• Journal of Korean Academy of Nursing
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• v.52 no.5
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• pp.535-549
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• 2022

Purpose: The study aimed to design and develop an automated personalized self-care (APSC) program for patients with type 2 diabetes mellitus. The secondary aim was to present a clinical protocol as a mixed-method research to test the program effects. Methods: The APSC program was developed in the order of analysis, design, implementation, and evaluation according to the software development life cycle, and was guided by the self-regulatory theory. The content validity, heuristics, and usability of the program were verified by experts and patients with type 2 diabetes mellitus. Results: The APSC program was developed based on goal setting, education, monitoring, and feedback components corresponding to the phases of forethought, performance/volitional control, and self-reflection of self-regulatory theory. Using the mobile application, the participants are able to learn from educational materials, monitor their health behaviors, receive weekly-automated personalized goals and feedback messages, and use an automated conversation system to solve the problems related to self-care. The ongoing two-year study utilizes a mixed method design, with 180 patients having type 2 diabetes mellitus randomized to receive either the intervention or usual care. The participants will be reviewed for self-care self-efficacy, health behaviors, and health outcomes at 6, 12, 18, and 24 months. Participants in the intervention group will be interviewed about their experiences. Conclusion: The APSC program can serve as an effective tool for facilitating diabetes health behaviors by improving patients' self-care self-efficacy and self-regulation for self-care. However, the clinical effectiveness of this program requires further investigation.

• Journal of Yeungnam Medical Science
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• v.35 no.1
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• pp.27-35
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• 2018

Diabetes and depression are serious chronic conditions. As a result of their increasing prevalence, diabetes and depression, together with population growth and aging, are public health issues. The rate of depression in adults with either type 1 diabetes or type 2 diabetes is high relative to the general population. The coexistence of diabetes and depression has attracted much interest. Although it is unclear whether diabetes and depression are causally linked, most studies have shown that the association between diabetes and depression might be bidirectional. Currently, emotional well-being is becoming an increasingly important aspect of diabetes care and self-management. Psychiatric disorders and diabetic distress among people with diabetes may increase the risk of diabetes complication and mortality. Thus, assessment and appropriate management of depression in people with diabetes should be considered to achieve psychological well-being and optimize medical outcomes.

• 한국노년학
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• v.38 no.1
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• pp.169-185
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• 2018

The purpose of this study examined the feasibility and efficacy of a senior center-based diabetes self-management program applying action research approach. The cyclical action research method was applied for this study: plan, act, evaluate, and reflect in delivering three waves of the intervention program. Three waves of a 12 weeks-length small group diabetes self-management program were offered during the period of 15 months in a senior center in Seoul. Planning of $2^{nd}$ and $3^{rd}$ wave program were based on reflection of $1^{st}$ and $2^{nd}$ program evaluation respectively. Among the 46 participants, 93.48% (N=43) completed the program. The quantitative evaluation showed statistically significant improvement in HbA1C(p<.001), fasting plasma glucose(p<.001), BMI(p=.016), waist circumference(p=.001), systolic blood pressure(p=.036), diabetes self-management behavior(p<.001) and health knowledge(p=.008). Qualitative data revealed that individual management was very helpful in empowering and adhering for own diabetes care for the participants. Participants reported high satisfaction towards the program with mean satisfaction score of 65.12. Application of the Diabetes Self-management program with action study strategy was successful in community setting for improving participants' subjective and objective outcomes. Action research method guides the practitioner to tailor the program to respond for the participants and field needs.

• The Korean Journal of Food And Nutrition
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• v.21 no.4
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• pp.530-535
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• 2008

Evidence for the effects of different health behaviors, including diet, in elderly diabetes is currently limited. The aim of this study was to compare the quality of diet and health behaviors in Korean elderly T2DM patients, using a glycemic control. T2DM elders(>65 yr, n=48) were recruited and categorized by the concentration of glycated-hemoglobin HbA1c; subjects with HbA1c<7% were the good control(GC) group, and subjects with $HbA1c{\geq}8%$ constituted the poor control(PC) group. General characteristics, self-management behavior questionnaires, and 3-d diet records were all collected and assessed. No significant differences in general characteristics between GC and PC were detected, with the exception of a higher level of education in GC(p<0.05). A twofold longer duration of diabetes was observed in PC as compared to GC(p<0.01). The GC group did exercise for a longer time(p<0.001), and had an earlier beginning of diabetes self-management education (DSME) by healthcare practitioners using a team teach as compared with the PC group(p<0.05). The total dietary quality index(p<0.001) and individual index for carbohydrate(p<0.001) or vegetables and fruit(p<0.05) were better in GC than in PC. Therefore, the earlier DSME including intensive exercise and balanced diet selection should be expected to improve glycemic control in diabetic Korean elders.

