@2024 Afarand., IRAN

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ISSN: 2252-0805    The Horizon of Medical Sciences 2018;24(1):17-22

Background
… [1, 2]. Diabetes is one of the most common chronic metabolic diseases [3] and if there is no proper action to prevent, control, treat, and educate specific cases of it, there will be numerous limitations and dilemmas for patients and people at risk [4].
Previous Studies
… [5-12]. Studies have shown that diabetes can have a negative effect on overall health and well-being, psychical functioning, complications, psychosocial status, and the individual, family and social relationships of affected people, any may lead to decline in their quality of life [13]. … [14, 15]. One of the types of patient education is peer education that is very effective in facilitating and promoting health and creating a learning environment [16]. Peer education has many differences with other types of education. In this educational approach, due to the similar characteristics of members, a simple and reliable environment is created and patients can use the experience of their peers to improve their symptoms [17]. … [18-20].
Aim(s)
The aim of this study was to investigate the effect of peer education on the quality of life of middle-aged people with type 2 diabetes.
Research type
The present research is a semi-experimental design with pretest-posttest design with control group.
Research society, place and time
This research was conducted in the community of type 2 diabetic patients referred to the 22nd Bahman Diabetes Clinic of Gonabad University of Medical Sciences in 2016.
Sampling method and number
edical Sciences in 2016. Sampling method and number A total of 80 people were selected by convenience sampling method and then randomly assigned into two intervention and control group (each group was 40). According to the study by Saeedpour et al., The sample size was estimated to be 40 in each group with potential drop of 15% [21]. The criteria for entering the study included passing 6 months from the diagnosis of diabetes by a doctor, aged between 30 and 59 years, having a willingness to participate in research, reading and writing skills, the absence of cognitive problem, physical and psychological disability, and the possibility of direct telephone calls with the patient and active member of his family. Exit criteria included type 1 diabetes and gestational diabetes, patient death during the study, non-attendance at a training session for patients in the intervention group, the patient’s progression to new physical problems, such as neuropathy, visual impairment, forgetfulness, and the lack of learning that results in loss of the ability to take care of oneself and continue the training program, and ultimately avoiding the patient from continuing to collaborate in the research. Counterparty inclusion criteria included peer involvement with internal desire, no chronic complications of diabetes (diabetic food ulcer or subsequent amputation, renal failure and blindness, or severe vision loss) according to the physician's diagnosis, having HbA1C within the normal range (between 5.7 and 6.4), having a moderate to high quality of life, and a successful experience in controlling diabetes. Four peers were selected including two men and two women.
Used devices&materials
Demographic information questionnaire including gender, age, marital status, occupation, education level, insurance status and supplementary insurance, history of smoking, time to diagnose diabetes, educational history and educational program, source of information, history of hospitalization of diabetics and before and after blood sugar were used and the questionnaire of diabetic quality of life (DQOL) by Thomas et al. [22] was used as a research tool. In this first stage, in 4 sessions, the content of research was conducted by the researcher for the peer group which included the research objectives, the implications, the importance and benefits of peer education, and the communications skills of peers with patients, diabetes, exercise, blood glucose control, insulin infusion or anti-diabetes pill consumption, foot care, smoking and stress. In order to ensure the readiness of the peers, the supplementary issues were presented and revised at the end of sessions. The method of training in these sessions was to use lectures and questions and answers. After completing each session, the booklets included the topics discussed at that session were given to the peers. In the second stage, the diabetic quality of life questionnaire were studied in two intervention and control groups. Then, the intervention group was trained in 3 sessions of 2 hours by their peers with the presence of the researcher which included familiarizing the patients with each other and getting acquainted with the peer, transferring information about the nature, symptoms, sign and course of treatment, and control of blood sugar and exercise, methods of blood glucose control, insulin infusion, or taking anti-diabetic pills, foot care, smoking and stress. Each session began with questions and answers between peers and the patients that at the beginning and end of each session, based on the needs and wishes of the participants, additional items from the previous sessions were presented by the peers in the presence of the researcher. At the end of each meeting, peer and group members expressed their successful experience. At the end of each session, the patients were treated and in order to continue the communication and participate in the final stage, the date of the session for the third stage was given to the test group in order to be aware and participate in the final session. Finally, one month later, using quality of life questionnaire for diabetic patients, quality of life was assessed in both groups. The control group also received routine training during the intervention including training by a doctor, nurse, or internal posters. Data were analyzed using SPSS 20 software. The Kolmogorov-Smirnov test was used to examine the normal distribution of data. Chi-square, Fisher exact test, and independent t-test were used to compare the demographic variables in the two groups. Chi-square test was used to assess the quality of life status (weak, moderate, and good) in the two groups. Also for normal data, paired t-test (comparing the difference in the mean of intervention group before intervention and after intervention) and independent t-test (comparison of mean difference between intervention and control group before intervention) and for non-parametric data, U man-whitney test (comparison of the mean difference between intervention and control group, one month after intervention) and Wilcoxon (comparison of mean difference of control group) were used.
Findings by Text
The mean age of 80 studied patients was 48.86±6.50 years that the mean in the intervention and control group were 48.45±7.36 and 49.28±5.65 years respectively. Most patients were married, housewives, had education level of junior high school and diploma and had a history of diabetes over 3 years. The two groups did not differ significantly in terms of demographic variables (p>0.05; Table 1).The quality of life of the patients before and after intervention in the intervention and control group was moderate and not significant (p=0.420). one month after the training, the quality of life of the patients in the intervention group was good and the quality of life of the patients in the control group was moderate, which showed a significant difference one month after the training (p=0.015; Table 2).The mean score of life quality in the intervention and control groups were +13.12±8.61 and +0.27±7.29 (p<0.001; t=7.19). There was no significant difference between the two groups before the intervention. One month after the intervention, the quality of life scores of patients in the control and intervention groups were significantly different. There was a significant difference between the quality of life scores before and after the intervention in the intervention group (Table 3).
Main comparison to the similar studies
[23]. In Johnson et al., peer support improved the quality of life and metabolic control of patients [24] which was consistent with the study. In Sharif et al. research, it was shown that there was a significant difference between the quality of life scores of the patients before and after training in the intervention group, while in the control group, this difference was not significant that results was not consistent with this research. … [25, 26]. Liu et al. also found that peer education was very effective in self-control and psychosocial factors such as the quality of life of diabetic patients and the intervention group had higher mean scores [27]. … [28].
Suggestions
It is suggested that a similar study be carried out over longer period of time and repeatedly monitored for the purpose of establishing health behaviors.
Limitations
From the limitations of this research, the low motivation of the research units in the initial stage for attending educational session can be mentioned that was compensated by encouraging and tracking research samples.
Conclusions
Peer education improves the quality of life of middle-aged people with type 2 diabetes.
Acknowledgments
I am grateful to dear professor, Mr. Ali Delshad Noghabi, Graduate council, Student Research Committee of Gonabad University of Medical Sciences, Clinical Development Unit of Allameh Behloul Gonabadi, Head of Nursing Department of Diabetic Clinic, and all patients participating in this study.
Conflict of interest
Non-declared
Ethical Permissions
Ethical confirmation of this research was obtained from the Ethics Committee of Gonabad University of Medical Sciences with code IR.gmu.rec.1395.75.
Funding Sources
This article is the results of a master's degree in community health nursing, Midwifery and Nursing Faculty of Gonabad University of Medical Sciences.

TABLES and CHARTS

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