Analysis of the factors that affect the ability of the diabetes selfmanagement

Endang Sri P Ning *, Mahdalena *, Syamsul Firdaus *

* Health Polytechnic of Banjarmasin
Mr Cokrokusumo Street Number 3A Banjarbaru South Kalimantan 70714
E-mail: eenspn75@[Link]
Abstract
Introduction: The prevalence of diabetes is increasing and certainly needs further treatment. DM
patients shall be able to manage their disease themself in order to avoid complications in the future.
The ability to manage and treat patients with diabetes mellitus is needed. Many factors affect the
patient's self-management ability and contribute to health outcome of patients with diabetes. This
study aims to analyze the factors that affect the ability of the diabetes self-management. Method:
The method used was observational with cross sectional approach. Samples were taken from
Diabetes patients in June-August 2014 at Ratu Zalecha Hospital Martapura and met the inclusion
criterias. Univariate analysis with frequency distribution and multivariate using Logistic Regression
statistical tests with significance level 0.05. Result: Results showed there is no sociodemographic
effect (age, duration of disease, family history and economic status) of the self-management
capabilities (p> 0.05), There is the influence of self-efficacy ((p = 0.005) and family support ((p =
0.00 ) with the ability of the diabetes self-management. The researchers suggest that the factor of
family support is the dominant factor in affecting the ability of self-management. Discussion: self
management of diabetic patients was not influenced by socioeconomic but by self-efficacy and their
family support. In the presence of family support will greatly help people with diabetes to be able to
increase confidence in its ability to perform self-care.
Keywords: self-management, self-efficacy
INTRODUCTION
Diabetes Mellitus (DM) is a
group of metabolic diseases with
characteristic increase in blood glucose
levels (hyperglycemia) that occurs due to
abnormalities in insulin secretion, insulin
action or both (Smeltzer & Bare, 2008).
Diabetes mellitus has become a threat to
human health in the 21st century.
The prevalence tendency of DM
is based on interviews in 2013 was 2.1 per
cent (Indonesia), higher than in 2007
(1.1%), some provinces showed an
appreciable increase prevalence of DM
including South Kalimantan from 1.4% to
2% (Riskesdas , 2013).
In the province of South
Kalimantan, DM ambulatory patients
throughout the hospital, with a lifespan of
more than 65 years in Banjarmasin city
ranks 7th out of 20 major diseases with

the number of patients 123 patients

(6.45%). As for inpatients, the number of
patients over the age of 65 years ranks 6th
with the number of patients 200 people
(4.46%) (South Kalimantan Provincial
Health Ministry, 2008).
Treatment in Patients with
diabetes mellitus and its complications
requires a long time and cost, which can
cause the burden on patients and families.
Therefore, the change in behavior to
perform self-care, family and patients
have the ability to manage their own
health, including in controlling blood
glucose levels and through self-care as
well, expected life expectancy and
productivity of people with diabetes
remain high. Based on this, understanding
of diabetes must be done thoroughly, both
risk factors, diagnosis, treatment and
complications.

Health condition and quality of

life of diabetes patients depending on the
patient's ability to manage the disease
well. Self-care management refers to
individual ability to manage symptoms,
treatment, physical condition and
psychosocial and changes life style as
the result of living with the conditions of
chronic disease (Barlow et al, 2002).

support with the ability of selfmanagement of the person with diabetes.

The population or subjects in
this study were all patients who seek
treatment at DM polyclinic of Ratu
Zalecha Hospital Martapura in June August 2014 to meet the inclusion criteria
desired. Samples that participate in this
study was 143 people. Instrument of the
research for all variables performed by
administering a questionnaire.

Self-care management can be

defined as the ability to carry out
activities for themselves which helps to
meet the needs of health-related. This
capability can be increased and
maintained for specific health objectives.
Patients will get their self-care disturbed
if they can not do the treatment of selfcare themselves.

RESULTS
Univariate analysis
The results of the age grouping is seen
that the majority of respondents in
productive age (21-50 years) is as much
as 83.2%. The duration of illness (long
suffered from DM) most of 5 years
(61.5%), the majority have a family
history of diabetes (56.6%) and had a
higher economic status (67.8%).

