency

%

1

Dietary habits

a.       Strict vegetarian

b.       Occasional non vegetarian

c.        Non vegetarian

 

12

00

53

 

18.5

00

81.5

 

8

3

54

 

12.3

4.6

83.1

2

Intake of high calorie food per week

a.       Once

b.       Twice

c.        Thrice or more

d.       Never

 

46

4

1

14

 

70.8

6.2

1.5

21.5

 

42

4

1

18

 

64.6

6.2

1.5

27.7

3

Days exercised per week

a.       Less than 3 days

b.       3 days and more

 

38

27

 

58.5

41.5

 

40

25

 

61.5

38.5

4

Duration of walking

a.       15 minutes

b.       30 minutes

 

3

10

 

4.6

15.4

 

5

8

 

7.7

12.3

5

Duration of outdoor games (cricket)

a.       1 hour

b.       2 hours

 

12

16

 

18.5

24.6

 

10

17

 

15.4

26.2

6

Duration of indoor games (chess/carom)

a.       15 minutes

b.       30 minutes

c.        1 hour

 

1

4

1

 

1.5

6.2

1.5

 

4

1

0

 

6.2

1.5

0

7

Duration of watching TV

a.       15 minutes

b.       30 minutes

 

33

32

 

50.8

49.2

 

36

29

 

55.4

44.6

8

Duration of using computer

a.       15 minutes

b.       30 minutes

c.        1 hour

 

8

5

2

 

12.3

7.7

3.1

 

6

2

1

 

9.2

3.1

1.5

 

Table 4 shows that in both the groups most of the children were non vegetarians (81.5% & 83.1%), take high calorie food like chocolate once a week (70.8% & 64.6%), exercise less than 3 days in week (58.5% & 61.5%). Watching TV (50.8% & 55.4%) was the most done leisure time activity.

 

Table 5: Mean, standard deviation, mean difference and ‘t’ values of pre test and posttest Perceived self efficacy scores

Group

Pretest

Posttest

Mean difference

t

Interpretation

Experimental group(n=65)

Mean – 22.35

SD – 2.47

Mean – 51.91

SD – 2.54

29.56

-85.7

Significant

Control group(n = 65)

Mean – 22.23

SD – 2.59

Mean – 22.32

SD – 1.83

0.09

-.287

Not significant

 

Table 5 shows that the mean value of perceived self efficacy in experimental group has considerable increased after the structured teaching.  The ‘t’ value is 12.3 which is significant. It indicates that the structured teaching has been effective in improving the perceived self efficacy.

 

Table 6: Comparison of HbA1c

Group

Pretest

Posttest

Mean difference

t

Interpretation

Experimental group(n=65)

Mean – 8.6

SD – 0.864

Mean – 7.1

SD – 0.958

- 1.5

12.3

Significant

Control group(n = 65)

Mean – 8.6

SD – 1.0

Mean –8.6

SD – 0.584

0.0

0.012

Not significant

 

Table 6 shows that the mean value of the HbA1c level decreased in posttest in the experimental group whereas it remains the same in pretest as well as in posttest in the control group. This shows the structured teaching and improved self efficacy have been effective in reducing the HbA1c level in experimental group.


 

DISCUSSION:

The present study shows that the perceived self efficacy has improved after the structured teaching and it has an impact on reducing the HbA1c in the experimental group. It also shows a strong correlation between perceived self efficacy and HbA1c (-0.831 significant at 0.01level).

 

 

CONCLUSION:

Type 1 diabetes is a life threatening disease. It has a greater blow on children because of the younger age and various aspects of growth and development. They need a longer duration and education with guidance to get themselves prepared to live with the disease. Individualized teaching at regular intervals may be helpful to achieve glycemic control, and to prevent diabetic related complications. This will play a vital role in helping these children to have near normal growth and development.

 

RECOMMENDATIONS:

The impact of attitude and practice of self care activities on HbA1c also can be studied.

 

REFERENCES:

1.       WHO Report, October 2013.

2.       Rajiv Gupta, Diabetes In India: Current status, Industry Voice, Express Health Care, Aug 2008.

3.       Bhatia and Agarwal, Insulin therapy for patients with type 1 diabetes, Journal of Physicians of India, July 2007, Vol. 55, Sup and Notes: 29 - 40

4.       Tolijamo and Hentinen, Adherence to self-care and glycemic control among people with insulin dependent diabetes mellitus, Journal of Advance Nursing, 2001 Jun: 34(6): 780 – 786.

5.       Yulh-Ling Wang, Sharon A. Brown and Sharon D. Horner, School based lived experiences of adolescents with type 1 diabetes: a preliminary study, Journal of Nursing Research, Dec 2010, Vol 18, No. 4, 258 - 265

 

 

 

Received on 15.09.2014                Modified on 12.10.2014

Accepted on 25.10.2014                © A&V Publication all right reserved

Int. J. Nur. Edu. and Research 2(4): Oct.- Dec. 2014; Page 319-323