@2024 Afarand., IRAN

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ISSN: 2252-0805    The Horizon of Medical Sciences 2017;23(1):41-47

Background
Diabetes mellitus is a metabolic disease characterized by hyperglycemia resulting in lack of insulin secretion, its malfunction or both [1].
Previous Studies
… [2-14]. Nursing models can be appropriate guides for improving the quality of care. Therefore, the use of these model has been emphasized in the care of patients [16]. Collaborative care model was first designed by Mohammadi in 2001, and it was implemented and evaluated for controlling high blood pressure in Babol City [15]. … [17-23].
Aim(s)
This study aimed to determine the effect of intervention based on collaborative care model on the self-concept promotion in patients with diabetes type II.
Research type
This study is a randomized clinical trial.
Research society, place and time
This study was conducted in 2015 among all the patients with diabetes type II admitted to the emergency room of Imam Zaman Hospital in Mashhad City.
Sampling method and number
… [24]. A total of 30 participants in each group and a total of 60 patients were selected based on convenience sampling and were randomly assigned into two control and experimental groups using permutation blocks (four block). Inclusion criteria were consent to participate in the study, age between 21 and 60 years, after at least 6 months of diagnosis, and lack of mental health problems and difficulties in learning. Individuals who did not wish to continue to participate in the study or had the absence in more than one training session or follow-up visits were excluded. In the experimental group, 3 participants and in the control group one participant were excluded. Therefore, the number of participants in the experimental group and control group was reduced to 27 and 29 respectively.
Used devices&materials
The instrument used in the research was a questionnaire consisted of three sections: personal information, the disease information, and Beck self-concept questionnaire. The personal information section included demographic information such as age, gender, weight, height, marital status, occupation, education level, income level, family size, sources of support, and family supervisor. Also, disease information section was prepared based on the available resources in books and articles, the comments of the professors of the field, and Collaborative Care Model. This section was used to assess the cause of admission, number of hospitalization, duration of disease, the patients’ awareness of their disease and the ways to control it, the source of information, willingness to learn, family support and smoking. Beck Self-Concept Scale (BSCT) includes 25-item Likert Scale from one to five (very positive, positive, neutral, negative, and very negative) which measures 25 features. Scoring of negative questions is reverse. The scores of this questionnaire are ranged from 15 to 125 and more scores mean better self-concept [25]. This questionnaire is a valid and reliable tool that is also used in patients with diabetes. Reliability of this questionnaire has been 0.80 and 0.88 using internal consistency and test-retest method respectively [26]. The intervention in the experimental group was based on the Collaborative Care Model (motivation, preparation, engagement and evaluation) and the control group received only usual care. Intervention in the experimental group was based on the stages of the model so that a three-month period (according to the model) was developed including motivation, training sessions and follow-up. The first step in this model is “motivation”. The purpose of this phases is to motivate the patient. Inciting motivation in the patients is through introducing patient-care problems, current conditions, risks and complications of the disease. The patients were introduced to each other in this phase, and then lecture was presented about the diabetes, its symptoms, and its different types by a nurse. At the end of the visit, time and place of the next visits based on determined time table were reminded. The second step in the collaborative care model is “preparation”. Preparation contributes to prepare appropriate program for involving all the members of the collaborative team i.e. patient, nurse and doctor. At this stage, the patients were divided into three groups each having 10 patients. Then, the time of each sessions of the visits was coordinated with the patients and doctor and three meetings were hold. Collaborative training meeting (first visit): The aim of this step is introducing the short and long complications of diabetes, introducing the effects and mental problems of diabetes, and studying the problems of the patients. The information required for this purpose were presented through lecture and display the image presented by a nurse. The meeting lasted about 90 minutes. Collaborative training meeting (second visit): the aim of this step is introducing the exercise program and regular physical activity and its benefits, discussing the importance of proper diet, the importance of weight loss and discussing the disease problems. The duration of this session was, also, 90 minutes. Collaborative training method (Third visit): the purpose of this stage is talking about the instruction of oral medication, injections, and familiarity with complications in case of arbitrary or negligent use, training of insulin injection and mixing different types of insulin, complications of frequent injections of insulin, suitable places for insulin injection, the importance of monitoring and measuring blood sugar and studying the patients’ problems. This meeting, also, took about 90 minutes. Engagement: The content of this session was a final estimation and evaluation of the implementation of the model and giving feedback to the clients and informing them about the extent of their participation. Evaluation: in the final evaluation to assess the impact of implementation of collaborative care model on improving persons’ self-concept, the scores of people in the test group were measured again and the same evaluation was performed for the control group. Data entered into the computer and was analyzed with SPSS 30 software. Descriptive statistics (central tendency, and distribution) were used for determining self-concept before and after intervention in the control and experimental group. At first the normality of data was investigated using Kolmogorov-Simonov test. To compare the self-concept scores before and after intervention in each group, paired t-test, and to compare it in the two control and experimental group the independent T-test was used.
Findings by Text
Age rang of the participants was 27-58 years with the mean 54.36±7.37 years in the experimental group and 74.06±6.89 years in the control group. The mean family size in the experimental and control groups were 3.08±1.09 and 4.31±1.13 persons respectively. Duration of the disease in the participants were minimum 2 and maximum 15 years and in the 70% of the patients, the history of disease was over the 3 years. The mean disease duration time in the experimental and control group were 5.62±2.54 and 6.36±3.71 years respectively. Also, the mean BMI in the experimental and control group were 82.38±3.61 and 82.66±1.92 kg per square meter respectively. There was no significant difference between the two groups in terms of BMI, family size, disease duration, number of hospitalization, age, gender, marital status, occupation, education level, income level, activity level, and smoking (p>0.05; Table 1). No significant difference was observed in the mean scores of self-concept before and after intervention in the control group (p=0.066). However this difference was observed in the experimental group (p<0.001). Also, no significant difference was observed between the control and experimental groups after the intervention in terms of self-concept mean score (p<0.001; Table 2).
Main comparison to the similar studies
Similar to the results of this study, the mean score of self-concept in patients with type II diabetes in the study conducted by Samadi et al. [24] and Safavi et al. [26] was low. Impaired self-concept affect peoples’ health and compatibility and make them prone to weakness, helplessness, hopelessness, and depression [26]. … [27-29].
Suggestions
It is recommended that this model be widely used to teach patients with type II diabetes.
Limitations
The limitation of this study was its follow-up duration.
Conclusions
Intervention based on collaborative care model enhances the self-concept in patients with type II diabetes.
Acknowledgments
The researchers appreciate all the participants, the respectful president and all the employee of Imam Zaman Hospital Emergency Department as well as Gonabad University of Medical Sciences Research Deputy.
Conflict of interest
Non-declared
Ethical Permissions
This study was approved by Gonabad University of Medical Sciences Ethical Committee (IR. GMU.REC. 1394.23) and it was registered at the Iran Center of Clinical Trial with Code IRCT2015071522682N3. Also, written consent form was taken from all the participants.
Funding Sources
This study has been funded by Gonabad University of Medical Sciences.

TABLES and CHARTS

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