Self-management
in
DM
patients refers to the ability of the
individual
to
maintain
effective
management from their behavior such as
they are supposed to drink prescribed
medications, following a diet and exercise
program, diligent monitoring blood sugar
levels, and overcoming emotional
condition due to the difficult living with
diabetes (Lorig and Holman, 2003).

Based on the level of self-efficacy seen

most of the respondents have a low
efficacy rate (93.0%). Based on family
support of diabetics mostly high as 75
people (52.4%) and there are those who
have low levels of support as many as 68
people (47, 6%).

Many research show that the

Psycho-social factors, such as patients
knowledge, attitude, self-efficacy, social
networking and the important social
support determine the ability of Diabetics
in self-management. Several studies
conducted in China show that some factor
that contribute to Patients health
outcome, such as knowledge and selfefficacy, age factor, income, occupation,
educational level, duration of suffering
the disease and co - morbid condition
(Zhong, et al, 2011).

Bivariat analysis
The results of the bivariate analysis
discusses the relationship between age,
duration of disease, family history, selfefficacy and family support with self-care
management of patients with diabetes.
The relations between age with the ability
of self-care management.

MATERIALS AND METHODS

This research uses non
experiment research with analytic
descriptive method in cross sectional
design that aims to analyze the
relationship of socio-demographic factor
(age, duration, family history and family
economy), diet efficacy factor and family

Relations of age to the ability of selfcare management.

Table 1 Relations of age to the ability
of self-care management.

Age

Self-management

amount 75 52.4 68 47.6 143 100

Low

High Total

f % f % f

Nonproductiv
6 52. 5 47. 11 10
e (> 50 years
2 1 7 9 9 0
old)

Percentage of respondents who have high selfmanagement capabilities actually owned by

the respondent which disease duration 5
years (50%), but not statistically significant
differences (P> 0.05).
Relation of Family History to the ability of

self-care management.
Table 3 Relation of Family History to the

ability of self-care management.

Productive
0.8
1 54. 1 45.
10
(21-50 years
23
5
3 2 1 8
0
old)

Self-management
Histor
Low
y

7 52. 6 47. 14 10
5 4 8 6 3 0

amount

f
Percentage of respondents who have high selfmanagement capabilities actually owned by
the non-productive respondents (47.9%), but
statistically significant differences (P> 0.05)

Duratio Low
n
of
desease
f

High

Total

O,
861
there is 43 53.1 38 46.9 81 100

Table 2 Relation of disease duration to the

ability of self-care management.

Total

32 51.6 30 48.4 62 100

Relation of disease duration to the ability of

self-care management.

Self-management

High

amoun
75 52.4 68 47.6 143 100
t

Percentage of respondents who have high

self-management capabilities own by
respondents with a family history of
diabetes 5 years (46.9%), but
statistically there is no significant
differences (P> 0.05).

Relation of Socio-economic to the

ability of self-care management.
<5 th

31 56.4 24 43.6 55 100

.458

5 th

Table 4 Relation of Socio-economic to

the ability of self-care management.

44 50 44 50 88 100

Socio

Self-management

economi
Low
c
f %

High Total

f % f

2 54. 2 45.

Low

5 3 1 7

46

5 51. 4 48.
0 5 7 5

amount

97

74 55.6 59 44.4 133 100

High

1 10.0 9 90.0 10 100 0:05

amount 75 52.4 68 47.6 143 100

10
0

Percentage of respondents who have high

self-management capabilities owned by
the respondent who had high self-efficacy
(90%), statistically there is significant
differences (P 0.05).

