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Management of Diabetes Type 2 Patient
1. Artikel Penelitian
Sudah di submit ke International Journal Diabetes in Developing Countries
2. Draft Manuskrip
1. Title Page
Title: Health literacy, self-efficacy and self-care management among people with diabetes type 2
in Indonesia.
Authors:
1. Kusrini S. Kadar, BN. MN. PhD (KK)
Affiliation: Faculty of Nursing, Universitas Hasanuddin, Makassar, Indonesia.
ORCID: https://orcid.org/0000-0002-9208-4859
2. Fitri A. Sabil, BN (FS)
Affiliation: Postgraduate Nursing Program Student, Faculty of Nursing, Universitas
Hasanuddin, Makassar, Indonesia.
3. Dr. Elly L. Sjattar, BN, MH (ES)
Affiliation: Faculty of Nursing, Universitas Hasanuddin, Makassar, Indonesia.
ORCID: https://orcid.org/0000-0002-7376-5771
4. Professor Lisa McKenna (LM)
Affiliation: School of Nursing and Midwifery, La Trobe University, Australia
ORCID: http://orcid.org/0000-0002-0437-6449
5. Saldy Yusuf, BN, MHS, PhD (SY)
Affiliation: Faculty of Nursing, Universitas Hasanuddin, Makassar, Indonesia.
ORCID: https://orcid.org/0000-0002-5993-9325
6. Muh. Zukri Malik, BN, MN (ZM)
Affiliation: School of Nursing, STIKes Panakukang, Makassar, Indonesia
7. Nurul Fadilah Gani, BN, MN (NFG)
Affiliation: School of Nursing, STIK Nani Hasanuddin, Makassar, Indonesia.
Correspondent author:
Kusrini S. Kadar, BN. MN. PhD
Affiliation: Faculty of Nursing, Universitas Hasanuddin, Makassar, Indonesia.
Address: Faculty of Nursing Universitas Hasanuddin
Jl. Perintis Kemerdekaan Km. 10 Kampus UNHAS Tamalanrea
Makassar, Indonesia, Postcode: 90245
E-mail: kusrinikadar@unhas.ac.id; kusrini.kadar@gmail.com
Ph. +62 82291611122
Title: Health literacy, self-efficacy and self-care management among people with diabetes
type 2 in Indonesia
Introduction
Diabetes mellitus is a chronic condition where blood glucose levels are raised due to disturbance of insulin,
either where the body cannot produce any insulin (type 1), or sufficient insulin or the body cannot use
insulin effectively (type 2) [1]. Uncontrolled diabetes is associated with long-term complications such as
cardiovascular disease, eye and kidney disease and nerve damage [1, 2]. In 2015, 415 million adults in the
world reportedly suffered from diabetes, four times higher than in the 1980s. It is predicted that by 2040
the number will rise to 642 million people [3], and among those almost 80% will live in low to middle
income countries. In Western Pacific countries, which includes Indonesia, there are reportedly around 170
million people with diabetes, roughly 1 in 11 adults [1, 3]. Indonesia is one of the 22 countries and
territories of the IDF Western Pacific (WP) region where around 159 million people have diabetes, and
more than half (54%) have not yet been diagnosed and are at higher risk of developing harmful and costly
complications. By 2045, this number is predicted to rise to 183 million [4]. In 2017, there were over
10,276,100 cases of diabetes in Indonesia making Indonesia second ranked after China [5]. Around two
thirds of people with diabetes in Indonesia do not know they have the condition and thus are very late to
access health services, by which time they already have complications [3]. In South Sulawesi Province
Indonesia, there has been a sharp increase in the number of people with diabetes from 1.5% in 2007 to 7.1%
in 2013 [6] putting this province in third position for numbers of people with diabetes in the country. In
2016, the fourth most common cause of death and premature death in Indonesia was diabetes and this
disease has been estimated to cause 100,400 deaths annually, responsible for 6.5% of all deaths [7].
