Results
Relative frequency distribution and demographic variables in research units, it was reported that the most participants in the study were male (52 = 52.5%), with below diploma education (83 = 83.8%), married (86 = 86.9%), without special illness (60 = 60.6%), employed (50 = 50.5%), living in city (87 = 87.9%), owner (72 = 72.7%), smoking history (76 = 76.8%), lack of exercise (73 = 73.7%), no history of stress, depression and taking antipsychotic medication (91 studies = 91.9%; 72 studies = 72.7%, 81 studies = 81.8%), respectively. Sixty-one subjects believed that their relationship with their spouses is satisfactory and 63 studies had more than 5 million Rial monthly income (Table
1).
Table 1
Relative frequency distribution and demographic variables in the research units
Sex | Male | 52.5 | 52 |
Female | 47.5 | 46 |
Total | 100.0 | 98 |
Education | less than Diploma degree | 83.8 | 83 |
more than Diploma degree | 16.2 | 15 |
Total | 100.0 | 98 |
Marriage | Married | 86.9 | 86 |
Single and divorced | 13.1 | 12 |
Total | 100.0 | 98 |
special disease | No | 60.6 | 60 |
Yes | 39.4 | 38 |
Total | 100.0 | 98 |
Occupation | Employee | 50.5 | 50 |
Other job | 49.5 | 48 |
Total | 100.0 | 98 |
Residency | Urban | 87.9 | 87 |
Rural | 12.1 | 11 |
Total | 100.0 | 98 |
Housing situation | Own house | 72.7 | 72 |
Tenant | 27.3 | 26 |
Total | 100.0 | 98 |
Cigarette smoking | No | 23.2 | 22 |
Yes | 76.8 | 76 |
Total | 100.0 | 98 |
Exercise | Yes | 26.3 | 25 |
No | 73.7 | 73 |
Total | 100.0 | 98 |
Stress | Yes | 8.1 | 7 |
No | 91.9 | 91 |
Total | 100.0 | 98 |
Depression | Yes | 27.3 | 26 |
No | 72.7 | 72 |
Total | 100.0 | 98 |
Antipsychotic medication | Yes | 18.2 | 17 |
No | 81.8 | 81 |
Total | 100.0 | 98 |
Exposure to smoke | Yes | 8.1 | 7 |
No | 91.9 | 91 |
Total | 100.0 | 98 |
Relation between spouse | Very satisfied | 15.2 | 14 |
Satisfied | 61.6 | 61 |
Normal | 13.1 | 13 |
Dissatisfied | 7.1 | 7 |
Very dissatisfied | 3.0 | 3 |
Total | 100.0 | 98 |
Monthly income money by Iranian Rial | Less than 5 million (Rial) | 36.4 | 35 |
More than 5 million (Rial) | 63.6 | 63 |
Total | 100.0 | 98 |
The relative and absolute frequency of the gender of the participants in this study in terms of the test and control groups regarding gender (p = 0.27), place of residence (p = 0.20), accommodation status (p = 0.23), smoking (p = 0.10), exercise (p = 0.07), stress (p = 0.06), depression (p = 0.77), drug consumption (p = 0.96), exposure to cigarette smoke (p = 0.44), relationship between couples (p = 0.10), academic status (p = 0.55), marital status (p = 0.12), having special diseases (p = 0.90), occupation (p = 0.91), and income status (p = 0.93) showed no significant difference..
Elevated blood pressure is when readings consistently range from 120 to 129 systolic and less than 80 mmHg diastolic, Hypertension Stage 1: is when blood pressure consistently ranges from 130 to 139 systolic or 80–89 mmHg diastolic, Hypertension Stage 2: is when blood pressure consistently ranges at 140/90 mmHg or higher, Hypertensive crisis: If your blood pressure is higher than 180/120 mmHg. According to the results in Table
2 revealing the mean rank of the test and control groups in terms of the variables of interest in the study, based on the Mann-Whitney test findings, a significant difference was observed between the test and control groups before and after the intervention in terms of the variables of mean systolic and diastolic blood pressure after the intervention (
p < 0.05).
