@2024 Afarand., IRAN

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ISSN: 2383-2150    Journal of Education and Community Health 2018;5(1):4-12

Background
Diabetes is the most common chronic disease worldwide and is a common health problem, which can be considered as a major problem for the individual, the family and the community [1].
Previous Studies
... [2-6]. Patients with type 2 diabetes due to its chronic nature and the need for continuous care are exposed to its complications, so their quality of life is affected [7]. ... [8-13]. The active participation of the patient in health care increases his motivation to improve the condition, the greater impact of healthcare, and more satisfaction. The role of the patient in self-care is evident; therefore, he or she should be involved in planning the goals and care services. Using a specific framework, in which all aspects are considered, can provide better services to diabetics [14, 15]. … [17, 16]. In this regard, in the present study, a native model called Collaborative Care Model designed by Mohammadi (2001) was used to train self-care for patients with diabetes and its effectiveness was evaluated in improving the quality of life of these patients.... [18-23].
Aim(s)
This study was conducted to evaluate the effectiveness of collaborative care model on the quality of life in patients with type 2 diabetes.
Research type
This research is a semi-experimental study with pre-test post-test design.
Research society, place and time
This study was done on 60 patients with type 2 diabetes referring to the clinic of Imam Khomeini hospital diabetes in Jiroft city in 2017.
Sampling method and number
60 participants were selected based on the convenience sampling method. The inclusion criteria included patients with type 2 diabetes for at least two years, having a medical record in the health centers, no participating in similar studies, and no significant psychiatric disorder according to the patient’s statement. Exclusion criteria also included no acute or chronic disease affecting the collaborative care model (cancer, stroke, etc.). It should be noted that the participants were excluded from the study when they were not willing to collaborate with the research team.
Used devices&materials
Data collection tools included a researcher-made questionnaire to assess demographic characteristics, metabolic indices and vital signs before and after three months after intervention and the quality of life questionnaire for patients with diabetes. The quality of life questionnaire for patients with diabetes was developed by Poorkakhki in the Shahid Beheshti University in 2005 and its facial, content, and construct validity has been confirmed [24]. ... [25]. In addition, the researcher-made scale designed based on the content of the self-care educational booklet of the collaborative care model was used to assess patients' awareness about the trainings designed in 11 dimensions of the familiarity with diabetes. All ethical considerations, including the confidentiality of information, explaining all stages of the research and its length, and the voluntary participation in each stage of the research were observed. For sampling, the researcher referred to the clinic daily and examined patients' records to meet the inclusion criteria, so their type 2 diabetes was confirmed by a specialist. The researcher then explained research objectives as well as the time of classes for patients and their informed consent were obtained. In this study, 60 patients with type 2 diabetes were divided into four groups of 15 subjects and the collaborative care model was performed equally for each group. On the referral day, the samples were interviewed prior intervention and demographic information as well as their answers about diabetes and quality of life were collected and the primary assessment was carried out as a pre-test. Collaborative care model as an educational model included four stages: motivation, preparation, engagement and evaluation. Trainings were conducted at the motivation stage, informing the patients about diabetes and its complications, with the cooperation of all team members, including two physicians (the internist and general practitioner), nurses and patients. In the next stage (preparation), educational objectives and timing of training programs and follow-up were explained. Involvement was also performed through training sessions. In these two stages, collaborative educational (three times) and follow-up (two turns) visits were conducted. The final evaluation was carried out at the sixth session and at the end of the third month and the impact of the collaborative care model on the control of diabetes and its complications, as well as the changes in the quality of life of patients was re-measured using the quality of life questionnaire. Data was analyzed by SPSS 20 software using Wilcoxon, Mac-Nemar and Paired T-tests.
Findings by Text
The mean age of the samples was 51±10 years. 58.3% were female and 83.3% were married, 31.7% were illiterate and 33.3% were housewives. The body mass index (BMI) of most subjects ranged from 25 to 29.9 and their mean BMI was 25.9. 50% of patients had obesity. Most subjects had moderate economic status (53.3%) and were covered by insurance (96.7%). Most of them (38.3%) were informed about their diabetes between 6 and 10 years. 8.3% of patients were smokers and 71.7% had a history of diabetes in their first-degree relatives. There was not a significant difference between the mean of quality of life improvement based on different variables (age, sex, marital status, education, occupation, length of type II diabetes, insurance, economic, and housing status, and family history of diabetes) before and after the intervention (p>0.05). The results of Wilcoxon test showed a significant difference in the care indices (control of blood glucose, its frequency, and the number of visiting the physician), as well as the diet and physical activity in patients (p<0.001). In addition, according to the results of paired t-test, the mean systolic blood pressure (from 137.5 ± 2.8 to 124.5 ± 2.2) and diastolic (from 82.6 ± 1.6 to 4.4 ± 3.9), and the pulse per minute (from 82.3 ± 2.6 to 76.4 ± 0.2) of the patients decreased significantly three months after the intervention compared with before intervention (p<0.001). In metabolic indices, the results of paired t-test in showed a significant difference in the mean fasting blood glucose, triglyceride, low density lipoprotein, high density lipoprotein and cholesterol in type 2 diabetes before and after intervention (p<0.001; Table 1). The results of the Mac-Nemar test also showed a significant difference in dietary treatment in patients with type 2 diabetes before and after the collaborative care model (p<0.001). Most of the samples (58.3%) used oral medications for treatment. Furthermore, 67.3% of patients in addition to type 2 diabetes reported disorders, such as heart disease, and high cholesterol and blood pressure. The responses to the educational items in diabetic awareness questionnaire in the evaluation stage and after performing collaborative care model showed that the total mean scores increased significantly after the performing the model (p<0.001; Table 2). Based on the paired t-test results, the mean scores of quality of life in physical, psychological, social, economic dimensions, diabetes, and treatment were significantly increased performing collaborative care model compared with before intervention (p<0.001; Table 3).
Main comparison to the similar studies
Main comparison to the similar studies ... [26, 27]. The results of Klein et al. showed that increased diabetes-induced cholesterol, such as increased blood glucose has a negative effect on quality of life [16]. In addition, the results of Borzu & Biabangardi research on blood glucose control in patients with type 2 diabetes indicated that the mean blood glucose levels decreased compared with the control group after intervention [28]. ... [29-31]. Norris et al. study also indicated that educational programs improve the quality of life, especially its physical dimension [32]. Chwastiak et al. found that after performing collaborative care in patients with type 2 diabetes not only their blood glucose levels were controlled; their behavioral and psychological problems were also decreased [33]. The results of Khoshab et al. research showed the positive effect of collaborative care model on quality of life in patients with heart failure [35,34]. Chahkhoie et al. also found that the lifestyle of patients with multiple sclerosis has improved after performing collaborative care model [36]. ... [37, 38].
Suggestions
Studies using randomized sampling with control group with different time and place conditions, as well as other types of diabetes are recommended for a better evaluation of the factors affecting the quality of life of patients with diabetes.
Limitations
No control group and a specific place and time were the limitations of this study.
Conclusions
Despite individual differences of patients in studied variables, collaborative care model can improve the quality of life and control the metabolic parameters of type 2 diabetic patients.
Acknowledgments
All patients participating in the research and the director and the physicians of the Imam Khomeini Hospital in Jiroft are appreciated.
Conflict of interest
None declared.
Ethical Permissions

Funding Sources
This research was supported by the authors.

TABLES and CHARTS

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