Lack of self-care behaviour is considered among the most important factors affecting mortality for people
with diabetes. [8] Self-care behaviour is defined as the ability that someone has to make decisions and
actions to overcome health problems and/or to improve health status [9]. Lifestyle management is a
fundamental aspect of diabetes care to facilitate knowledge, skills and abilities necessary for optimal
diabetes self-care [10]. Although many factors such as age, gender, and educational level have been proven
to affect self-care behaviour of people with diabetes, all those factors cannot be modified [11]. Several
studies have found that some psychosocial factors, such as health literacy and self-efficacy, also play
important roles in self-care management of people with type 2 diabetes [8, 9, 11, 12]. Health literacy is
described as the degree to which individuals have the ability to obtain, process, and understand basic health
information and services needed to make appropriate health care decisions, and is important for good health
[13-15]. Low levels of health literacy have been associated with poorer health outcomes in many chronic
conditions [12, 16]. Studies have shown that health literacy is correlated with self-efficacy, where
improving self-efficacy can also improve self-care management and promote health literacy [8, 9, 17, 18].
Self-efficacy is the belief one has in their own abilities to meet challenges ahead and complete a task
successfully [8]. As Bandura emphasized, self-efficacy is “the belief in one’s capabilities to organize and
execute the sources of action required to manage prospective situations ”, thus efficacy beliefs influence
how people think, feel and can motivate themselves to act [19]. In order to be able to manage better health
behavior, a person needs to have knowledge and skills related to health, which is known as health literacy,
and self-belief that the person holds about their capabilities of what to do with the knowledge and skills
that they have [20].
Although many studies have been conducted about health literacy, self-efficacy and self-care behaviour or
self-care management, the unique contributions of those variables are not as well understood [9]. Patients
with higher health literacy levels may feel more confident in their ability to perform self-care management
[21]. Although many studies have been conducted related to those variables, there are very limited studies
from Indonesia as there are no statistics and evidence available on the subject. Therefore, this study was
conducted with two aims: to determine health literacy status, self-efficacy level and self-care management
level; and to determine the relationship between health literacy, self-efficacy and self-care management in
people with diabetes type 2 in Makassar District, Indonesia.
Results
Most participants were female (76.2%), just over half had completed senior high school education (51.4%).
Duration of diabetes ranged from 1 to 25 years, with an average years of 7 years. More than half of the
participants had complications from their diabetes (59%). Participants’ ages ranged from 40-70 years, with
the average age being 60 years old. The median scores of health literacy, self-efficacy, and self-care
management were 48.46 ±5.56 (min-max 35-62), 52.24 ±10.96 (min-max 35-78), 45.3 ±7.23 (min-max 31-
64) respectively (Table 1).
Table 1
Demographic and clinical characteristics of participants (n=105)
Characteristics n %
Gender
Male 25 23.8
Female 80 76.2
Education
Primary school and lower 29 27.3
Junior High School 15 14.3
Senior High School 54 51.4
Bachelor and higher 7 6.7
Complication
No 43 41.0
Yes 62 59.0
Min-Max Mean ± SD
Age 40-75 60 7.81
Diabetes duration (year) 1-25 7 3.81
Min-Max Median ± SD
Table 3
Correlation matrix of health literacy level, self-efficacy level, and Self-care management (n=105)
Acknowledgements
The authors acknowledge and thank to the participants, people with type 2 diabetes reside in three working
areas of Puskesmas in Makassar City, Indonesia for their participation, and for the Research and to the
Centre of Research and Community Service Universitas Hasanuddin for funding this research.
Author contributions
All authors conceptualized the project design, analyzed statistical data, interpreted data, drafted the article
and revised it critically for important intellectual content, and finally approved the version to be published;
KK, FS, ES, LM and SY developed the idea, designed the project, interpreted data, and prepared and
submitted the article; ZM, NFG, and FS collected the data, performed statistical analysis, and interpreted
the data; and KK, ES and SY and LM supervised and monitored all aspects of this study. All authors
contributed equally to the final version of the manuscript.
Funding source
The author(s) received financial support from World Diabetes Foundation (WDF Grant no. 05-131) and
Biomedical Research Group (BMRG), BIRDEM.
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