Changing self-care knowledge of the outpatients with Type 2 diabetes having treatment at Yenbai provincal hospital of endocrinology in 2018 after health intervention

Journal of military pharmaco-medicine no7-2019

CHANGING SELF-CARE KNOWLEDGE OF THE OUTPATIENTS
WITH TYPE 2 DIABETES HAVING TREATMENT AT
YENBAI PROVINCAL HOSPITAL OF ENDOCRINOLOGY
IN 2018 AFTER HEALTH INTERVENTION
Vu Thi Huong Nhai1; Vu Van Thanh2
SUMMARY
Objectives: To evaluate the change of self-care knowledge of the outpatients with type 2
diabetes having treatment at Yenbai Provincial Hospital of Endocrinology in 2018 after health
education. Subjects and methods: Intervention study on the same group of subjects with
comparison before and after was conducted. Data were collected by directly interviewing 108
people with type 2 diabetes for outpatient examination and treatment at Yenbai Provincial
Hospital of Endocrinology from January to April, 2018 with self-assessment questionnaires of
diabetes self-care. Direct consultation was taken in small groups of 2 - 4, the content of the
consultation is based on the American Diabetes Association's self-care recommendation (2017)
and guidelines for the diagnosis and treatment of type 2 diabetes by the Ministry of Health
(2017). Results: Before the intervention, the rate of patients with self-care knowledge was
19.4%. After the intervention, the rate of patients with self-care knowledge rose up to 91.7%.
The average knowledge score was 17.3 ± 3.6 before the intervention and up to 25.2 ± 2.8 of a
total of 30 points after one-month intervention. Conclusion: Self-care knowledge of the
outpatients with type 2 diabetes having treatment at in Yenbai Provincial Hospital of
Endocrinology was improved significantly after health education.
* Keywords: Type 2 diabetes; Knowledge; Self-care; Yenbai province.

INTRODUCTION
Diabetes is the chronic disease which
does not commonly spread and rapidly
increase worldwide in the 21st century [8].
According to the report of the International
Diabetes Federation (IDF) in 2017, there

are about 425 million people with diabetes
in the world, equivalent to every 11 adults
who have 1 people with this disease and
more than 212 million people (50%) suffer
from diabetes without being diagnosed
[9]. Vietnam is one of the four countries in

Southeast Asia with the highest incidence
of diabetes with about 3.5 million adults
(20 - 79 years old), but up to 54% are
undiagnosed, 85% are only detected to
have the disease when they have a
dangerous complication [9]. Diabetes is a
major burden for individuals, families and
the whole society. One more person dies
every 8 seconds and every 30 seconds a
person is amputated because of diabetes
[9]. Most countries have to spend 5 - 20%
of total health expenditure on diabetes [9].

1. Yenbai Medical College
2. Namdinh University of Nursing
Corresponding author: Vu Van Thanh ()
Date received: 20/07/2019
Date accepted: 26/08/2019

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Journal of military pharmaco-medicine no7-2019

Studies have shown that patients play
a key role in disease management and
a reasonable educational intervention
program will contribute to improve selfcare knowledge for patients and will help
to manage disease better [13]. However,
in fact, during daily medical examination,
health education is less focused [11].
Deficiencies in self-care knowledge lead
to improper behavior reduce treatment
effectiveness; contribute to increase
complications, increase treatment cost,
increase disability and death rates [12]. In
Vietnam, there have been a number of
intervention studies in patients with type 2
diabetes, but there have not been many
intervention studies in the field of nursing
about the self-care knowledge of patients.
According to the report of Yenbai
Provincial Hospital of Endocrinology, up
to April 2018, the whole province had
1,955 people with type 2 diabetes, who
were undergoing outpatient treatment at
the hospital and the number of diabetic
patients was increasing rapidly [2]. Yenbai
is a mountainous province with many
ethnic minorities living, the incidence of
disease is not similar to the ones studied.
Therefore, the aims of this study was: To
evaluate the change of self-care knowledge
of the outpatients with type 2 diabetes

having treatment at Yenbai Provincial
Hospital of Endocrinology in 2018 after
being trained about health.
SUBJECTS AND METHODS
1. Subjects.
- Selection criteria: Patients aged 18
and older were diagnosed with type 2
diabetes within one year of the time of
data collection; being on outpatient
88

