page i
Certification ii
Dedication iii
Acknowledgements iv
Abstract v
Table of Contents vi
List of Tables viii
List of Figures ix
List of Appendices x
CHAPTER ONE: INTRODUCTION
1.1Background to the Study 1
1.2Statement of the Problem 3
1.3 Objective of the Study 3
1.4 Research Questions                                                                                   4
1.5 Hypotheses 4
1.6 Scope of the Study 4
1.7 Significance of the Study 4
1.8 Operational Definition of Terms 5
CHAPTER TWO: REVIEW OF LITERATURE
2.0 Introduction 6
2.1 Definition, cause, symptoms, complication and types of diabetes mellitus 6
2.2Epidemiology of Diabetes mellitus 8
2.3 Impact of Diabetes in Nigeria                                                                   9
2.4Organizations of diabetes care in Nigeria 9
2.5 Profile of patients with diabetes in Nigeria                                          11
2.6 The way forward                                                                                      12
2.7 Previous research in diabetes self-management intervention       14
2.8 Diabetes self-management Education 15
2.9 Diabetes self-management                                                                              17
2.10 Barriers to diabetes care                                                                          20
2.11 Conceptual model                                                                             22
CHAPTER THREE: METHODOLOGY
3.0 Introduction                                                                                            25
3.1 Research Design                                                                                            25
3.2 Population                                                                                          25
3.3 Sample size and sampling Technique 25
3.4 Instrumentation                                                                        26
3.5 Validity of Instrument                                                                            27
3.6 Reliability of Instruments                                                         27
3.7 Data Collection Procedure 27
3.8 Method of Data Analysis 28
3.9 Ethical Consideration 28
CHAPTER FOUR: DATA ANALYSIS, RESULTS AND
DISCUSSION OF FINDINGS
4.0 Introduction 30
4.1 Data analysis and results 31
4.2 Discussion of Findings 39
CHAPTER FIVE: SUMMARY, CONCLUSION
AND RECOMMENDATIONS
5.1 Summary                                                                                                44
5.1.1 Nursing Implication                                                                             45
5.2 Conclusion                                                                                        45
5.3 Recommendations                                                                                  46
5.4 Suggestion for Further Studies 47
REFERENCES 48
APPENDICES 57
LIST OF TABLES
Table Page
1 Frequency and percentage on demographic data of respondents 31
2 Descriptive statistics of diabetic patient’s knowledge regarding self-management 33
3 Comparative frequency distribution of Knowledge Responses from questionnaires 34
4Descriptive statistics of diabetic patient’s practice of self-care activities 36
5 Comparative frequency distribution of Self-care Activities Responses from 37
6Descriptive and inferential statistic of diabetic patient’s pre/post-intervention 38
Knowledgeregarding self-management
7Descriptive and inferential statistic difference of diabetic patient’spre/ 38
Post-interventionpractice of self-care activities
LIST OF FIGURES
Figure Page
1 Dorothea Orem self-care conceptual model 22
2 Self-care conceptual model                                                                                24
APPENDICES
Appendix Page
A: Informed Consent form 57
B: Questionnaire 58
C: Training program hand-out 61
 D: Pictures from the field work                                                              66
 E: Study Setting Clearance                                                                               68
 F: BUHREC                                                                                           69
 G: Turnitin Report                                                                             70
CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Diabetes mellitus (DM) is a metabolic disease in which glucose level in the blood is high over extended periods (World Health Organization, 2014). DM results when the pancreas is unable to produce insulin or cell of the body is not responding to insulin produced (Shoback, 2011). In 2013 alone 4.6 million people died of DM (Aschner, Beck-Nielsen, Bennett, Boulton, & Colagiuri, 2013). Low and middle-income countries of the world is being affected by DM, there are more than 77 % morbidity and 88 % mortality (International Diabetes Federation, 2013). Type 2 diabetes mellitus (T2DM) is the commonest form of DM and it account for 90 % of disease (Aschner et al., 2013).
13.2% is the prevalence rate of DM with registered 4,600 people (International Diabetes Federation, 2014). Estimate of the World Health Organization (WHO) states that DM prevalence among adults in 2014 was 9%, a prediction of at least 350 million people with T2DM by 2030 (WHO, 2015). In accordance with a national survey carried out, the prevalence of diabetes mellitus in Nigeria increased from 2.2% to 5.0% by 2013 estimates of the International Diabetes Federation (IDF). Complications of diabetes are common at the time of presentation in Nigeria: neuropathy 56%, erectile dysfunction 36%, nephropathy 9%, and retinopathy 7% (Chinenye & Ofoegbu, 2013). This is partly because diabetes is a progressive illness with an initial asymptomatic phase associated with on-going tissue damage and decline in pancreatic beta cell mass and function.
