Evaluation of group education strategies and telephone intervention for type 2 diabetes

Pereira, Priscila de Faria; Santos, Jéssica Caroline dos; Cortez, Daniel Nogueira; Reis, Ilka Afonso; Torres, Heloisa de Carvalho

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Revista da Escola de Enfermagem da USP

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Sumário

Original Article • Rev. esc. enferm. USP 55 • 2021 • https://doi.org/10.1590/S1980-220X2020002603746 copy

Evaluation of group education strategies and telephone intervention for type 2 diabetes^* * Extraído da dissertação: “Avaliação das estratégias comportamentais de educação em grupo e intervenção telefônica para o diabetes mellitus tipo 2”, Programa de Pós-Graduação, Escola de Enfermagem, Universidade Federal de Minas Gerais, 2019.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To evaluate group education strategies and telephone intervention regarding the variables empowerment, self-care practices, and glycemic control of people with diabetes.

Method:

Clinical trial with eight randomized clusters, conducted between 2015 and 2016, with 208 users with type 2 diabetes mellitus allocated for group education, telephone intervention, or control group. Sociodemographic data, glycated hemoglobin, empowerment, and self-care practices were collected.

Results:

The user mean age was of 63.5 years (SD = 8.9 years), with the participation of 124 women, which amounts to 59.6% of these users. The strategies led to a statistically significant reduction in the levels of glycated hemoglobin (p < 0.001). The telephone intervention was also observed to present statistically significant results regarding self-care practices (p < 0.001) and empowerment in diabetes (p < 0.001) when compared to group education.

Conclusion:

The telephone intervention presented statistically significant results for empowerment and practices of self-care when compared to group education. Brazilian Registry of Clinical Trials (Registro Brasileiro de Ensaios Clínicos): RBR-7gb4wm.

DESCRIPTORS
Health Education; Self Care; Self Efficacy; Diabetes Mellitus; Nursing; Clinical Trial

Variable	Total (n = 208)	CG (n = 89)	GE (n = 57)	TI (n = 62)	P
Age in years (mean±SD)	63.5 ± 8.9	63.7 ± 9.1	63.4 ± 9.7	63.4 ± 7.9	0.9550^† † Kruskal-Wallis test;
Sex (n (%))
Male	84 (40.4)	36 (40.4)	25 (43.9)	23 (37.1)	0.7541^‡ ‡ Chi-squared Test;
Female	124 (59.6)	53 (59.6)	32 (56.1)	39 (62.9)
Education (n (%))
Illiterate	12 (5.8)	7 (7.9)	2 (3.5)	3 (4.8)	0.4047^§ § Fisher’s Exact Test; HbA1c: Glycated Hemoglobin; ESM: Diabetes Mellitus Self-care Questionnaire; Escala de Autoeficácia em Diabetes - Versão curta (EAD-VC).
Primary ed. Incomplete	135 (64.9)	60 (67.4)	33 (57.9)	42 (67.8)
Primary ed. Complete	18 (8.7)	7 (7.9)	4 (7.0)	7 (11.3)
Incomplete secondary education	8 (3.8)	4 (4.5)	3 (5.3)	1 (1.6)
Complete secondary education	23 (11.0)	6 (6.7)	12 (21.0)	5 (8.1)
Incomplete higher education	1 (0.5)	0 (0.0)	0 (0.0)	1 (1.6)
Complete higher education	11 (5.3)	5 (5.6)	3 (5.3)	3 (4.8)
Marital status (n (%))
With partner	131 (63.0)	57 (64.0)	36 (63.2)	38 (61.3)	0.9418^‡ ‡ Chi-squared Test;
No partner	77 (37.0)	32 (36.0)	21 (36.8)	24 (38.7)
Profession (n (%))
Active	51 (24.5)	22 (24.7)	15 (26.3)	14 (22.6)	0.8926^‡ ‡ Chi-squared Test;
Inactive	157 (75.5)	67 (75.3)	42 (73.7)	48 (77.4)
Time with the Disease (n (%))
0 to 5 years	67 (32.2)	33 (37.1)	12 (21.1)	22 (35.5)	0.3375^‡ ‡ Chi-squared Test;
6 to 10 years	59 (28.4)	23 (25.8)	19 (33.3)	17 (27.4)
Over 10 years	82 (39.4)	33 (37.1)	26 (45.6)	23 (37.1)
Comorbidities (n (%))
Yes	157 (75.5)	64 (71.9)	47 (82.5)	46 (74.2)	0.3384^‡ ‡ Chi-squared Test;
No	51 (24.5)	25 (28.1)	10 (17.5)	16 (25.8)
Income in m.w. ^* * minimum wages; (mean±SD)	1.49±0.9	1.52±1.1	1.53±0.9	1.42±0.6	0.7777^† † Kruskal-Wallis test;
HbA1c		8.0 (5.1-14.2)	7.7 (5.4-11.9)	8.1 (5.6-13.7)	0.2077^† † Kruskal-Wallis test;
ESM		3.6 (1.0-5.9)	3.5 (1.5-5.6)	3.5 (1.8-5.4)	0.8475^† † Kruskal-Wallis test;
EAD-VC		31.0 (23-37)	31.0 (26-40)	31.0 (14-35)	0.2627^† † Kruskal-Wallis test;

Variable	Control Group			Group Education			Telephone Intervention
Variable	Before	After	p	Before	After	P	Before	After	P
HbA1c	8.0 (5.1-14.2)	8.3 (5.5-16.3)	0.132^* * Wilcoxon Test;	7.7 (5.4-11.9)	6.9 (5.2-11.2)	0.003^* * Wilcoxon Test;	8.1 (5.6-13.7)	7.3 (5.5-12.4)	< 0.001^* * Wilcoxon Test;
ESM	3.6 (1.0-5.9)	2.5 (0.8-5.2)	< 0.001^* * Wilcoxon Test;	3.5± 0.99	3.4± 1.1	0.786^† † Paired t Test.	3.6± 0.973.56	4.2± 1.146.21	< 0.001^† † Paired t Test.
EAD-VC	31.0 (23-37)	30.0 (21-40)	0.836^* * Wilcoxon Test;	31.4± 2.9	32.2± 3.3	0.211^† † Paired t Test.	31.0 (14-35)	34.0 (24-39)	< 0.001^* * Wilcoxon Test;

Variable	Relative Effect (median, %)			TI x GE x CG	CG x GE	CG x TI	GE x TI
	CG^‡ ‡ Control group;	GE^§ § Group education;	TI^‖ ‖ Telephone intervention.	TI x GE x CG	CG x GE	CG x TI	GE x TI
	n = 89	n = 57	n = 62	p ^* * Kruskall-Wallis test;	p ^† † Dunn Test with p-values adjusted by Bonferroni correction;	p ^† † Dunn Test with p-values adjusted by Bonferroni correction;	p ^† † Dunn Test with p-values adjusted by Bonferroni correction;
HbA1c	2.96	-2.90	-8.80	< 0.001	0.0050	< 0.0010	0.150
ESM	-21.00	0	13.72	< 0.001	0.0002	< 0.0010	0.022
EAD-VC	-2.94	0	9.38	0.001	0.6060	0.0004	0.027

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Heloisa de Carvalho Torres, Av. Alfredo Balena, 190, Santa Efigênia CEP 30130-100 – Belo Horizonte, MG, Brazil heloisa@enf.ufmg.br