075
4
High

Low:

10
0

7 52. 6 47. 14 10
5 4 8 6 3 0
Relation of Family Support to the

Percentage of respondents who have high

self-management ability possessed by the
respondents have seen high social
economic (48.5%), but statistically it has
no significant differences (P> 0.05). If we
seen in Table 1 to Table 4 it appears that
all sociodemographic vairabel not
statistically
associated
with
selfmanagement capabilities.

ability of self-care management

Table 6 Relation of Family Support to the

ability of self-care management

Relation of Self Efficacy to the ability

Self-management

of self-care management

Table 5 Relation of Self Efficacy to the

ability of self-care management

Self-management
Self
Low
efficacy
f %

High

f %

High

Total

f %

f %

Low:

Total P

Family
Low
support

5 75. 1 25. 68 10 0:00

0
1 0 7 0

High

amount

2 32. 5
4 0

10
68 75 0
1

7 52. 6 47. 14 10
5 4 8 6 3 0

Table 8 Final Model of multivariate analysis

Relation of Self Efficacy and Family
Support to Self Management of
Patients with DM

No variabl coefficien
.

Percentage of respondents who have high

self-management capabilities is the
respondent who had a high family support
(68%), statistically there is significant
differences (P 0.05).

tB

self1 efficac 0.203

y

P R
beta Valu Squar
e

1.59 0,142 0.276

5

MULTIVARIATE ANALYSIS
Table 7 Multivariate Analysis Relation of
economic status, self-efficacy and
family support to selfmanagement

No. variable

economic
status

selfefficacy

Family
support

Kooefisien P
B

Value

1,240

0.594

Family
support

0.183

1.70 0,000
1

Statistical test results obtained by the

coefficient of determination (R square)
= means that the two variables (selfefficacy and family support) can
explain the variation of the variable
self-management of 27.6%. Can be
seen from the p-value Value that the
variables that contributed most to self
management is family support.
DISCUSSION

0.195

0.133

.178

0,000

From the table above it is known that

there are two variables that have value
p> 0.05 those are economic status and
self-efficacy, then the expenditure on
economic status variables because p
value> 0.05, and the final modeling
done as shown in table 8 as follows:

Based on the majority patients

are in the productive age, and when
viewed from the value of the average
age of respondents is 58.2 years. The
high number of people with diabetes
over the age of 40 years may be due to
the middle aged population and the
elderly who suffer from diabetes are
common in developing countries.
Middle age are particularly at risk of
developing the disease, especially type
II diabetes, but did not rule out the
possibility that type II diabetes can also
occur under middle age.
The results of this study are
supported by the theory mentioned

Corwin (2009) that in people aged over

40 years with low glucose diet
arrangement will experience shrinkage
of pancreatic beta cells progressively as
well as the buildup of amyloid around
Beta cells of the pancreas. Beta cells of
the pancreas is left in general are still
active, but insulin secretion decreases, it
is also consistent with the statement of
the American Diabetes Association
(ADA) in 2014 that the age of 40 years
is one of the risk factors for type 2
diabetes mellitus.
The results of this study showed
that most patients had diabetes mellitus
for more than 5 years is 61.5%. These
results are consistent with similar
studies conducted by Ariani (2011) in
which the average patient with diabetes
is 6 years old.
Long suffered from type 2
diabetes are often less describe the
actual disease process. This is because
many patients with type 2 diabetes
newly diagnosed after experiencing
complications, though the course of the
disease have occurred many years
earlier but not yet diagnosed. Until now
DM is a chronic disease that can not be
cured completely but can still be
controlled so that the patient will live
the rest of his life with the disease.
People who have descent of
diabetes have higher risk of developing
DM. PERKENI 2011 stated that one of
the risk of diabetes is heredity.
According to the American Diabetes
Association, if one parent has diabetes,
the risk of getting diabetes is 1 to 7, if
one of them is diagnosed after the age of
50 know the risk is about 1 in 13, and if
both parents are diabetic patient, the risk
of DM is 1 in 2.
This study resulted in that most
respondents have a high economic status
((67.8%). Low Socioeconomic by
personal
or
household
income,
education, employment and living area
associated with low levels of physical
and emotional health, it can improve