• Women's Health Nursing
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• v.27 no.2
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• pp.75-92
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• 2021

Purpose: This study aimed to analyze the content and effectiveness of psychosocial support interventions for women with gestational diabetes mellitus (GDM). Methods: The following databases were searched with no limitation of the time period: Ovid-MEDLINE, Cochrane Library, Ovid-Embase, CINAHL, PsycINFO, NDSL, KoreaMed, RISS, and KISS. Two investigators independently reviewed and selected articles according to the predefined inclusion/exclusion criteria. ROB 2.0 and the RoBANS 2.0 checklist were used to evaluate study quality. Results: Based on the 14 selected studies, psychosocial support interventions were provided for the purpose of (1) informational support (including GDM and diabetes mellitus information; how to manage diet, exercise, stress, blood glucose, and weight; postpartum management; and prevention of type 2 diabetes mellitus); (2) self-management motivation (setting goals for diet and exercise management, glucose monitoring, and enhancing positive health behaviors); (3) relaxation (practicing breathing and/or meditation); and (4) emotional support (sharing opinions and support). Psychosocial supportive interventions to women with GDM lead to behavioral change, mostly in the form of self-care behavior; they also reduce depression, anxiety and stress, and have an impact on improving self-efficacy. These interventions contribute to lowering physiological parameters such as fasting plasma glucose, glycated hemoglobin, and 2-hour postprandial glucose levels. Conclusion: Psychosocial supportive interventions can indeed positively affect self-care behaviors, lifestyle changes, and physiological parameters in women with GDM. Nurses can play a pivotal role in integrative management and can streamline the care for women with GDM during pregnancy and following birth, especially through psychosocial support interventions.

• Journal of Korean Academic Society of Home Health Care Nursing
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• v.22 no.2
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• pp.206-215
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• 2015

Purpose: This study aimed to provide basic data to enhance self-nursing ability by investigating the symptoms of autonomic neuropathy and self-management activities in patients with diabetes accompanying hypertension. Methods: Subjects were 113 type-2 diabetic patients who were diagnosed as hypertensive in two primary medical institutions and taking anti-hypertensive treatments. The existence of postural hypotension was evaluated by blood pressure and pulse rate, and the subjective symptoms of autonomic neuropathy and self-management activities were checked by structured questionnaires. The collected data were analyzed by chi-square test, Fisher's exact test, t-test, Wilcoxon rank sum test and analysis of covariance. Results: Postural hypotension occurred in 4.4% of the subjects. Urinary frequency and dizziness during postural changes were the most frequent symptoms of autonomic neuropathy, and 57.5% of the subjects complained of symptoms in two or more domains. The group with autonomic neuropathy symptoms showed higher age, higher living stress, and fewer self-management activities in the diet and foot management domains as compared to the group without autonomic neuropathy symptoms. Conclusion: From these results, we learned that strengthening education on self-management for diet and foot management and customized interventions considering age and living stress are required through early identification of the symptoms of autonomic neuropathy in patients with diabetes accompanying hypertension.

