الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Diabetic retinopathy is the most common ophthalmic complications of diabetes mellitus and is one of the leading causes of vision impairment and vision loss among adults. The severity and progression of diabetic retinopathy are strongly associated with prolonged duration of diabetes mellitus, poor glycemic control, hypertension, and hyperlipidemia. Diabetic retinopathy can progress in stages from non-proliferative diabetic retinopathy, where pathology is intra-retinal to proliferative diabetic retinopathy where pathology extends forward onto the retinal surface into the vitreous and beyond.
Many complications can result from diabetic retinopathy as vitreous hemorrhage, retinal detachment, glaucoma, and blindness. These complications can be prevented through lifestyle modification, especially self-care practices. Self-care practices education integrates traditional patient education in primary care to support patients to live the best quality of life with their diabetic retinopathy.
This makes health education a very important role of the nurses. So, the nurses’ role extends to reducing the effect of disease and improving the quality of life for diabetic retinopathy patients. Patient education raise awareness which links with motivation to adhere to self-care practices management goals. So, the nurses have a key role in developing an effective educational intervention for diabetic retinopathy patients to help patients in performing effective self-care practices.
The aim of the study:
This study was aimed to evaluate the effect of an educational intervention on self-care practices among patients with diabetic retinopathy.
Research hypothesis:
Diabetic retinopathy patients who receive educational intervention will exhibit improvement in self-care practicesthan those patients who do not receive it.
Materials:
This study was conducted at the reception of the Vitreoretinal Outpatient Clinic at Alexandria Main University Hospital. It is working 6 days per week from Saturday to Thursday from 8 am to 1 pm. It has one nurse and one room that is well prepared for an eye examination.Subjects of this study werea convenience sample of 60 adult patients with diabetic retinopathy.The study subjects were divided randomly into two equal groups; the control and the study group (30 for each group), the control group was exposed to routine care only and the study group received an educational intervention.
Tools of the study:
Three tools were used for data collection:
The tool I: Patients’ Bio-socio demographic Data Structured Interview Schedule
This tool was developed by the researcher and it consisted of two parts:
a. Socio-demographic data: includedage, gender and level of education, area of residence, marital status, occupation, monthly income, treatment system, and health care provider at home.
b. Clinical data:family history about having diabetes mellitus, diabetic retinopathy and its complications; patients’ past medical history related to a complaint of other chronic diseases, previous hospitalization and its causes, type of diabetes and time since seeking medical help; present history related to the onset of diabetic retinopathy, chief complaints, the occurrence of complications of diabetic retinopathy and prescribed medications.
Tool II: Diabetic Retinopathy Patient’s Knowledge Assessment Questionnaire:
This tool was developed by the researcher to assess patients’ knowledge related to diabetic retinopathy. It included a group of MCQ questions related to the following: definition of diabetic retinopathy, signs, and symptoms of the disease, risk factors for developing diabetic retinopathy, complications of diabetic retinopathy disease, methods of treatment, self-care of diabetic retinopathy, prevention of complications of diabetic retinopathy and sources of information about diabetic retinopathy disease.
Tool III: Self-Care Practices Structured Interview Schedule
It was developed in Arabic by the researcher. This part included (6) items related to eye care, self-monitoring of glucose in the blood, periodic health checkups, proper intake of medications, dietary intake, and physical activity.
Method
The actual study was conducted in four phases as the following:
Phase I: Assessment phase: initial assessment of these patients (control and study group) was carried out before the educational intervention using tools I, II and III, to collect the needed data, clinical data, assess existing knowledge and self-care practices as well as, assessing the patients’ needs before developing the educational intervention.
- The data was collected from the control group first then from the study group to prevent theoretical contamination of the study group.
Phase II: Planning and developing of the intervention phase
Based on relevant recent literature and the identified patients’ needs, the educational intervention objectives, priorities, and contents were developed by theresearcher. The content was organized according to a feasible learning sequence (from easy to difficult) to enhance patients’ understanding. The content of the educational intervention covered knowledge of diabetic retinopathy & 6 items related to eye care, self-monitoring of glucose in the blood, periodic health checkups, proper intake of medications, dietary intake as well as, physical activity. Illustrated colored booklet was formulated by the researcher and distributed to each patient of the study group in the implementation phase.
Phase III: Implementation of the intervention phase
The developed self-care practices educational intervention was conducted and applied individually to each patient through face-to-face lectures and also PowerPoint slides and was supported by using a written booklet as an illustrative guide for more clarification.
The educational intervention was conducted in 2 sessions. The first session was carried out during the assessment phase; while the second session was carried out after a month. Each session continued for 45-60 minutes.
