Promoting Self-Care in Under-Resourced Persons Living with Diabetes

Background: Diabetes mellitus, type 2 (DM2) is a complex, chronic illness that requires both medical care and patient education to prevent complications (e.g., coronary heart disease, neuropathy, diabetic retinopathy). Myriad educational strategies have been utilized, including interactive dialog, written/print materials, computer-mediated options, group-based training programs, and self-help groups. Our safety net healthcare organization provides services for south Texas’ most socioeconomically disenfranchised population. Many are under-resourced (e.g., inadequate finances or insurance) and are often unable to use written materials (e.g., illiteracy, inability to read or hear, language barriers). Research demonstrates efficacy in teaching patients about other disease processes when innovative strategies (e.g., gamification) are used.

Purpose: The purpose of this evidence-based practice project was to explore the extant literature to determine what strategies have shown promise in promoting self-efficacy and self-care among persons with DM2.

Methods: Nurses working in an ambulatory care setting devised the following PICO question: What innovative technological pedagogies (I) or conventional teaching modalities (C) impact patient engagement in self-efficacy and self-care (O) among socioeconomically-disenfranchised patients with type II diabetes (P)? Nursing Reference Center Plus yielded 88 articles; 24 of these met specific inclusion criteria and were appraised by at least two members of the team. Incongruences were resolved by the entire team to reach consensus. A majority (n=14) of the articles were research, and 10 others were non-research papers.

Results: The literature is replete with citations supporting the importance of self-care in persons with DM2. Early involvement in self- or supportive-care by the patient and family demonstrated multifarious benefits. Educational modalities (e.g., 1:1 demonstration/return demonstration, group-based programs, mobile technology, gamification, communicating in a culturally-sensitive manner) have all shown promise in promoting self-care in this often-marginalized population.

Implications: It is imperative that nurses determine if individuals are auditory, visual, or tactile learners. Maybe they learn best by hearing, seeing, or doing a particular skill. Diabetes education can be comprehensive; therefore, it is vital to divide the teaching into segments that are congruent with the patient/family members’ ability to comprehend.

Conclusion: Patients’ understanding, involvement, and engagement are critical components in promoting self-efficacy and self-care in persons living with DM2. When individuals comprehend and adhere to the regimen, there are likely fewer complications and hospitalizations, and patient outcomes are enhanced.