• Clinical and Experimental Pediatrics
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• v.54 no.2
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• pp.45-50
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• 2011

Compared to that in the Caucasian population, type 1 diabetes mellitus (T1DM) incidence rates are very low in Koreans. Therefore, compared to the recent development of pharmacological therapy applicable to Korean children with T1DM, interest in nonpharmacological therapy and psychosocial support systems remains low, as is the development of Korean-style T1DM education programs for therapeutic application. Children who have been newly diagnosed with diabetes are placed in completely new environments for treatment. For appropriate control of diabetes, patients have to self-monitor blood glucose levels and inject insulin several times a day and must use extreme self-control when they eat foods to avoid increases in blood glucose levels. Blood glucose excursions resulting from impaired pancreatic ${\beta}$ cell functions cause mental stress due to vague fears of chronic complications of diabetes. In addition, children with diabetes cannot be excluded from the substantial amount of studies required of Korean adolescents, and the absolute shortage of time for ideal control of diabetes adds to their mental stress. Many of these patients are psychologically isolated in school where they spend most of their time, and they are not appropriately considered or supported with respect to blood glucose control in many cases. In this respect, this author will introduce some of the newest views on nonpharmacological therapy and psychosocial support systems that account for important parts of T1DM management and seek measures to apply them in conformity with the social characteristics of Korea.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.21 no.7
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• pp.331-341
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• 2020

This study examined the effects of an Experience Sharing Self-management Program (ESSP) on physiological indexes, knowledge, and self-management implementation among hypertension and diabetes patients in a primary public health center in G city. A quasi-experimental research was conducted with a non-equivalent control group pretest-posttest design. The experimental group (n=30) participated in a 12-week ESSP, and the control group (n=25) received only general services of a primary public health center between May 1 and October 31 in 2018. Data were analyzed with x2 test (Fisher's exact test), Mann-Whitney test, and Ranked ANCOVA using SPSS/WIN 22.0 program. The results showed significant differences in systolic blood pressure (F=14.56, p<.001), diastolic blood pressure (F=7.05, p=.012), knowledge (F=14.30, p=.001), self-management implementation (F=29.73, p<.001) of hypertension patients, knowledge (F=7.92, p=.010), and self-management implementation (F=4.54, p=.044) of diabetes patients between the two groups. Therefore, the ESSP was effective for reducing the blood pressure of hypertension patients and improving the knowledge and self-management implementation among hypertension and diabetes patients in a primary public health center.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.19 no.2
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• pp.168-178
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• 2012

Purpose: The purpose of this study was to compare self-care behavior, diabetes-related stress and stress coping style among 3 blood glucose control groups (good, inadequate, and poor blood glucose control groups). Methods: Participants were 102 type 2 diabetic patients (good group: 41, inadequate group: 31, poor group: 30). Data were collected from Feb 19 to Mar 24, 2010 and were analyzed using Chi-square, Fisher's exact test and ANCOVA with SPSS/WIN 12.0. Results: Using ANCOVA with frequency of admission, and illness duration as covariates, significant differences were found among the 3 groups in self-care behavior (total score) and the exercise subscale. Using ANCOVA significant differences were found among 3 groups in diabetes-related stress (total score), emotional burden subscale and regimen distress subscale. Using ANCOVA no difference in stress coping was found among the 3 groups, but there was a significant difference in the problem-oriented coping subscale. Conclusions: Self-care behavior, diabetes-related stress, and stress coping style are factors influencing blood glucose control. The results of this study suggest that for improving blood glucose control, self care education program focused on diet and exercise in addition to stress management program for promoting problem oriented coping capability are recommended.

• Research in Community and Public Health Nursing
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• v.28 no.2
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• pp.216-225
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• 2017

Purpose: The purpose of the study was to analyze the effects of self-care behavior, empowerment, and social support on glycosylated hemoglobin in patients with type 2 diabetes. Methods: The data were collected during the period of July 1 to July 31, 2016. In total, 172 participants were recruited from outpatients who had been diagnosed with type 2 diabetes at a health care center, a health promotion center at National Health Insurance Corporation, and a tertiary hospital. Statistical data were analyzed with SPSS 20.0 using frequency analysis, t-test, ANOVA, $Scheff{\acute{e}}$ test, Pearson's correlation coefficients, and hierarchical regression analysis. Results: The study results showed that self-care behavior (${\beta}=-.34$, p<.001), empowerment (${\beta}=-.34$, p<.001), and social support (${\beta}=-.20$, p=.018) were found to be influential factors affecting glycosylated hemoglobin, with an overall descriptive power of 69%. Conclusion: Self-care behavior, empowerment, and social support are considered to be important factors in blood glucose management for the patients with type 2 diabetes. Therefore, self-caring blood glucose programs and internal synchronizing education through social support and empowerment need to be improved.