Table 2
The difference of the mean and standard deviation as well as the mean score of test and control groups before and after the intervention in terms of the variables of interest in the study
age | case | 49 | 44.63 | 31.36 | 5.29 | 0.06 |
control | 49 | 55.26 | 32.98 | 4.42 |
Systole (Before) | case | 49 | 49.38 | 134.89 | 18.58 | 0.82 |
control | 49 | 50.61 | 135.20 | 19.05 |
Diastole (Before) | case | 49 | 52.57 | 73.06 | 13.26 | 0.35 |
control | 49 | 47.48 | 72.30 | 10.36 |
Systole (After) | case | 49 | 48.03 | 118.70 | 15.14 | 0.001 |
control | 49 | 51.01 | 120.71 | 13.54 |
Diastole (After) | case | 49 | 49.56 | 60.91 | 6.28 | 0.04 |
control | 49 | 51.45 | 61.72 | 10.06 |
According to the results in Table
3 capturing the mean difference of the studied variables in terms of the test and control groups, it was found that following the intervention, the mean waist circumference in the test group was 98.6 ± 9.8, 101.5 ± 7.8 in the control group, the mean FBS was 131.08 ± 16.04 and 238.02 ± 40.01 in the test and control groups respectively after the intervention, and the mean BMI was 27.3 ± 3.4 and 30.3 ± 3.8 in the test and control groups respectively after the intervention. Based on the findings obtained from independent t-test, there was significant difference between the two groups in terms of waist circumference, BMI, and FBS after the intervention (
p < 0.05).
Table 3
Investigating the mean difference of the studied variables in terms of test and control groups before and after the intervention concerning the variables of interest
Waist (Before) | case | 49 | 100.6 | 9.83 | 0.06 |
control | 49 | 99.90 | 10.17 |
Waist (After) | case | 49 | 98.68 | 9.82 | < 0.0001 |
control | 49 | 101.58 | 7.82 |
FBS (Before) | case | 49 | 250.26 | 50.55 | 0.18 |
control | 49 | 252.06 | 39.58 |
FBS (After) | case | 49 | 131.08 | 16.04 | < 0.0001 |
control | 49 | 238.24 | 40.01 |
BMI (Before) | case | 49 | 29.77 | 3.66 | 0.42 |
control | 49 | 29.64 | 4.03 |
BMI (After) | case | 49 | 27.30 | 3.45 | < 0.0001 |
control | 49 | 30.16 | 3.89 |
According to the results in Table
4 capturing the mean difference of the studied variables in terms of the test and control groups, it was found that following the intervention, the mean waist circumference in the test group was 98.6 ± 9.8, 101.5 ± 7.8 in the control group, the mean FBS was 131.08 ± 16.04 and 238.02 ± 40.01 in the test and control groups respectively after the intervention, and the mean BMI was 27.3 ± 3.4 and 30.1 ± 3.8 in the test and control groups respectively after the intervention. Based on the findings obtained from independent t-test, there was significant difference between the two groups in terms of waist circumference, BMI, and FBS after the intervention (
p < 0.05).
