Journal of Korean Academy of Nursing

Research Paper

The Development of Automated Personalized Self-Care (APSC) Program for Patients with Type 2 Diabetes Mellitus: Park, Gaeun , Lee, Haejung , Khang, Ah Reum; J Korean Acad Nurs 2022;52(5):535-549. Published online October 31, 2022; DOI: https://doi.org/10.4040/jkan.22046

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.

Citations

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Participation experience in self-care program for type 2 diabetes: A mixed-methods study
Mihwan Kim, Haejung Lee, Gaeun Park, Ah Reum Khang
Journal of Korean Gerontological Nursing.2024; 26(1): 31. CrossRef
Long‐Term Effects of an Automated Personalized Self‐Care Program for Patients With Type 2 Diabetes
Haejung Lee, Gaeun Park, DaeEun Lee, Ah Reum Khang, Min Jin Lee
Nursing & Health Sciences.2024;[Epub] CrossRef
Automated Personalized Self-care Program for Patients With Type 2 Diabetes Mellitus: A Pilot Trial
Gaeun Park, Haejung Lee, Yoonju Lee, Myoung Soo Kim, Sunyoung Jung, Ah Reum Khang, Dongwon Yi
Asian Nursing Research.2024; 18(2): 114. CrossRef
Healthcare coaching program for youth with type 1 diabetes in South Korea: a pilot study
Dae Eun Lee, Haejung Lee, Chong Kun Cheon, Ju Young Yoon
Child Health Nursing Research.2024; 30(1): 17. CrossRef
The Association between the Low-density Lipoprotein-Cholesterol to High-density Lipoprotein-Cholesterol Ratio and the Incidence of Type 2 Diabetes Mellitus in Korean Adults: A Secondary Data Analysis Using a Community-based Cohort Study in Korea
Bo-Kyoung Cha
Journal of Korean Academy of Fundamentals of Nursing.2023; 30(1): 66. CrossRef

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Original Articles

Effects of Web-based Diabetic Education in Obese Diabetic Patients: Hee Seung Kim; Journal of Korean Academy of Nursing 2005;35(5):924-930. Published online March 28, 2017; DOI: https://doi.org/10.4040/jkan.2005.35.5.924

Abstract PDF

Purpose

The purpose of this study was to evaluate the effect of web-based diabetic education on plasma glucose and serum lipids in obese people with diabetes.

Methods

A random allocation design with control and experimental groups being assessed pre- and post-intervention was used. Eighteen patients were randomly allocated to an intervention group and 16 to a control group. Participants were requested to input their blood glucose levels weekly for 3 months at http://www.biodang.com by cellular phone or wire Internet. The researcher sentoptimal recommendations to each patient weekly for 3 months using a short message service (SMS) of the cellular phone and wire Internet.

Results

Patients in the intervention group had a mean decrease of 1.2% in glycosylated haemoglobin (HbA₁c) levels and those in the control group had no difference in HbA₁c levels. There was a significant mean change in 2-hour post prandial blood glucose (2HPPG) for the intervention group, with a mean change of -120.1 mg/dl. The mean change in the control group, however, was not significant.

Conclusion

These findings indicate that this web-based intervention using SMS of the cellular phone for 3 months improved HbA₁c and 2HPPG, but did not affect total cholesterol, triglyceride, and high density lipoprotein cholesterol in obese type 2 diabetic patient.

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The Effects of Short Term Comprehensive Life Style Modification Program on Glycemic Metabolism, Lipid Metabolism and Body Composition in Type 2 Diabetes Mellitus: Ji Soo Yoo, Suk Jeong Lee, Hyun Chul Lee, So Hun Kim, Eun Seok Kang, Eun Jeong Park; Journal of Korean Academy of Nursing 2004;34(7):1277-1287. Published online March 28, 2017; DOI: https://doi.org/10.4040/jkan.2004.34.7.1277

Abstract PDF

Purpose

This study was to evaluate the effects of a short term comprehensive life style modification program on glycemic metabolism, lipid metabolism and body composition in type 2 diabetes mellitus patients.

Method

A nonequivalent control group with a pre post test was designed. Data collection was done from October 2003 to June, 2004 at a hospital. Glycemic metabolism was measured by a.c., p.c. and HbA1c, and lipid metabolism was measured by cholesterol, HDL cholesterol, LDL cholesterol and triglycerides. Body Composition was measured by body weight, body mass index, waist, measurement waist per hip ratio, body fat, muscle weight and abdominal fat tissue(intra abdominal distance). The Experimental group, which was composed of 29 participants, was educated based on a life style modification protocol at a weekly meeting for 12 weeks and carried out exercise, diet along individual parameters and self monitoring, while 24 participants in the control group received only diet education.

Result

1.The experimental group showed a significant lower a.c.(t=2.11, p=.04) and HbA₁c(t=2.65, p=.01) compared to those of the control group. 2. The experimental group showed a significant lower LDL than the results of the control group(t=2.42, p=.02). 3. The experimental group showed a significant lower weight(t=3.09, p=.00), BMI(t=3.01, p=.00), body fat(t=2.94, p=.01) and abdominal fat tissue(t=3.05, p=.01) than those of the control group.

