The effects of a self-care promoting program on engagement in self-care behaviors, clinical outcomes, and vision-related quality of life among persons with type 2 diabetes and diabetic retinopathy

Diabetes (DM) is a global epidemic, and diabetic retinopathy (DR) is the most common microvascular complication of diabetes resulting in visual impairment and blindness. Promoting self-care behaviors is crucial for persons with DR to control DR severity progression and prevent blindness. This study is randomized controlled trial study (RCTs) aimed to investigate the effects of a Self-Care Promoting Program (SCPP) on engagement in self-care behaviors, clinical outcomes, and vision-related quality of life (VRQoL) among persons with type 2 DM and DR. The SCPP was developed based on the Self-Care of Chronic Illness theory and the American Association of Diabetes Educators Guidelines (AADE). The sample consisted of 98 adults and older adults with type 2 DM and DR, registered at the retinal center of the super tertiary hospital. They were randomly assigned to experimental and control groups (49 persons each). The experimental group received the SCPP plus routine care, while the control group received only routine care. The instruments used were the demographic questionnaire, the modified Thai version of the self-care of diabetes index (SCODI), the self-care for diabetes eye care questionnaire (SCFDE), the impact of visual impairment (The IVI-Thai version), and patient’s retinal images. Data were analyzed using descriptive statistics, chi-square, independent t-test, and repeated measures MANOVA. Results showed that the experiment group had significantly increased the mean score of engagement in self-care behaviors than before entering the program and more than those in the control group at weeks 8 and 16 (p<.001). Moreover, the mean score of HbA1C and VRQoL of the experimental group had significantly decreased and lowered than baseline and more than those in the control group at week 16 (p<.001 and p<.05). There were no significant differences in visual acuity (VA) improvement and the decrease of DR severity between the two groups. However, the experimental group decreased DR severity progression more than before participating in the program, whereas the control group did not. Results suggest that it is essential for DR nurses to focus on health education in enhancing the DR persons’ confidence to perform a monitor, and manage self-care behaviors. These strategies can help patient awareness with early detection by regularly monitoring themselves to achieve diabetes outcomes in order to prevent blindness from DR.