The Effect of a Patient Activation Tailored Intervention on Type 2 Diabetes Self-Management and Clinical Outcomes: A Study from Saudi Arabian Primary Care Settings
Nasser Almutairi, Vinod Gopaldasani, Hassan Hosseinzadeh
Abstract
Background. Type 2 diabetes mellitus (T2DM) is a global public health challenge. T2DM self-management, including diet, physical activity, blood glucose self-monitoring, foot care, and adherence to medication, is considered a primary tool for managing diabetes. Patient activation, an individual’s knowledge, skill, and confidence in managing their health and healthcare, was recognized to be associated with better T2DM self-management and clinical outcomes. Patient activation intervention has been described as a potential approach for enhancing chronic disease self-management. This study is aimed at examining the effect of a patient activation-tailored intervention on T2DM self-management and clinical outcomes in primary care settings in Saudi Arabia. Method. A pre- and postintervention study was conducted among ≥18 years old T2DM patients attending primary healthcare centers in Saudi Arabia. Collected data included demographics, clinical data, the Patient Activation Measure (PAM), the Summary of Diabetes Self-Care Activities (SDSCA), the diabetes knowledge test (DKT2), the problem area in diabetes test (PAID-5), and the diabetes quality of life test (DQOL). The intervention was tailored based on the participants’ patient activation level. The intervention consisted of monthly face-to-face sessions for three months and a telephone follow-up per month for three months postintervention. Descriptive statistics, a paired sample <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mi>t</a:mi> </a:math> -test for scale variables, and Wilcoxon’s signed-rank test for categorical variables were used for data analysis. Results. A total of 82 patients, mostly female (61%) with a mean age of <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mn>51.3</c:mn> <c:mo>±</c:mo> <c:mn>9.9</c:mn> </c:math> years old, completed baseline and postintervention surveys. After six months of intervention, there was a significant change in patient activation score from 54.74 to 61.58 ( <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mi>p</e:mi> <e:mo><</e:mo> <e:mn>0.001</e:mn> </e:math> ), hemoglobin A1c (HbA1c) from 8.38 to 7.55 ( <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mi>p</g:mi> <g:mo><</g:mo> <g:mn>0.001</g:mn> </g:math> ), and body mass index (BMI) from 30.90 to 29.16 ( <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"> <i:mi>p</i:mi> <i:mo><</i:mo> <i:mn>0.001</i:mn> </i:math> ). Also, there was a significant change in SDSCA scores (diet from 3.12 to 3.67, exercise from 2.54 to 3.49, and blood glucose self-testing from 2.37 to 3.24) ( <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M6"> <k:mi>p</k:mi> <k:mo><</k:mo> <k:mn>0.001</k:mn> </k:math> ) and DKT from 6.29 to 7.22 ( <m:math xmlns:m="http://www.w3.org/1998/Math/MathML" id="M7"> <m:mi>p</m:mi> <m:mo>=</m:mo> <m:mn>0.01</m:mn> </m:math> ). Conclusion. Our findings suggested that tailoring interventions based on patients’ activation levels is more likely to yield promising T2DM self-management and clinical outcomes.