Conclusion

The results provided evidence for the effectiveness of a short term comprehensive life style modification program composed of exercise, diet, support, self efficacy elevation and self monitoring in type 2 diabetes mellitus.

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Literature Review on Lifestyle Intervention Program for Adults in Korea
Keun-Young Yang
Journal of Digital Contents Society.2023; 24(8): 1815. CrossRef
Blood Biochemical Characteristics, Dietary Intake, and Risk Factors Related to Poor HbA1c Control in Elderly Korean Diabetes Patients: Comparison between the 4th(2007-2009) and the 7th(2016-2018) Korea National Health and Nutrition Examination Surveys
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Korean Journal of Community Nutrition.2022; 27(5): 406. CrossRef
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Tae-Jeong Bae, Na-Eun Jeon, Soo-Kyong Choi, Jung-Sook Seo
Korean Journal of Community Nutrition.2020; 25(3): 214. CrossRef
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Hae Jin Kang
The Journal of Korean Diabetes.2018; 19(2): 106. CrossRef
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Hyoung Sook Park, Kyoungnam Kim
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Il Sun Ko, Tae Hwa Lee, Gwang Suk Kim, Se Won Kang, Mi Ja Kim
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Dong Hoon Lee, Seung Hwan Lee, Kiyong An, Jin Young Moon, So Hun Kim, Yoon Jin Choi, Moonsuk Nam, Justin Y. Jeon
The Korean Journal of Obesity.2011; 20(3): 147. CrossRef
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Ji-Soo Yoo, Suk-Jeong Lee, Hyun-Chul Lee, Mi-Ja Kim
Asian Nursing Research.2007; 1(2): 106. CrossRef

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Structural Equation Modeling on Self-Care Behavior and Quality of Life in Older Adults with Diabetes Using Citizen Health Promotion Centers: Songheun Lee, Hyunli Kim; J Korean Acad Nurs 2017;47(4):514-525. Published online January 15, 2017; DOI: https://doi.org/10.4040/jkan.2017.47.4.514

Abstract PDF

Abstract Purpose

The purpose of this study was to construct and test a structural equation model for Diabetes self-management (DSM) behavior and Quality of life (QoL) in older adults with diabetes who use Citizen Health Promotion Centers. The theory used this study was a combination of the Information-Motivation-Behavioral Model (IMB) and Self-Determination Theory (SDT) to reflect autonomous characteristics of participants.

Methods

Data were collected from April 20 to August 31, 2015 using a self-report questionnaire. The sample was 205 patients with type 2 Diabetes who regularly visited a Citizen Health Promotion Center. SPSS 22.0 and AMOS 22.0 programs were used to analyze the efficiency of the hypothesized model and calculate the direct and indirect effects of factor affecting the participants’ DSM behavior and QoL.

Results

The supported hypotheses were as follows; 1) The variable that had a direct effect on QoL was health behavior adherence (γ=.55, p=.007). 2) The variables that had a direct effect on DSM behavior were DSM information (γ=.15, p=.023), DSM confidence (γ=.25, p<.001), and autonomous motivation (γ=.13, p=.048). 3) The variable that had a direct effect on DSM confidence was autonomy support (γ=.33, p<.001).

Conclusion

The major findings of this study are that supporting patient's autonomous motivation is an influential predictor for adherence to DSM behavior, and integrative intervention strategies which include knowledge, experience and psychosocial support are essential for older adults with diabetes to continue DSM behavior and improve QoL.

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Factors Influencing Physical Activity among Community-dwelling Older Adults with Type 2 Diabetes: A Path Analysis: Sun Joo Jang, Hyunju Park, Hyunjung Kim, Sun Ju Chang; J Korean Acad Nurs 2015;45(3):329-336. Published online June 30, 2015; DOI: https://doi.org/10.4040/jkan.2015.45.3.329

Abstract PDF

Purpose

The purpose of the study was to identify factors influencing physical activity among community-dwelling older adults with type 2 diabetes. The study design was based on the Theory of Triadic Influence.

Methods

A total of 242 older adults with type 2 diabetes participated in this study. Six variables related to physical activity in older adults, including self-efficacy, social normative belief, attitudes, intention, experience, and level of physical activity, were measured using reliable instruments. Data were analyzed using descriptive statistics, Pearson's correlation analyses, and a path analysis.

Results

The mean physical activity score was 104.2, range from zero to 381.21. The path analysis showed that self-efficacy had the greatest total effect on physical activity. Also, experience had direct and total effects on physical activity as well as mediated the paths of social normative beliefs to attitudes and intention to physical activity. These factors accounted for 10% of the total variance, and the fit indices of the model satisfied the criteria of fitness.

Conclusion

The findings of the study reveal the important role of self-efficacy and past experience in physical activity in older adults with type 2 diabetes.