cardiovascular disease and poor

glycemic control (Brown et al, 2004).
These results indicate that most
of the 143 patients with diabetes have
low levels of confidence (self-efficacy)
at 93.0% (133 people). This proves that
most patients do not have the selfawareness and good psychology in
managing diabetes mellitus. Value
confidence of patients most in this study
is seen almost on all the pillars of the
management of diabetes is dietary
management then medication adherence,
education management of complications
of diabetes and the last management of
sports / physical activity where it can be
influenced by several aspects of selfefficacy as a personal experience , the
experience of others, verbal persuasion
and emotional-psychological.
Lack of confidence in patients in
performing physical activity / exercise
in the management of diabetes can occur
because patients have complications that
required should not be a lot of activity, a
lack of encouragement (emotionalpsychological) both internal and
external such as the absence of
association special group DM ,
According to Bandura (1997) in Carr
(2009) in addition to personal
experience, the experience of others and
verbal
persuasion,
emotionalpsychological conditions also influence
a person in making decisions regarding
self efficacy. A person who has
confidence in his ability to solve
problems then he will choose and
perform useful and effective action to
resolve the problem properly.
Based on the results of the
study showed that family support
diabetics mostly high as 75 people
(52.4%) and there are those who have
low levels of support as many as 68
people (47, 6%).
According Hensarling (2009)
family support is defined as assistance
provided by other family members that
will provide physical and psychological

comfort to people who are faced with a

situation of stress or illness. With the
use of the family support system
consisting of information support,
emotional, and instrumental assessment,
which is part of the overall support of
family-centered approach to the family
so that it can improve health and
adaptation in life.
High family support occurs
due to factors that influence one of
them is age factor, considering almost
all respondents' average age above 40
years shows the final stage adult
development has begun to ripen or
entering the development stage with the
elderly. This condition is very
influential to function decrease of the
body so the family becomes
increasingly concerned with the state of
the patient. Hence their family are
giving high support to patient both
informational, emotional, instrumental
and assessment support.
Low Family support can be
caused by factor of the long suffered
where most respondents suffered from
diabetes > 5 years (61.5%) have low
family support. It is caused by family
that has been tired enough to provide
information about the disease and
proper treatment for the patient, the
family has been less eager to prepare all
the needs of facilities and infrastructure
required by the patient, the family
already feel less motivated to provide
support to the patient in order to remain
on patient self-care treatment process ,
and the family is lazy and does not care
anymore to provide an assessment to
the patients about self-care that should
be done.
In this study, if we view from
the aspect of family support, where
family support in the form of awards or
ratings still low this is because families
are still not able to provide feedback of
compliment when the patient succed to
finish off the drug , never invited to the
doctor to check their feet, eyes and
never take sports together. According to

research carried out Karlina (2012) that

support good judgment three times will
do the secondary prevention. So we
need strategic efforts to increase efforts
for self-care in patients with diabetes
mellitus (DM) through a family
approach in particular through the
support aspect of the assessment.
In addition to low family
supports, instrumental supports are also
low where the family is unable to
provide the medical devices to perform
self-care in diabetic patients, and
families are not able to provide special
diets for people with diabetes. Whereas
the good instrumental support can
improve health status.
Funnell et al (2007) suggest
that diabetes is a disease that must be
managed independently (self care).
Chronic diseases such as diabetes
require a patient-centered approach, in
the form of patients empowerment that
constitute to nursing philosophy that
emphasizes the approach to facilitate the
patient s themselves to change in
behavior.
The
ability
of
selfmanagement in the respondents
according to the American Association
of Diabetes Educators (2012), in which
self-care activities (self care activity) on
the client diabetes mellitus type II refers
to the components of the management of
diabetes mellitus includes diet, exercise,
medication, monitoring blood glucose
self, and foot treatment.
Based on the research results
show that the ability of selfmanagement of diabetes mostly low that
is 75 people(52.4%) and there are those
who have
high ability to selfmanagement of 68 people (47, 6%).
Viewed from the aspects of
self-care is still low, the aspect of selfcare exercise and blood sugar control
still lacking this is because respondents
do not spend time in a week to exercise
at least 30 minutes and the respondent