Table 4
Investigating the difference of mean and standard deviation of the studied variables across the test groups before and after the intervention as well as in the control group before and after the intervention
case | Pair 1 | FBS (Before) | 250.26 | 50.55 | < 0.0001 |
FBS (After) | 131.08 | 16.04 |
Pair 2 | Waist (Before) | 100.6 | 9.83 | < 0.0001 |
Waist (After) | 98.68 | 9.82 |
Pair 3 | BMI (Before) | 29.77 | 3.66 | < 0.0001 |
BMI (After) | 27.30 | 3.45 |
Pair 4 | Systole (Before) | 134.89 | 18.58 | < 0.0001 |
Systole (After) | 118.70 | 15.14 |
Pair 5 | Diastole (Before) | 73.06 | 13.26 | < 0.0001 |
Diastole (After) | 60.91 | 6.28 |
control | Pair 1 | FBS (Before) | 252.06 | 39.58 | 0.89 |
FBS (After) | 238.24 | 40.01 |
Pair 2 | Waist (Before) | 99.90 | 10.17 | 0.65 |
Waist (After) | 101.58 | 7.82 |
Pair 3 | BMI (Before) | 29.64 | 4.03 | 0.98 |
BMI (After) | 30.16 | 3.89 |
Pair 4 | Systole (Before) | 135.2 | 19.05 | 0.431 |
Systole (After) | 134.9 | 15.1 |
Pair 5 | Diastole (Before) | 72.30 | 10.36 | 0.22 |
Diastole (After) | 61.72 | 10.06 |
Based on the findings of Table
5 and paired t-test, the mean and standard deviation of FBS was 254.2 ± 50.5 and 251.08 ± 16.04 before and after the intervention in the test group respectively, the mean waist circumference was 102.6 ± 7.8 and 100.6 ± 7.8 before and after the intervention respectively in the test group, the mean BMI was 30.3 ± 3.6 and 28.3 ± 3.4 before and after the intervention respectively in the test group, the mean systolic blood pressure was 134.18 ± 8.5 and 120.7 ± 13.5 before and after the intervention in the test group respectively, and the mean diastolic blood pressure was 73.13 ± 06.3 and 62.9 ± 6.2 before and after the intervention respectively in the test group. According to the findings of paired t-test, the difference between and after the intervention was significant for the test group (
p < 0.05).
Table 5
The mean score of quality of life of patients with diabetes before and after the intervention in terms of test and control groups
Quality of Life before | case | 49 | 49.06 | 1914.00 | 37.8 | 3.6 | 0.08 |
control | 49 | 50.72 | 3036.00 | 38.5 | 3.9 |
Quality of Life after | case | 49 | 56.14 | 2751.00 | 59.1 | 2.2 | 0.03 |
control | 49 | 50.21 | 2199.00 | 56.6 | 2.8 |
According to Table
5 and investigation of the mean score of quality of life of patients with diabetes before and after the intervention, before the intervention the mean score in the test and control groups was 37.8 and 38.5 respectively, where according to Mann-Whitney test, the score differences were not significantly different between the two groups (
p = 0.089). The mean quality of life score after the intervention in the test and control groups was obtained as 59.1 and 56.6 respectively, where according to Mann-Whitney test, the score difference was significant between the two groups (
p < 0.05). Furthermore, the difference of the scores before and after the intervention in the test and control groups according to Wilcoxon test showed a significant difference, suggesting improved quality of life after the intervention in the test group. Finally, according to quality of life questionnaire scoring, a relatively desirable quality of life was found in patients post intervention.
Discussion
Using the resources and social networks has positive effect on increasing the health and awareness of people, especially patients, in the society and this process provides enough information to take an effective step in controlling diabetes better. Therefore, the accesses of diabetic patients to the required information help them to take the proper decision and have higher control on the environment [
68]. Education of preserving and promoting health is one of the initial approaches to help people to change their wrong habits that are implemented in the widespread and diverse levels of the society [
69]. Today, information and communication technology is used as a powerful tool to promote the quality and efficiency of education such that it has transformed the traditional education methods [
70]. The rapid development of internet technologies has caused that electronic education becomes an important form of education in the information era [
71]. Electronic education is a widespread set of applied software and information technology based method including computer, compact disk, internet network, intranet and virtual university that provide the life-lasting education for people in each time and place [
72]. The results of this study shows that based on the results of this study, most participants in the study were male, with below diploma education, married, employed and the mean rank of quality of life after intervention was significant in the experimental and control groups.