treatment at Yenbai Provincial Hospital of
Endocrinology for at least 1 month (there
has been enough minimum experience to
assess before intervention); capable of
receiving and answering questions; agreed
to participate in the study.
- Exclusion criteria: Patients with serious
complications must go to the inpatient
hospital; patients did not fully participate
in health assessment and education
programs in this study.
* Time and place of study:
- Data collection time: From January to
April 2018.
- Research location: Outpatient
Department of Yenbai Provincial Hospital
of Endocrinology.
2. Methods.
* Research design:

Health education intervention studies
had compared before and after on a
research group.
* Samples and sampling methods:
- Sample size:
Applying the formula for calculating
sample size for intervention research is as
follows:
Z
(1 − α )
n= 

p 0 (1 − p 0 ) + Z (1 − β )

( p0 −

p1 )

p1 (1 − p1 ) 


2

2

In which, n: The number of research
subjects; Z (1-α) = 1.65 and Z (1-β) =
1.29; p0: The rate of patients with selfcare knowledge before intervention was
0.374 according to Nguyen Vu Huyen Anh
(2016) in Dienbien [1]; p1: The proportion

of patients with knowledge after the
intervention was 0.524. From that
calculation, n = 93.


Journal of military pharmaco-medicine no7-2019
- Sampling method: Convenient sample
selection. Select all patients diagnosed
with type 2 diabetes who were receiving
outpatient treatment at Outpatient
Department, Yenbai Provincial Hospital of
Endocrinology to response the sampling
criteria, during the period from 01 - 2018
to 04 - 2018; the research team selected
108 people who agreed and fully
participated in the post-health education
assessment. Thus, the sample size was
determined to be 108.
* The method of data collection:
- Data collection tool:
The data collection toolkit was based
on the Diabetes Self-Care Knowledge
Questionnaire toolkit (DSCKQ) 30 after
obtaining the author's permission and
referring to the translation used in the
study of Nguyen Vu Huyen Anh at
Dienbien in 2016 [1]. The toolkit was
examined, revised and evaluated by three
experts in the field of diabetes. Then
investigate more than 30 patients who

response the sampling criteria to correct
the toolkit. The result of the toolkit had a
CVI of 0.83; Cronbach's Alpha coefficient
was 0.81.
- Scale and evaluation:
Each correct answer is 1 point. Each
answer is incorrect or does not know the
answer is 0 points. The maximum total
score is 30 points. The total score is
presented as a percentage (%). Self-care
knowledge will be divided into 2 levels:
- Knowledge gained: When reaching
21 points or more on a total of 30 points
(correct answer ≥ 70% of the total score).
- Knowledge does not gained: When
correct answer < 70% of the total score.

- Steps to collect data:
+ Step 1: Training for 3 collaborators
are 3 lecturers of the Nursing Department,
Yenbai Medical College about the purpose,
content, and method of investigation.
+ Step 2: Conducting surveys and
assessing the self-care knowledge of the
research subjects by direct interview
method through the prepared questionnaires
while the patients wait for the test results
with time about 25 to 30 minutes.
+ Step 3: Conduct counseling and
health education for the study subjects

under the intervention program. Interview
appointments again after 1 month.
+ Step 4: The patients who had received
calling before 2 days to remind their
appointment for the second interview.
Investigate the self-care knowledge of the
research subjects after 1 month of
educational intervention (T2) by questionnaire
and how to perform like the first interview.
* Program of intervention:
- Intervention content:
Health education program about
knowledge of self-care for people with
type 2 diabetes, using communication
materials and leaflets developed by
researchers based on professional
documents Guidelines for diagnosis and
treatment of type 2 diabetes issued together
with No. 3319/QD-BYT at July 19, 2017 of
the Minister of Health and ISTEP-D
program in the period of 2017 - 2018
(Intensive training program on diabetes).
- How to intervene:
Hand out communication materials and
leaflets for research subjects to read
before consulting 10 - 15 minutes; health
counseling and education on self-care
knowledge for people with type 2 diabetes
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Journal of military pharmaco-medicine no7-2019
caused by researchers; answering questions
about the intervention contents of the
research subjects.
* Methods of data analysis:
Data were cleaned, entered and
analyzed using SPSS 18.00 software.
Use appropriate algorithms to validate
values before and after intervention.
RESULTS AND DISCUSSION
1. General characteristics of the
subjects.
Among 108 research subjects of type 2
diabetes, aged from 19 to 86 years old,
the average age was 59.4 ± 12.2. Most of
them were in the age group of 60 years
old or older, accounting for 51.8%. This
result was similar to the research results