Ali, Barke, Bullard, Gregg, and Imperatore, (2012) reported that glycemic control at the suboptimal level likely cost diabetic patients increased care requirement, complications and related health care costs. Improper glycemic control has a link with an increased risk of visual impairment, kidney failure and cardiovascular disease (Balkau, Borch-Johnsen, Colagiuri, Lee, Shaw &Wong, 2011). The possible reasons for poor glycemic control includes poor adherence and awareness, manpower insufficiency, time constraint, lack of appropriate guidelines on diabetic education for health practitioners and diabetic patients (Amade, Gudina, Ram, & Tesfamichael, 2011).
Because of lack of awareness, patients with DM suffer from its complications (Gul, 2010). The way to self-management includes testing the blood glucose, adequate diet, regular examination of the foot and eye, all this have shown to reduce complications from DM (Aschner et al., 2013; Biswas, Ferrari, Islam, Islam, Lechner &Niessen, et al., 2015).Therefore, proper blood glucose control among Diabetes Mellitus patients prevents short and long-term complications and reduce cost and long hospital stay.
The aim of self-management of DM is to ensure that the blood glucose level is at a normal range and to reduce the risk of complications. There are seven self-care behavior people having DM must ensure to keep their glucose level normal: they include eating healthy, physically active, self-monitoring of glucose content, compliance with medication, risk-reduction behaviors, good problem-solving and healthy coping skill (American Association of Diabetes Educators, 2010). This measures are useful for physicians managing diabetic patients and it has impacted positively on glycemic control, complication reductions and improvement in quality of life (American Diabetes Association, 2009). Self-management goals and its implementation are written in collaboration with the diabetic patient and health care professionals, it promotes patient self-management, decrease the prevalence of DM and its complications (Ahola & Groop, 2013).
Haidet, Naik, Rodriguez and Teal (2011), also emphasized the importance of patient education for better outcomes of self-management of diabetes, stated that patient education is necessary because it promote high quality diabetic care. Diabetic education programmes stress the importance of patients comprehending the practical approach to self-manage their disease condition. Knowledge and understanding are important in helping patients towards better self-management of diabetes mellitus.
Education help people having DM initiate good self-management and coping skill. Continuous DM education help people having the disease care for themselves.(American Diabetes Association, 2014).There is good report when intervention is long term, it includes follow-up and patients care is individualized. Intervention which promotes behavioral changes improves clinical outcome (Haidet, Naik, Rodriguez &Teal, 2011).Anderson and Funnell (2013), said that self-management education is a process of facilitating knowledge, skill and ability, is an important component of an effective diabetic management. Self-Management place patients at center of care, empowering patients to make decision that will improve clinical outcome.
1.2 Statement of the Problem
Diabetes Mellitus has significantly contributed to the reduction of life expectancy by 15 years and have increased heart disease incidence by four time (IDF, 2014; WHO, 2014). In Nigeria, diabetes mellitus contributes to medical morbidity and mortality (Chinenye, Ogbera, & Onyekwere, 2013). Patients having diabetes stay long on medical wards and pay high bills with various complications such as stroke, adult-onset blindness, lower extremity amputation from foot gangrene, heart/kidney failure and premature death (Fasanmade, Nwaiwu & Olayemi, 2015; Isezuo, Ohwovoriole, & Sabir, 2013). An estimated 3.4 million persons died of high glucose level in 2004 & 2010 according to WHO (Fact sheets, 2013).
According to International Diabetes Federation, (2010), the prevalence of DM in Nigeria varies from 0.65% in rural Mangu to 11% in urban Lagos state. World Health Organization, (2014), suggest that Nigeria have the highest number of people having diabetes. In Nigeria, up to 73% of diabetic patients do not practice self-monitoring of blood glucose (Chinenye, Uchenna, & Unachukwu, 2010; Chinenye, et al., 2013). A study done in Malaysia, (Azmi, Barakatun-Nisak, & Firouzi, 2015) show 72 % of patients with poor glycemic control and in Ethiopia (Abebe, Alemu, Berhane, Mesfin, & Worku, 2015) show two third of patients with poor control.
American Association of clinical Endocrinologist, (2010) report that 1 in 3 patients having T2DM is controlled while one and half of patients comply with medication. It was obvious from this and other surveys that the status of glycemic control and other targets such as lipid, glycated hemoglobin (HbA1c), blood pressure levels and adequate education were below expectations (Chinenye, et al., 2013; IDF, 2012).Therefore, the need for a study on effect of nurse-led training on self-management of diabetes amongst diabetic patients attending medical outpatient clinic in General Hospital Odan, Lagos.
1.3 Objective of the Study
