Educational intervention on insulin knowledge and management at home

Quantitative, before and after study. Participation of 61 people with diabetes mellitus on insulin therapy in a medium-sized municipality in southern Brazil between January and August 2017. For data collection, were used a questionnaire addressing sociodemographic and clinical variables, another questionnaire addressing knowledge about insulin use/management, and a checklist for observation of insulin preparation and administration. The intervention consisted of verbal guidance, insulin management demonstration, supervision of the application technique and delivery of a folder. Data were collected before the intervention and three months after its completion. The MacNemar’s test was applied to evaluate the effect of the intervention.

Results

The intervention was effective in acquisition of knowledge related to the storage, preparation and use of insulin. There was a difference in the frequency of correct answers on the knowledge and administration of insulin before and after intervention and 31 questions were subject to intervention, which was efficient in 96.77% of cases and statistically significant in 80.64%.

Conclusion

There was a significant improvement in knowledge and use/management of insulin after the educational intervention.

Diabetes mellitus; Insulin; Health education; Self care

Question	Performance		p-value^#
	Initial	Final
	n(%)	n(%)
Is able to correctly inform the type of insulin used
Right	32(52.5)	57(93.4)	0.0001*
Wrong	29(47.5)	4(6.6)	0.0001*
Is able to say the type of syringe used
Right	57(93.4)	60(98.4)	0.0833
Wrong	4(6.6)	1(1.6)	0.0833
Is able to inform the size of syringe used
Right	8(13.1)	49(80.3)	0.0001*
Wrong	53(86.9)	12(19.7)	0.0001*
Is able to say how many units correspond to each needle line
Right	9(14.8)	53(86.9)	0.0001*
Wrong	52(85.2)	8(13.1)	0.0001*
Is able to say the needle size
Right	2(3.3)	28(46.0)	0.0001*
Wrong	59(96.7)	33(54.0)	0.0001*
Application sites
Right	61(100)	61(100)	**
Wrong	0(0)	0(0)	**
Rotates application sites
Right	46(75.4)	60(98.4)	0.0002*
Wrong	15(24.6)	1(1.6)	0.0002*
Observes local reaction at application
Right	49(80.3)	54(88.5)	0.0253*
Wrong	12(19.7)	7(11.5)	0.0253*
Place of insulin storage
Right	7(11.5)	44(72.1)	0.0001*
Wrong	54(88.5)	17(27.9)	0.0001*
Insulin transport
Right	17(27.9)	42(68.9)	0.0001*
Wrong	44(72.1)	19(31.1)	0.0001*
Validity of insulin open vial
Right	4(6.6)	50(82.0)	0.0001*
Wrong	57(93.4)	11(18.0)	0.0001*
What is done with the needle before disposal
Right	59(96.7)	61(100)	**
Wrong	2(3.3)	0(0)	**
Reuses the needle
Right	2(3.3)	9(14.7)	0.0082*
Wrong	59(96.7)	52(85.3)	0.0082*
Material disposal location
Right	20(32.8)	51(83.6)	0.0001*
Wrong	41(67.2)	10(16.4)	0.0001*
Suitable container for carrying needles/sharp objects to the Health Center^##
Right	16(80.0)	50(98.0)	0.0455*
Wrong	4(20.0)	1(2.0)	0.0455*

Question	Performance		p-value^#
	Initial	Final
	n(%)	n(%)
Handwashing
Right	36(59.0)	56(91.8)	0.0001*
Wrong	25(41.0)	5(8.2)	0.0001*
Leaves Insulin out of the fridge before application
Right	3(4.9)	52(85.2)	0.0001*
Wrong	58(95.1)	9(14.8)	0.0001*
Observes the liquid
Right	13(21.3)	35(57.4)	0.0001*
Wrong	48(78.7)	26(42.6)	0.0001*
Shakes the vial to mix contents
Right	50(82.0)	61(100)	**
Wrong	11(18.0)	0(0)	**
Cleans the rubber of the vial with alcohol
Right	1(1.6)	40(65.6)	0.0001*
Wrong	60(98.4)	21(34.4)	0.0001*
Injects air into vial before aspirating
Right	1(1.6)	34(55.7)	0.0001*
Wrong	60(98.4)	27(44.3)
Positions the vial upside down
Right	57(93.4)	61(100)	**
Wrong	4(6.6)	0(0)	**
Insulin NPH and insulin regular aspiration sequence^##
Right	3(33.3)	8(88.9)	0.0253*
Wrong	6(66.7)	1(11.1)
Draws air bubbles from syringe
Right	51(83.6)	59(96.7)	0.0047*
Wrong	10(16.4)	2(3.3)	0.0047*
Sets the dose after removing air bubbles
Right	49(80.3)	56(91.8)	0.0082*
Wrong	12(19.7)	5(8.2)	0.0082*
Recaps needle until application
Right	13(21.3)	32(52.5)	0.0001*
Wrong	48(78.7)	29(47.5)	0.0001*
Cleans skin with alcohol
Right	14(22.9)	59(96.7)	0.0001*
Wrong	47(77.1)	2(3.3)	0.0001*
Pinches the skin adequately
Right	29(47.5)	58(95.1)	0.0001*
Wrong	32(52.5)	3(4.9)	0.0001*
Inserts the needle at a straight angle (90°)
Right	54(88.5)	61(100)	**
Wrong	7(11.5)	0(0)	**
Waits 5 seconds after injection with syringe plunger pressed to remove needle from skin
Right	1(1.6)	50(82.0)	0.0001*
Wrong	60(98.4)	11(18.0)	0.0001*
Does not rub the skin after application
Right	43(70.5)	59(96.7)	0.0001*
Wrong	18(29.5)	2(3.3)	0.0001*

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author Pamela dos Reis E-mail: pamdosreis@gmail.com