Improving Glycemic Control in Older Adults Using a Videophone Motivational Diabetes Self-Management Intervention
Hawkins, Shelley Y., Research and Theory for Nursing Practice
Older adults experience the greatest burden of diabetes. Resources must be available and accessible to empower older adults to perform diabetes self-care. The purpose of this study was to evaluate a videophone motivational interviewing (MI) diabetes self-management education (DSME) intervention to improve glycemic control of rural older adults. Sixty-six participants (mean age = 64.9 years, range 60-81) with uncontrolled diabetes were enrolled in a 6-month videophone intervention. Experimental group participants (n = 34) received weekly, then monthly, videophone MI DSME calls, whereas control participants (n = 32) received monthly videophone healthy-lifestyle education calls. Although both groups experienced a decreased HbA1c, there was a statistically significant difference in experimental group mean values (p = .015), but not the control group (p = .086). The experimental group demonstrated statistically significant increases in diabetes knowledge (p = .023) and diabetes self-efficacy (p = .002). Experimental group participants with high self-efficacy in contrast to low self-efficacy had a statistically significant decrease in HbA1c (p = .043).
Keywords: diabetes self-management ; telehomecare ; motivational intervention ; videophone
Type 2 diabetes mellitus (T2DM) is emerging as a public health epidemic of the 21st century, with approximately 17 million persons affected in the United States ( American Diabetes Association [ADA], 2010 ). Older Americans experience the greatest burden of diabetes. Currently, 12.2 million or 23.1% of adults aged 60 and older are living with the disease (ADA, 2010). Diabetes self-management education (DSME) is a critical part of diabetes care and must be ongoing to facilitate the knowledge, skill, and ability necessary for diabetes self-care ( Funnell et al., 2008 ). However, the majority of DSME programs are delivered in an episodic way with limited follow-up resulting in short-term diabetes-related health improvements ( Osborn & Fisher, 2008 ). Like all patients, older adults need participatory patientcentered interventions that provide ongoing diabetes self-management support (DSMS) to facilitate long-term management ( Funnell et al., 2008 ). Furthermore, DSME resources must be readily available and accessible for older adults. This requires health care providers to explore acceptable alternative delivery systems that empower older adults to perform diabetes self-care ( Bowles & Horowitz, 2008 ; Wakefield et al., 2008 ).
Evidence exists that glycemic control can significantly delay the development of and/or reduce the risk of long-term complications associated with T2DM ( Holman, Paul, Bethel, Matthews, & Neil, 2008 ; Skyler et al., 2009 ). DSME is foundational for achieving glycemic control and preventing or delaying the onset of complications by improving patient self-care behaviors ( Stettler et al., 2006 ; UKPDS, 1998 ). However, health-related improvements from DSME programs do not persist over the long term without ongoing follow-up interventions ( Heisler & Resnicow, 2008 ). Initial improvements in metabolic and behavioral outcomes diminish approximately after 6 months from lack of self-management (ADA, 2010). At intervals longer than 12 months, there have been reports of decline of more than 50% of knowledge learned ( Grover, Kozik, & Fogelfeld, 2007 ; Tang et al., 2005 ).
DSME programs have traditionally approached diabetes as a physical illness rather than biopsychosocial, whereby education is initially delivered following diagnosis and episodically following a health crisis precipitated by poor glycemic control (Anderson & Funnell, 2008). The health care provider is the problem solver and identifies the patient's learning needs, while the patient remains passive and powerless. Standardized brochures, videotapes, and other educational resources are used with all patients regardless of age, gender, culture, or functional abilities ( Leeman, Skelly, Burns, Carlson, & Soward, 2008 ). …