Family Nursing and Disease Control in Adults with Diabetes

1. Family Nursing and Disease Control in Adults with Diabetes Babak Motamedi, RN, DNSc Faculty of Nursing, Islamic Azad University Dehaghan Branch, Dehaghan, Iran,

2. Azad University, DehaghanBranch, Isfahan

3. Introduction: • There is a growing recognition in Nursing, of the importance of the patients’ social context in enabling them to manage their chronic illnesses effectively. • In Diabetes research, studies have focused on the effects of the family milieu of a child with diabetes on his or her adherence to the insulin, diet, and activity regimen, to glycemic control, and to emotional adaptation. • Several cross-sectional studies report that poor glycemic control is associated with poor family functioning. • Two longitudinal studies have confirmed this finding, while one found no such relationship. • Working with adolescents, demonstrated the complexity of the relationship between family function and glycemic control.

4. Introduction (con) • When simple correlations were examined, good glycemic control was associated with high family cohesion, flexibility, and high marital satisfaction. • When the duration of disease was controlled, these relationships decreased significantly and only held for patients with short disease duration. • There are only a few studies that have investigated the relationship of family environment to outcome for adults with diabetes.

5. Research Questions: • Whether glycemic control is related to family system variables in adults with diabetes? • Whether psychosocial adaptation is related to family system variables in adults with diabetes?

6. This study will be introduced some useful measurement tools facilitating nursing interventions and outcomes for insulin- treated adults with diabetes

7. Research Design and Methods • One hundred and fifty subjects were recruited from adults with diabetes being treated at two sites. • Only subjects currently on an insulin regimen were included in order to minimize potential effect of type of treatment. • The subjects completed questionnaires after their visit or at home and returned them by mail.

8. Demographic data The patients' medical charts provided information on age, sex, type of diabetes, duration of diabetes, and number of diabetes related medical complications (eye problems/retinopathy, kidney disease, foot infections, amputations, heart problems, stroke, and numbness/neuropathy).

9. Chehelsoton Palace, Isfahan

10. > 18 years of age Diagnosed with diabetes for > 1 year No current Psychiatric disorder Able to read the forms Able to provide written informed consent ٭ ٭ ٭ ٭ ٭ Subjects were included if they were :

11. Social and demographic characteristics of subjects ( eye problems / retinopathy / kidney disease / foot infections / amputations / heart problem / stroke / neuropathy )

12. Metabolic control Method • Metabolic control was determined by measuring glycated hemoglobin levels (HbA1c), using the Abbot IMX glycated hemoglobin Assay. • HbA1c values reflect the average blood glucose over the preceding 3 months and is widely accepted as a reliable and valid index of metabolic control. This test was completed as a routine part of their clinic visit.

13. Glycemic Control ( HbAIC levels) of subjects

14. Study Questionnaires • Family System Measures • Psychosocial adaptation Measures

15. Quality of life measures Cognitive appraisal Family System Measures Family Environment Scale (FES ) Diabetes family Behavior Checklist (DFBC ) Psychosocial adaptation Measures Diabetes Quality Of Life ( DQOL ) Medical Outcomes Study Health Survey ( SF_36 ) Well _ Being Questionnaire ( WBQ ) Appraisal Of Diabetes Scale ( ADS )

16. Family System Measures 1- Family Environment Scale ( FES ) 90 – item FES , measures family interaction and communications Developed by Moos 1981 18 items of the cohesion and conflict subscales were examined Test – retest reliabilities 0.68_ 0.86 Use in Researches on Breast cancer, Renal disease , Low back pain Subjects indicate that statements are true or false about their families, such as: Family members really help and support one another We fight a lot in our family

17. Family System Measures 2 – Diabetes Family Behavior Checklist ( DFBC ) 16 item DFBC Developed by Schafer ( 1986 ) Measures supportive and non supportive family behavior specific to diabetes Test – retest value 0.84 _ 0.69 Subjects rate how often a particular family member will for example : Praise you following your Diet ? Criticize you for not exercising regularly ?