Diabetes is the main cause of retinopathy, neuropathy, nephropathy, and the cause of 60% of feet amputation cases [
73]. Further, diabetes increases the risk of heart attacks, strokes, and the mortality caused by cardiovascular disease by 2–4 times compared to other patients [
74]. Therefore, investigating the quality of life and enhancing it in diabetic patients have always been considered an important health outcome, and is noted as a major issue in taking care of patients with diabetes [
59]. In this regard, various studies have dealt with investigating the quality of life of diabetic patients. In a review study conducted by Sheps et al., it was found that weblogs, microblogs, social network sites, professional network sites, and thematic network sites have had maximum applications in healthcare [
70]. In another review study performed by Cooper and Kar, it was reported that self-care is an indispensable part of diabetes management, and diabetic individuals through daily living with this condition improve their skill regarding self-management. This study suggests that Internet has changed into a valuable resource for diabetic patients. Indeed, Internet allows them to promote and improve the site content, share their experiences with others, and communicate with other individuals in a similar situation [
75]. Further, in the study by Mano, a promising theoretical framework was presented for effectiveness of use of social media in encouraging use of online healthcare services. They reported that finding practical and economical solutions to support the use of social media and encouraging access to online health information and usage of online healthcare services can enhance the health literacy and health self-management at individual level as well as productivity in presenting healthcare services at institutional level [
76,
77].
Soleimani et al. [
78] reported that concerning the effect of diabetes control and self-care behaviors as well as self-management on the desirability of quality of life, it is proposed that these educations be taken more seriously for enhancing the quality of life of diabetic patients, which highlight its importance. Similarly, Ghiathvandian et al. [
79] also reported that self-management education was effective on the quality of life of diabetic patients and recommended that concerning the important role of education in the management and control of chronic diseases such as diabetes, more efficient and effective self-management educations should be noted by health policymakers regarding diabetic patients. In the study by Saeidpour et al. [
80] again self-care and self-management educations were recommended for enhancing the quality of life of diabetic patients, and considered it as a public health promoter.
Such educations have found a new form considering the progressive growth of use of social networks and weblogs, which can be more effective and available for all patients [
81]. The epidemics of use of Internet and social networks is such that all people even in the farthest points of the country can also gain access to the scientific experience and concepts of physicians and researchers in healthcare issues, and gain more awareness about their disease [
81]. In this way, anyone especially patients who have been focused on in this research in particular can create a personal weblog through the Internet easily and within a short time. Alternatively, they can become members of different weblogs and websites and see or publish the contents they have produced including text, image, voice, and video [
81]. Accordingly, this highlights the importance of self-management education through weblogs on the quality of life of diabetic patients.
In this study, the self-management education through weblog resulted in improvement of anthropometric indicators including the waist circumference as well as BMI and FBS. In investigating the mean difference of the tested variables in terms of the test and control groups, it was observed that after the intervention, the waist circumference, FBS, and BMI had a significant difference between the test and control groups. Further, paired t-test results revealed significant difference before and after the intervention in the test group in terms of the criteria including FBS, mean waist circumference, mean BMI, as well as mean systolic and diastolic blood pressure.
The results of this study also suggested the positive effect of self-management education through weblog on improving the quality of life of diabetic patients. According to the results, it was also reported that the mean quality of life score of patients before the intervention was 49.06 and 50.7 in the test and control groups, respectively, showing no significant difference. However, in investigating the quality of life post intervention in the two groups, it was observed that the quality of life after the intervention was increased in the test groups, respectively revealing a significant difference. This indicates that the quality of life of patients has improved after the intervention. The positive effect of the intervention for the patients in the study by Gheiathvand et al. [
79] along with Saeidpour et al. [
62] was also reported suggesting that the difference between the quality of life score of patients before and after the intervention was significantly different. Baghianimoghadam et al. [
82] again in their study reported that educational intervention caused enhanced quality of life of diabetic patients after the intervention. Such a positive effect was also reported in the study by Aghamolaei et al. [
83] as well as Balenjani et al. [
84]. The study by Murray et al. [
85] also reported the positive effect of web-based education on enhancing the level of awareness of patients and improved self-management in these patients. They suggested that these educations can improve and enhance the level of quality of life of diabetic patients.