of Nguyen Thi Thu Thao with the average
age of the study subjects was 57.1 ± 12.8
[5]. In our study, the proportion of women
(61.1%) was higher than that of men
(38.9%). The majority of research subjects
were Kinh people, 75% of the remaining
were ethnic minorities; in which, Dao people
accounted for 11.1%. This was entirely
consistent with the proportion of ethnic
groups in Yenbai province according to

the results of the Yenbai population and
housing census in 2009 [3]. The subjects
of study mainly lived in rural areas
accounting for 64.8%. Research subjects
with lower secondary education accounted
for the highest percentage of 30.6% and
there were 9.3% illiterate. Thus, type 2
diabetes people who had a low education
level accounted for high rate.

2. The change of self-care knowledge after health education.
Table 1: The change of knowledge points of self-care after health education.
The average points
(mean ± SD)

The lowest points
(min)

The highest points
(max)

Before intervention

17.3 ± 3.6

8

25

After intervention

25.2 ± 2.8

16

30

p
< 0.001

Research results showed that the reality of self-care knowledge level of the research
subjects was still very low. The general knowledge score before the intervention
ranged from 8 to 25 out of 30 points. The average score was 17.3 ± 3.6. The rate of
patients with self-care knowledge was low, accounting for 19.4%.

Figure 1: The change in the level of general knowledge about self-care of the research
subject after health education.
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Journal of military pharmaco-medicine no7-2019
This result was lower than the research
result of Nguyen Vu Huyen Anh in Dienbien
in 2016 with 37.4% having standard
knowledge. This difference may be due
to: The proportion of illiterate study subjects
in our study was much higher (9.3%) and
mainly lived in rural areas (64.8%) compared
to research of Nguyen Vu Huyen Anh.
Therefore, it is possible to affect the ability

to access self-care knowledge for type 2
diabetes patients. According to the study
by Adibe et al, the longer time the patients
suffer from diabetes, the higher the level
of self-care knowledge they have [6]. In
our study, only those with type 2 diabetes
who were diagnosed with the disease
within 1 year were selected and in the
study by Nguyen Vu Huyen Anh, but the
proportion of study subjects with time
≤ 1 year only accounted for 11.7% [1].
However, there was a significant change

in point of self-care knowledge of people
with type 2 diabetes after health education.
The rate of research subjects with standard
knowledge had increased remarkably
from 19.4% to 91.7%; scores ranged from
16 to 30 points, the average score reached
25.2 ± 2.8 out of 30 points (the difference
was statistically significant with p < 0.001).
This result was consistent with Pereira's
research, which also indicated that the
educational program is used as an effective
intervention tool in disease control, selfcare management and a significant
improvement in self-care knowledge after
intervention [12]. In Vietnam, we have not
found any researches on assessing the
change of self-care knowledge of type 2
diabetes after education intervention have

been published. Therefore, we can not
compare the level of changing knowledge
among regions across the country.

Table 2: The proportion of research subjects with correct knowledge about physical
activity, diet, prevention of complications, and blood sugar self-monitoring before and
after health education.
Before
intervention
(%)

After
intervention
(%)

The relationship between frequency of blood sugar level
monitoring and physical activity

72.2

87.0

Understanding the frequency of physical activity

93.5

96.3

Understanding the intensity of physical activity

43.5

78.7

Should have a snack before going to bed

24.1

75.9

Classify food according to blood sugar index

54.6

82.4

Fulfill the schedule of meals

53.7

80.6

Content
Physical activity

Diet

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Journal of military pharmaco-medicine no7-2019
Prevention of complications
Need to take care of the feet carefully

