Impact of a multifaceted behavioral intervention program on promoting quality of life among patients with T2 diabetes residing in the city of Khoy

Abstract

Introduction: Diabetes and most importantly type 2 diabetes is one of the important health problems for health systems and 425 millions of people currently are living with the disorder worldwide. Irreversible complications of diabetes are alarming signals for health care systems to boost their attempts for early diagnosis, proper treatment and care of patients in order to prevent the costly and devastating complications. Medication non-adherence and lack of full motivation to adopt the required long term behavior change recommendations and proper management of diseases are amongst major causes of mortalities, diseases related complications and subsidence of quality of life. Self-regulation enhancement was suggested to be an effective intervention for high risk behaviors’ change, health behaviors’ adoption and their long term maintenance. Health care systems should focus on supporting their patients’ autonomous self-care and increase of their perceived self-competence. The health care systems in this case could have major role in responding to the escalating diabetes induced problems, its complications and improvement of the clinical care outputs. An appropriate level of perceived self-competence could facilitate achievement of self-management goals in diabetes patients which is achievable in a health care climate that support fulfilment of the patients’ basic psychological needs. Based on such a background to create a supportive health care climate, successful support of patients’ autonomous behaviors and improvement in self-perceived competence, a multi-facetted intervention will be required to reach consistent behavior change, reduction of the disease complications and an improved quality of life. Multi-faceted interventions were recommended to be the most significant methods of behavioral change in chronic diseases including type 2 diabetes. They could simultaneously target various obstacles in front of healthy behaviors therefore; are more efficient than single dimension interventions. If such interventions are especially planned based on the concepts of an evidence based theory framework they could even be more effective. This study aimed to examine the impact of multi-dimensional behavioral intervention on social-cognitive aspects, self-regulation level, medication adherence rate, degree of supportiveness of health care climate, level of perceived competence and finally the studied type 2 diabetes patients’ quality of life. Materials and Methods: This randomized controlled trial with sequential parallel comparison design (SPCD) was carried out on 88 patients with type 2-diabetes in the diabetes clinic of Shahid Madani Hospital of Khoy, North West of Iran. The patients have been randomly selected and allocated into two intervention and control groups consisting of 44 patients in each strand. The data collection tools included the Perceived Competence Scale for Diabetes (PCSD), the Treatment Self-Regulation Questionnaire (TSRQ), the Health Care Climate Questionnaire (HCCQ), the Morisky Medication Adherence Scale (MMSQ-8), the Multidimensional Diabetes Questionnaire (MDQ) and the Iranian version of the Diabetes Quality of Life Questionnaire (IDQOL-BCI) which all examined (except the latest one) for their validity and reliability before application. The standard translation/back retranslation procedures were applied to prepare a translated Persian version of the instruments. The data collection was performed at 3-time points in 2018. A pre-test was conducted and the collected data were analyzed to identify baseline educational needs of the study respondents. The behavioral-educational intervention was planned according to the findings of the pre-test stage and educational contents was derived from the National Care Guidelines for type 2-diabetes. The social-cognitive theory’s constructs and the Self-Determination Theory’s dimensions were utilized to classify the educational sessions’ contents. The intervention was conducted for the patients of intervention group, their families, and diabetes clinic nurses in the course of 4 sessions in 3-4 weeks. The study feasibility was also evaluated at the beginning, during and the end of the study stages according to the items of "Goals and Guiding Questions for Study Feasibility" checklist. The baseline data and data about the study’s primary and secondary outcome variables were collected prior to intervention, 2 and 6 months after the intervention. The study were analyzed using descriptive statistics and repeated measures tests in SPSS version 22. The same educational-behavioral intervention was performed on the control group’s patients at the end of study. Results: The application of general linear model for repeated measures indicated that time effect, group effect, as well as interaction effects of time and group for most variables after intervention were significant as p <0.05. A statistically significant increase was observed in the treatment adherence, self-regulation, supportive health care environment perception, perceived competence and scores of the Multidimensional Diabetes Questionnaire dimensions 2 months after the intervention. At the third time point (6 months after the intervention) despite the observed significant difference relative to the pre-intervention stage, the values of various variables indicated a decrease compared to the after 2 months measures but values of HbA1C and quality of life index indicated a significant rise (P <0.05). The study feasibility was confirmed based on the items of the "Goals and Guiding Questions for Study Feasibility" checklist including recruitment and sample characteristics, procedures and measures, intervention acceptability, resources and ability to manage study and preliminary evaluation of participants responses to intervention. Psychometric evaluation of the study’s data collection tools revealed acceptable face, content and structural validity. Discussion: The aim of this study was feasibility assessment and effectiveness appraisal of the multifaceted interventions on self-care outcomes of the registered T2 diabetes patients in the Iranian national health care systems. Based on the study results, multifaceted interventions could promote the quality of life in T2 diabetes patients and improve their self-care profile and medication adherence and also positively impact on their HbA1C level. This study revealed that implementation of the multifaceted interventions that consist educational medication in individual, environmental and behavioral dimensions is feasible and could improve the patient's self-regulation and self-care competencies for a better disease self-management.