People With Diabetes in Indonesia: Exploring Diabetes Care

Friday, 20 July 2018: 10:45 AM

Titan Ligita, MN, BSN1
Kristin Wicking, PhD, MSN, BSN, GradCertEd, RN1
Nichole Harvey, PhD, MNSt, BN, GradCertEd, RN, RM, CritCareCert2
Intansari Nurjannah, PhD, MNSc, BSN3
Karen Francis, PhD4
(1)Nursing, Midwifery and Nutrition; College of Healthcare Sciences, James Cook University, Townsville, Australia
(2)Medicine; College of Medicine and Dentistry, James Cook University, Townsville, Australia
(3)School of Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
(4)College of Healthcare Sciences, James Cook University, Townsville, Australia

Purpose: The aim of this study was to generate a theory of the process of health education for people living with diabetes in Indonesia. This grounded theory study sought to answer the following research question: How do people with diabetes in Indonesia learn about their disease?

Methods: This study employed a grounded theory methodology influenced by symbolic interactionism and constructivism. Researchers will effectively employ appropriate research designs that reflect their own viewpoints about reality and the research methodology adopted (Birks, 2014). Methodologically, the use of constructivist grounded theory underpinned by symbolic interactionism has been popular among nurse researchers as this design allows them to understand participants’ attitudes and experiences while also explicating the process used in providing health care (Higginbottom and Lauridsen, 2014). A total of 28 audio-recorded interviews with 26 participants, 270 pages of interviews transcript, 114 memos and 46 field notes were collected and generated. Three phases of data collection were undertaken. The first two phases involved face to face semi-structured interviews in Indonesia, specifically West Kalimantan province, that has a notably high diabetes prevalence rate (National Institute for Health Research and Development, 2013). Seven participants (a person with diabetes, a nurse academic, two nurse clinicians, a specialist doctor, a pharmacist and a dietician) were interviewed in the first phase. The second phase involved interviews with 17 participants (eight people with diabetes, a nurse, a general practitioner, a student nurse, three relatives of people with diabetes, a hospital health promotion officer, a kader (a lay health worker) and an exercise instructor living with diabetes). The final phase of data collection, which was completed via telephone interviews, involved 4 participants (a person with diabetes, an exercise instructor living with diabetes and a nurse academic and a nurse clinician). Interview data was supplemented with memos and field notes. Data were analysed using the constant comparative data technique that is a feature of grounded theory methodology.

Results: The research realised a theory entitled ‘exploring diabetes care’. This theory reflects the basic social process of how people with diabetes in Indonesia learn about their disease. The process of ‘exploring diabetes care’ includes five distinct categories: ‘seeking and obtaining advice and explanation’; ‘processing received information’; ‘responding to recommendations’; ‘appraising the results’; and ‘sharing with others’. All five categories have dynamic movement; both linear and cyclical. ‘Seeking and obtaining advice and explanation’ is defined as people with diabetes actively seeking and passively acquiring health information related to diabetes that was accessed from different places and sources. Once people with diabetes received advice and explanation, they then processed the advice and explanation by sifting and trusting. The processed advice and explanations included the recommendations offered, which needed to be selected. ‘Responding to recommendations’ means that people with diabetes made a decision about what to do. There were two ways of responding to recommendations: not following and following recommendations. Factors of physiology, psychology and resources influenced the people to act toward the recommendations. People with diabetes demonstrated their diverse health practices in applying a recommended therapy or diabetes care management. ‘Appraising the results’ refers to people with diabetes evaluating their chosen actions of following or not following. Further actions were then decided, based on their evaluation. The actions of appraising the results produced experiential insight. People with diabetes used experiential insight as received information and then made decisions to continue or to discontinue the previously applied recommendation/s. Then, they either choose to follow another previously known recommendation; or else they seek out other recommendations not previously considered. The last category, ‘sharing with others’, refers to the sharing of experiences, be it positive or negative, as a result of followed or not followed recommendations. This sharing of information occurs between the person with diabetes and their family, friends, health professionals and other people with diabetes. People experience the consequences of their actions. Satisfaction and dissatisfaction may result as an outcome of the choices made that can influence behaviour: to act or to refrain (Bandura, 1997). As diabetes management is both determined by its efficacy and is personally associated with individuals, then people’s values and beliefs will also influence the diabetes management plans that they adopt (Serrano et al., 2016).

Conclusion: People with diabetes can be empowered to adhere to diabetes management plans if self-efficacy is a feature of the care planning process (Bowen et al., 2015). Healthcare professionals including nurses need to work closely with people with diabetes. Establishing rapport, providing information and supporting them to make informed choices are necessary if self-efficacy is to be cultivated and a realistic individualised diabetes management care plan achieved. It is recommended that creative strategies be developed to change current health education and promotion practice that reflects commitment to person centred care.