Patients were asked to repeat the knowledge learned several times until the researcher make sure that the given knowledge was successfully mastered in the two sessions.
Patients were asked to repeat the educational intervention until the investigator was assured that the patient had mastered self-care practices.
Give time to patients to read and understand the information included in the illustrative booklet which was given to each patient in the study asa reference from the beginning of the first session of educational intervention. Thenthe researcher clarifies any questions and information if needed post sessions.
Phase IV: Evaluation phase:
Diabetic retinopathy patients were re-evaluated by the researcher using tools II and III, after implementation of the educational intervention to evaluate the effect of the educational intervention on self-care practices among patients with diabetic retinopathy.
Comparisons between the control and study groups were carried out using appropriate statistical analysis to evaluate the effect of the educational intervention on self-care practices among patients with diabetic retinopathy.
The main findings of this study showed that:
• The vast majority of both control and study group patients (96.7%, 80%), their age ranged from 50 to ≥ 60 years.
• Nearly three-quarters of the control and study group patients (73.3%) were females.
• The highest percentage of both control and study group patients (43.3%, 26.7%), respectively were illiterate.
• Nearly two-thirds of both control and study group patients (63.3%, 66.7%) were from urban areas.
• The majority of the control group patients (76.7%) and 70% of the study group patients were married.
• Over three-quarters of the control group patients (76.7%) and more than two-thirds of the study group patients (66.7%) were housewives.
• The majority of the control group patients (76.7%) and 63.3% of the study group patients did not have enough income per month.
• All of both control and study group patients (100%) followed the state expenditure system.
• As regards family history, the majority of both the control and study groups (83.3%, 80%), respectively had a positive family history of diabetes mellitus. In addition, 64% of the control group had a positive family history of diabetic retinopathy, and 62.5% of the study group their family had no diabetic retinopathy.
• Concerning past medical history, the majority of both control and study groups had other health (76.7%, 80%), respectively whereas the majority of them had hypertension (87%). Also, about two-thirds of the control and study groups were having type I diabetes mellitus (63.3%,60%), respectively.
• Regarding present medical history, the majority of both control and study groups have had diabetes mellitus for 15 years and more (80%, 70%), respectively. As well, more than three-quarters of both the control and study groups were complaining of blurred vision (76.7%, 83.3%), respectively.
• All of the control and study groups (100%) had poor total knowledge about diabetic retinopathy pre-self-care practices educational intervention application.There was no statistically, significant difference between the two groups pre-self-care practices educational intervention application. However, there was a marked improvement in the knowledge within the study group post-self- care practices educational intervention application where more than three-quarters of them (86.7) had good total knowledge and only a minority of them (10%) had satisfactory knowledge with a statistically, significant difference between two groups p<0.001*). Also, there was no statistically, significant difference within the control group pre, and post-self-care practices educational intervention application. While; there was a statistically, significant difference within study group pre, and post-self-care practices educational intervention application (p<0.001*).
• More than two-thirds of the control group (66%) didn’t have a source of information. On the other hand, 63.3% of the study group their main source of information was an ophthalmologist.
• The majority of both control and study group patients (93.3%,96.7%), respectively had fair overall self-care practices pre-implementation of self-care practices educational interventionwith no, statistically, significant difference between the two groups. However, the study group showed marked improvement post-self-care practices educational intervention application where all of the study group (100%) had good overall self-care practices with statistically significant difference between the two groups p<0.001*). Also, there was no statistically, significant difference within the control group pre, and post-self-care practices educational intervention application; while the statistically, significant difference within the study group pre and post-self-care practices educational intervention application was (p<0.001*).
• Astatistically significant relationship was found between the total patients’ knowledge score and patients’ age (p=0.006*), patients’ level of education (p=0.001*),and monthly income (p=0.041*).
• There was no statistically, significant relationship between the overall patients’ self-care practices and studied patients’ socio-demographic data.
• A statistically, significant moderate positive correlation was found between the total patients’ knowledge score and patients’ overall practices score at P=0.023*, r=0.415*.
Conclusion:
It can be concluded that the studied patients who received self-care practices educational intervention had a significant improvement on knowledge and self-care practices than those who didn’t receive it.
The main recommendations of this study are:
• Provide Vitreoretinal Outpatient Clinic with enough qualified nurses to give diabetic retinopathy patients information about self-care practices.
• In-service training programs and continuing education sessions are to be provided to nurses about diabetic retinopathy, its complications, treatment modalities, and nursing management.
• Reinforcement of the information, self-care practices, and follow-up of patients every three months.
• Study the effect of health teaching programs about self-care practices on the patients’ health-related quality of life.