83.3

91.7

Should use soft socks, have good elasticity

71.3

80.6

Daily dental care is essential

86.1

90.7

Not only health workers can check blood sugar and blood
pressure for patients

22.2

75.9

Frequency of self-monitoring of blood sugar

26.9

74.1

Self-monitoring of blood sugar

According to the recommendation of the
American Diabetes Association in 2017
and the Ministry of Health's Guidelines for
Diet for Diabetes 2015, the diet plays a
very important and indispensable role in
managing diabetes. In our study, the
knowledge of patients' diet was limited.
Before the intervention, only 24.1% of the
study subjects knew that there should be
an extra meal before going to bed to
prevent hypotension during the night.
Percentage of subjects who could identified
and classified foods according to the blood
sugar index to be used appropriately
54.6% and knew to maintain regular time,
time between meals (53.7%) also increased
significantly after intervention were 82.4%
and 80.6%. This result was consistent
with the research result of Vu Thi Tuyet

Mai at Kiengiang General Hospital in
2014 [4].
Knowledge of self-monitoring of blood
sugar of research subjects was very
limited. Only 22.2% knew not only health

workers can check blood sugar, blood
pressure of patients and 26.9% knew the
frequency of self-monitoring of blood
sugar. From that situation, we put this
knowledge into the content of educational
intervention; in which, emphasizing the
role of patients themselves in monitoring
blood sugar and giving specific
instructions on the frequency of selfmonitoring of blood sugar. After the
intervention, the proportion of research
subjects with right knowledge on the
above content increased to 75.9% and
74.1%.

Table 3: The proportion of research subjects with correct knowledge about
medication adherence before and after health education.
Before
intervention
(%)

After
intervention
(%)

The use of diabetes medication needs to be maintained for a lifetime

85.2

94.4

When you feel well, you still need to take diabetes medicine

86.1

92.6

Drinking alcohol while using of diabetes mellitus drugs is a serious problem

75.9

88.9

Diet and exercise are as important as diabetes medications

63.0

83.3

When you feel well, there is still need for periodic health checkups

96.3

98.1

Content

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Journal of military pharmaco-medicine no7-2019

After intervention, the percentage of research subject had the right knowledge about
medication adherence increased from 83.3% to 98.1%.
According to Deepali’s research, 15.8% will stop taking drugs when they feel well,
equivalent to our research results before the intervention was 13.9%, but after the
intervention this ratio dropped to 7.4% [7].
Table 4: The proportion of research subjects with correct knowledge about the
consequences of uncontrolled blood sugar level before and after health education.
Before
intervention
(%)

After
intervention
(%)

Symptoms of neurological complications appear in the feet

49.1

82.4

Signs of hypoglycemia

24.1

75.0

High blood sugar levels can cause eye complications

92.6

97.2

High blood sugar levels can cause cardiovascular and kidney complications

85.2

95.4

Content

The proportion of research subjects
who knew about the consequences of
uncontrolled blood sugar levels increased
significantly; in which, the rate of knowing
the signs of hypoglycemia increased the
highest from 24.1% to 75.0%.
Most of the study subjects experienced
symptoms such as trembling, restlessness,
confusion, sweating, but they all did not
know those are signs of hypoglycemia
[10]. After the intervention, 75.0% of
the subjects knew the above symptoms
were signs of hypoglycemia (before the
intervention was 24.1%). Thus, in general,
the educational intervention program has
a positive impact on self-care knowledge
of people with type 2 diabetes, creating a
premise for patients to apply knowledge
to practice self-care and change acts in a

positive direction in life. Thereby, it is
necessary to widely implement the education
program for all type 2 diabetes patients.

CONCLUSION
The self-care knowledge of people with
type 2 diabetes in outpatient treatment at
Yenbai Provincial Hospital of Endocrinology
had been significantly improved after
health education: The rate of patients with
knowledge about self-care had increased
from 19.4% to 91.7%. The average score
of knowledge increased from 17.3 ± 3.6 to
25.2 ± 2.8 out of 30 points, the difference
was statistically significant with p < 0.001.
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Report on the implementation of tasks in the
first 6 months of 2017. Yenbai. October 2017.

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