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Trend Analysis in the Prevalence of Type 2 Diabetes According to Risk Factors among Korean Adults: Based on the 2001~2009 Korean National Health and Nutrition Examination Survey Data: Young-Ju Kim, Myoung-Nam Lim, Dong-Suk Lee; J Korean Acad Nurs 2014;44(6):743-750. Published online December 31, 2014; DOI: https://doi.org/10.4040/jkan.2014.44.6.743

Abstract PDF

Purpose

The objective of this study was to provide a trend analysis of the prevalence of diabetes relative to the socioeconomic, lifestyle, and physiologic risk factors among Korean adults aged over 30 years for a 10-year period using data from the Korean National Health and Nutrition Examination Survey.

Methods

Prevalence difference and the slope index of inequality were calculated for each risk factors using binomial regression by considering the repeated cross-sectional features of the data. The prevalence ratio and the relative index of inequality were calculated using log-binomial regression. Linear trend tests were performed using SAS 9.2.

Results

Crude prevalence of diabetes increased over the 10-year period, and was higher for men than for women. It was very high for adults 60 years or over, consistently increasing over time. The prevalence among unemployed men, women with higher level of stress, women with hypertension, and adults with serum triglyceride levels over 135 mg/dL increased over the 10-year period in comparison with the respective control group.

Conclusion

Considering the rapid economic development and associated lifestyle changes in Korea, action should be taken to control the prevalence of diabetes by both preventing and consistently monitoring these identified risk factors using a public-health approach.

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A Predictive Model on Self Care Behavior for Patients with Type 2 Diabetes: Based on Self-Determination Theory: Yeong Mi Seo, Won Hee Choi; J Korean Acad Nurs 2011;41(4):491-499. Published online August 31, 2011; DOI: https://doi.org/10.4040/jkan.2011.41.4.491

Abstract PDF

Purpose

The study was conducted to develop and test a hypothetical model which explains self-care behavior in patients with type 2 diabetes was established based on the Self-Determination Theory.

Methods

The participants were 218 patients with type 2 diabetes mellitus enrolled in an outpatient clinic of one endocrine center in Korea. The data were collected using questionnaires from April 5 through May 7, 2010. The descriptive and correlation statistics were analyzed using the SPSS/WIN 15.0 and the structural equation modeling procedure was performed using the AMOS 7.0 program.

Results

The results of this study showed that competence and autonomous motivation were the strong factors influencing self-care behavior in patients in this sample. Support from health provider for autonomy was a significant indirect factor on self-care behavior. These factors explained 64.9% of variance in the participants' self care behavior. The proposed model was concise and extensive in predicting self-care behavior of the participants.

Conclusion

Findings may provide useful assistance in developing effective nursing interventions for maintaining and promoting self-care behavior in patients with type 2 diabetes.

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The Effects of Tailored Diabetes Education on Blood Glucose Control and Self-Care: Kyung Sun Hyun, Kwang Mi Kim, Sook Hee Jang; J Korean Acad Nurs 2009;39(5):720-730. Published online October 31, 2009; DOI: https://doi.org/10.4040/jkan.2009.39.5.720

Abstract PDF

Purpose

The purpose of this study was to test the effects of tailored diabetic education on blood glucose control and self-care for patients with type 2 diabetes on insulin therapy.

Methods

The participants were 60 patients (experimental group: 30, control group: 30) with type 2 diabetes on insulin therapy. The patients were being seen at a university hospital in Seoul, Korea. Group diabetic education and tailored diabetic education were given to the experiment group while group diabetic education only was given to the control group. Data were collected before and three months after the education. χ² test, t-test, and ANCOVA were used to analyze the data.

Results

No significant differences in postprandial (PP2hrs) glucose and HbA1c levels were found between the two groups. Participants in the experiment group showed statistically significant differences in the area of self-glucose test, management of insulin injection, and life style change compared to those in the control group.

Conclusion

The results indicate that tailored education for patients with diabetes on insulin therapy improve self-glucose test, management of insulin injection, and life style. Therefore it is suggested that tailored education can be applied in diabetic education to improve self-care.

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The Effects of a Comprehensive Life Style Modification Program on Glycemic Control and Stress Response in Type 2 Diabetes: Ji Soo Yoo, Eun Jung Kim, Suk Jeong Lee; Journal of Korean Academy of Nursing 2006;36(5):751-760. Published online August 31, 2006; DOI: https://doi.org/10.4040/jkan.2006.36.5.751

Abstract PDF

Purpose

This study was to evaluate the effects of a comprehensive life style modification program on glycemic control and stress response in type 2 diabetes.

Method

The participants(n=34) with type 2 diabetes were divided into either a usual care(control) or treatment(experimental) group. The experimental group(n=21) received a program that was based on a comprehensive life style modification protocol at a weekly meeting for 16 weeks. They also participated in individually prescribed exercise and diet along with stress management and self monitoring. The participants were followed for 6 months, during which postprandial glucose, HbA_1C, and stress response inventory were measured.

Result

The experimental group showed a significant lower postprandial glucose and stress response compared to those of the control group. However, there was no significant change in the HbA_1C value in either group.

Conclusions

These results suggest that a type 2 diabetes comprehensive lifestyle modification program may lead to clinical improvement in glycemic control and reduce the stress response.

Citations

Citations to this article as recorded by

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