In the study by Nundy et al., it was found that based on investigating the diabetes cell phone project to improve glycemic control and save costs for the participants in a program in Chicago, improvement in glycemic control and patient satisfaction with general care had a significant difference; notably, 8.8% was saved in the net healthcare costs. This study also reported that the healthcare plans can support the three goals of improving patient health, improving the public health, and reducing the healthcare per capita costs [
75].
In the study by Kate Lorig et al., it was reported that online self-care program of diabetes for patients were followed up for 18 months indicated that after 6 months of study, physical activity and self-efficacy improved significantly for the test groups compared to the control group who received routine care. However, no change was found in other behavioral or health indicators [
66].
In a cohort study performed by Yu et al. (2014) in Toronto on “web-based intervention for supporting self-care among patients with type II diabetes: effect on self-efficacy, self-care, and diabetes”, it was found that after 9 months, the self-efficacy score and the clinical outcomes did not improve, where the self-management website did not improve the self-efficacy situation in diabetic patients and usage of website was limited and thus had no significant effect on the self-management of diabetic patients [
64]. This research reported there was a significant difference between experimental and control groups in terms of stress. Further, in the study by Hoffman et al. [
86] it was reported that the Internet based self-care interventions may lead to diminished anxiety associated with diabetes among individuals with type II diabetes, and generates positive outcomes for the psychological and behavioral situation of adults with type II diabetes. They can also improve dietary habits, behavioral habits, and medical management in these patients. The results of the study by Murray et al. [
85] on investigating web-based self-care also suggested positive effects for the patients.
These results indicate the importance of self-management training in diabetic patients and improve the status of stress and its complications in patients. The results of our study showed that the BMI of the Experimental group after intervention was significantly decreased, which was confirmed in a study by Tahir et al. (2017), and diabetic patients participating in self-care education program BMI and their weight decreased significantly [
87]. According to the study, Horner et al. (2019) showed that self-care education had a significant effect on quality of life and BMI of asthmatic patients [
88]. The results of Singh et al. (2019) have shown that BMI in diabetic patients with self-care education has significantly decreased [
89]. Which is consistent with the results of the present study. The present study has shown that self-care education has been effective in reducing blood pressure in diabetic patients, which confirms our study, Simanjuntak (2019), that self-efficacy education has been effective in reducing systolic and diastolic blood pressure in diabetic patients, [
90]. Also, Zimbudzi (2018) review study has shown that self-care education has a significant effect on systolic blood pressure in diabetic patients and has decreased significantly in the control group [
91]. This is in agreement with the results of this study. A study by Feng et al. (2018) has shown that systolic blood pressure significantly decreased in diabetic Chinese patients, in intervention group after self-care education [
92]. In a study conducted by Hailu et al. (2018) in Ethiopia, diabetic patients in the intervention group received a significant reduction in FBS, systolic blood pressure and diastolic blood pressure in the control group after intervention [
93]. This is in agreement with the results of the present study. In confirmation of the results of this study, Kisokanth et al. (2019) showed that self-care education in diabetic patients improved the FBS and BMI status of the patients in the intervention group compared to the pre-intervention group [
94]. According to the results of this study, the study of Jiang et al. (2019), WILMOTH (2019), showed that self-care education in diabetic patients improved weight, waist circumference and quality of life in diabetic patients [
95,
96].
In this study, only 20–47 years old people with the ability of using internet and having access to internet were considered. Regarding the electronic education and the absence of research team supervision, the partial implementation of self-management was another limitation of this study. This study was also done on the diabetic patients visiting Taleghani diabetes clinic and patients visiting other healthcare wards did not include in the study. Future studies are expected to have no limitations to the present study and be tailored to the more valid questionnaires in different languages.
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