Integrative Review of Self-Care Measurement in Diabetes Nephropathy

Sunday, 30 July 2017

Younghee Jun, MSN1
Jeonghwa Cho, MSN1
Keumok Park, MSN2
Youngshin Song, PhD2
(1)College of Nursing, Chungnam National University, Deajeon, Korea, Republic of (South)
(2)College of Nursing, Chungnam National University, Daejeon, Korea, Republic of (South)

Purpose: According to the International Diabetes Federation (IDF) Diabetes Atlas, 415 million people have diabetes mellitus (DM) in 2015. Along with increasing number of diabetes prevalence, its complications are also currently increasing. Among diabetes complications, the rate of prevalence for nephropathy was 30- 40 % of diabetes patients in literature. For controlling the diabetes nephropathy (DN), patients should have the complicated self-care competence. The self-care for DN should be included the proper behaviors not only to control their glucose level, but also to manage their kidney dysfunction. Lots of patients have experienced the difficulties for managing those complicated situations. For example, studies reported that diabetes patients have confused of what kinds of food they can eat during hemodialysis. As such, self-care management for diet, physical activity, glucose monitoring, and medications according to changing their diabetes progress should be monitored and educated by health care providers. However, lots of studies have researched the DN self-care behavior as measuring the diabetes focused self-care behaviors. For better understanding the research trend in terms of measuring tool for assessing the DN self-care behaviors, integrative review is needed. Thus, this purpose of this study was to describe self-care research related to diabetic nephropathy patients and to analyze instrument for measurement of self-care. The findings from this review can be provided the information on what kinds of measurement the studies were used for DN and what limitations those instruments.

The review questions were as follows;

Q1) How many studies were focused on self-care behavior for DN, and what study characteristics they reported

Q2) What kinds of instruments they used for measuring the self-care for DN?

Methods: Literature search was conducted using computerized databases such as Pubmed, CINAHL, Embase, and Cochrane (2005-2016). The search terms of this study were “diabetes mellitus”, “Self-Care”, and “Kidney disease”. The inclusion criteria were studies of self-care for DN, English literatures, and qualitative studies. If the studies designed using qualitative method, systematic review and meta-analysis, non-English paper, non-original study, and non-human sample, those studies were excluded. The literatures were searched by two researchers independently. The coding schemes for study consist of two folds such as population characteristics (sample size, age distribution, gender, clinical status, etc.) and study characteristics (design, instrument, main variables and its outcomes, methodological quality level, etc). Two researchers were coded those information from individual studies independently. The discrepancies in coding schemes between two coders were resolved by principal investigator.

Results: Q1 How many studies were focused on self-care behavior for DN, and what study characteristics they reported?

Total 1135 articles were reviewed the titles and abstracts. Of total, 939 studies were excluded because they were duplicated and did not meet the inclusion criteria. In the next step, 183 studies were excluded during full text review because the removed studies mentioned the concept of self-care without tools and some studies were not original papers. Thus, 13 studies were selected for final analysis.

The 6 studies out of 13 were cross-sectional design, and 4 studies were experimental design. The remained 2 studies were case study and mixed method study. The number of studies that included only DN patients was 8 articles. The numbers of sample size in 6 studies were less than 100, whereas the four studies were from 100 to 200. In remained three studies, more than 200 participants were recruited for study. Various academic areas such as Nursing, Medical, Pharmacology and Psychology were involved in studies. In 13 studies, the clinical factors such as biochemical results (BUN, Cr, HbA1c, etc.) and psycho-cognitive-emotional variables (self-efficacy, quality of life, knowledge of disease, self-management capacity, depression, feeling of loneliness, hopelessness, etc.) were used.

Q2) What kinds of instruments they used for measuring the self-care for DN?

Twelve instruments for measuring self-care behaviors in DN were found. Summary of Diabetes Self-Care Activities (SDSCA) revised instrument was used in five studies. The Self-Management Capacities Scale (SMCS), Dialysis Diet, and Fluid Non-Adherence Questionnaire (DDFQ) were used in 2 studies. The Morisky Medication Adherence Scale (MMAS)-4 items and 8 items (MMAS-8) were also measured in 2 studies for assessing the self-care in DN. Moreover, the Partners In Health (PIH), the cognitive restraint subscale of Three Factor Eating Questionnaire (TFEQ), and Self-care Ability Scale were used in 3 studies. Of total, 10 studies reported the reliabilities of their used self-care instrument, but remained 3 did not report the reliability and validity.

Conclusion:  In this integrative review, relatively small studies (13 studies) during past 10 years were conducted for DN self-care. Included studies were assessing the self-care for DN using non-DN specific instruments. That is, half of studies measured the self-care for DN using diabetes focused instrument, whereas several studies used the self-care instruments that can assess hypertension or kidney disease. Thus, DN specific instrument for measuring the self-care should be developed in future study. The appropriate DN specific self-care instrument will be contributed to measure the complicated self-care behavior in DN, and its information can be help to use for patients education.