18. Psycho Social adaptation 1 – Diabetes Quality Of Life Scale ( DQOL ) 46 item Developed by Jacobson ( 1988 ) Assesses four aspects of quality of life specific to diabetes include : For example, subjects rate how satisfied they are "with the amount of time it manage your diabetes" and how often they worry "about whether you will miss work Test – retest reliabilities 0.80 to 0.90 Diabetes Satisfaction , Diabetes Impact , Diabetes Worry . Social Worry

19. Psycho Social adaptation 2 – Medical Outcomes Study Health Survey ( SF_ 36 ) 36 item Assesses Six domains of functional health status include : It has been Studied with chronic illness population (arthritis, Heart disease ) Test – retest reliabilities 0.88 to 0.81 and good correlations with other general quality of life measures support its validity. Physical functioning , role functioning physical . Bodily pain . General health , vitality , Social functioning , role functioning

20. Psycho Social adaptation 3 – Well _ Being Questionnaire ( WBQ ) Subjects completed the 12 items of the anxiety and depression subscales of the WBQ Assesses Anxiety and depression (measure of affect) Bradley ( 1994 ) Internal Consistencies 0.64 to 0.74 Subjects rate haw frequently, for example : Feel that I am useful and needed Have felt nervous and anxious

21. Psycho Social adaptation 4 - Appraisal of Diabetes Scale ( ADS ) Carey 1991 7 item ADS Measuring the individuals appraisal of the illness in terms of his or her thoughts about diabetes Internal Consistencies 0.73 For example, Subjects rate : How effective are you in coping with your diabetes ? How much control over your diabetes do you have?

22. Statistical Analysis Descriptive statistics provided information on all variable The Development of models to explore the interrelationships of the variables employed Forward stepwise regression techniques. Variables were entered the model if they met a 0.1500 significance level F Values were computed for differences among the group Data was analyzed using SAS version 6.04 for windows P < 0.05 for acceptance

23. Stepwise regression analyses examining the effect of family environment and individual appraisal on glycemic control ( HBAIC ) Independent Probability *Significant at P < 0.05 ∂ , not significant at the 0.1500 level to permit entry into the model . Model R2 occur when the relevant independent variable ( e.g. DFBC positive ) is added to the model. Which Includes age and duration of diabetes . F test and Significant level are independent variable is added to the model .

24. Stepwise regression analyses examining the effect of family environment and individual appraisal on psychosocial adaptation ( DQOL ) ∂, not Significant at the 0.1500 level to permit entry into the model *P<0.05 , +P<0.001 . Model R2 occurs when the relevant independent variable (e.g. DFBC positive ) is added to the model , which includes age , duration of diabetes , sex , and number of complication . F test and significant level are indicated for the change in variance when the index is added to the model .

25. Stepwise regression analyses examining the effect of family environment and individual appraisal on psychosocial adaptation ( SF - 36 ) Model R2 Model R2 Model R2 Model R2 Model R2 Model R2 Model R2 ∂, not Significant at the 0.1500 level to permit entry into the model *P<0.05 , +P<0.001 . Model R2 occurs when the relevant independent variable (e.g. DFBC positive ) is added to the model , which includes age , duration of diabetes , sex , and number of complication . F test and significant level are indicated for the change in variance when the index is added to the model .

26. Results • 1-No Direct relationship between glycemic control and family System Variables. (FES,DFBC) • 2-When Family support the Diabetes regimen the patients is more satisfied with varied aspects of their own adaptation to the illness. • 3-More positive Family behavior, less effect of pain and better emotional role. • 4-Higher Family Cohesion reported less depression, less Anxiety, higher levels of physical function. • 5-Age is strong predictor of diabetes worry. • 6-Older individuals reported poorer physical and role function(sf-36). • 7-Diabetes in longer period reported more disease impact (DQOL). • 8-Women reporting a higher level of satisfaction in treatment, Diet, body appearance, life activity and vitality.

27. Conclusions • For insulin-treated adults with diabetes, family System Variables do not relate to glycemic control, but they do relate to psychosocial adaptation. • Future work should explore the impact of family-centered interventions on adaptation and sex differences in adaptation.