only check blood sugar when his blood

sugar is high. Based on the theory that
patients with type II DM main problem
is the lack of response to insulin
receptor, because of the disruption of the
insulin can not help transfer glucose into
cells. So, we need sports to help insulin
to transfer glucose into cells. As for
blood sugar control routine is necessary
in patients with diabetes where blood
sugar control routine helps in
monitoring the effectiveness of the
therapy as
diet,
exercise
and
medications and avoid the occurrence of
complications with early detection on
blood sugar levels are up or down so
they will get proper treatment.
The results of the bivariate analysis
shows that the percentage of
respondents who have a positive self
management are in non-productive
age (47.9%) and statistically there is
no significant differences p = 0, 853
(p> 0.05) between age and selfmanagement capabilities to manage
DM. These research is appropriate
with research conducted by Wu et al,
2007 declaring there was no
statistically significant correlation
between self-care with age.
In the analysis of the relationship
between the duration of illness by
self management capability is seen
that the respondents with a high
ability of self management had
disease duration> 5 years (50%) and
statistically also no significant
differences p = 0, 458 (p> 0.05).
The absence of this relation is
contrary to some studies that have
been done in duration of illness that
states strongly correlated to the
activity of self-care, duration of
desease disease > 9 years had a
positive relationship to medication
adherence and monitoring of blood
glucose (Chio et al, 2009;). Wu et al
(2007) also stated statistically there
is significant correlation exists
between long suffering from
diabetes with good self-care ability
(average 5.8 years).

The percentage of respondents who

have low ability to self-management
does not have a family history of DM
(51.6%) and is also statistically there is
no significant differences p = 0, 861
(p> 0.05). Researchers not yet to find
studies that analyze this relationship,
but according to an analysis by
researchers is by the presence of a
family history of diabetes is expected to
have experience in treating patients
with DM and should be able to
contribute
to
their
self-care
management after suffering from
diabetes.
Chio et al (2009) found that high
income is correlated with high self-care
ability, a high income is associated with
good physical maintenance activities.
The statement was not in accordance
with the results of this research that the
percentage of respondents who have a
positive self-management is at a high
economic status (68%) and statistically
there is no significant differences p = 0,
754 (p> 0.05) between age to selfmanagement for diabetes.
The analysis results of the
relationship between self-efficacy with
self management capability is the
respondents with high self management)
have high self-efficacy (90%). Based on
the statistical test p value <0.05 is 0.005,
it can be concluded that there is a
significant relationship between selfefficacy
with
self
management
capabilities.
Self-efficacy
is
an
important factor to determine the level
of compliance in performing self-care
management. The higher self-efficacy,
the better the results of self-care
management (Bandura, 1997).
Research conducted by Lee, Ahn
and Kim (2009) regarding self-care and
self-efficacy on blood sugar control
shows that there is a relationship
between self-efficacy with self care.
This study shows that the group has a
high self-efficacy also has a high value
of self care and evidenced by good
blood sugar control.

From the bivariate analysis

between family support with self
management obtained that there are 17
of respondents (25.9%) with low family
support have good self management.
The respondents who have higher
family support there are 51 (68%) of
respondents who have a good ability of
self management. From the analysis
obtained by OR of 6.3 means that
respondents with high family support
had 6.3 times the opportunity to perform
self management were high compared
with low family support. Based on the
statistical test p value <0.05 is equal to
0.000, it can be concluded that there is a
significant relationship between family
support with the ability of selfmanagement
According to Sacco & Yanover
(2006), effective social support can
improve the physical health of people
with diabetes to reduce symptoms of
depression, blood sugar control better
and increase compliance with self-care.
According to researchers with their
social support would greatly help people
with diabetes to be able to increase
confidence in its ability to perform selfcare. This study is also in line with
Ismonah, et al (2008) which states that
there is a significant relationship
between family support with self-care
management in diabetic patients (p =
0.000, a: 0.005).
Multivariate analysis showed that the
most significant factors associated with
diabetes self-care management of
patients in hospitals and hospitals Ulin
Banjarmasin Queen Zalecha Martapura
is controlled by the family support after
self-efficacy variables.
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