Empowerment of Posbindu Cadres in Improving Self-Care Activity

in Diabetes Mellitus Based on Levine Conversation

Alik Septian Mubarrok, Fahruddin Kurdi, Ratna Puji Priyanti and Supriliyah Praningsih

STIKES Pemkab Jombang

Keywords: Posbindu Cadres, Levine’s Conservation Model, Self-Care Activity, DM type 2.

Abstract: Management of diabetes mellitus requires the active participation of patients, families and communities. One

of them is the empowerment of Posbindu cadres in each region, this needs to be done to improve the ability

of cadres Posbindu to manage and run the health service work. The purpose of this study is to determine the

effect of empowerment of health cadres with self-care activity of people with diabetes mellitus. This research

used quasi experiment method with design of Non-Randomized Control Group Pretest-Postest design. The

population was all health cadres and people with Diabetes mellitus. The results showed that there were

significant differences between self-care activity treatment group and control group due to the application of

levine based health education by Posbindu cadre with independent t test result on Self Care Activity t value

was 24.680 (p = 0.000). For the conclusion is the application of Levine Conservation based health education

to the cadre give a significant influence in the improvement of self-care activity, because the conservation of

Levine in Posbindu cadre role maximally can influence the way of thinking (cognitive) , motivational, and

selection of behavioural care.

1 BACKGROUND

Diabetes mellitus (DM), better known as diabetes, is

a group of metabolic diseases characterized by high

levels of glucose in the blood (hyperglycemia) due to

insulin secretion abnormalities, insulin abnormalities,

or a combination of both (American Diabetes

Association 2010). The condition of this

hyperglycemia if it persists will result in damage and

failure of various organs especially the eyes, kidneys,

nerves, heart, and blood vessels (American Diabetes

Association 2012). The results of various

epidemiological studies indicate a tendency to

increase incidence rates and prevalence of type 2 DM

in various corners of the world. The World Health

Organization (WHO) predicts an increase in the

number of people with DM in Indonesia from 8.4

million in 2000 to about 21.3 million by 2030

(PERKENI 2011).

The national prevalence of Diabetes Mellitus is

1.1%. East Java Province is included in provinces in

Indonesia that have a prevalence of DM disease

above the national prevalence. DM also shows a

tendency to always be in the top ten diseases with the

highest number of visits in Sentinel Puskesmas in

East Java Province in the period 2010-2012. Jombang

regency is one of the districts in East Java where

Diabetes Mellitus disease is included in the list of 15

major diseases with the highest number of cases,

especially in 2016 and 2017 as many as 16,380 cases

(Dinkes Jombang, 2017). Puskesmas Mojoagung is a

Puskesmas in Jombang Regency which has a group

of people with Prolanis. The number of cases of DM

in Kesamben Puskesmas in 2017 is as many as 559

cases (Dinkes Jombang District, 2017).

Education to patients and their families aims to

provide insights into the course of the disease,

prevention, complications and management of DM,

which will greatly help increase family participation

in improving management outcomes. The existence

of organizations of associations of people with

diabetes such as PERKENI, PERSADIA, PEDI, and

others become very necessary, because the

association can help improve the knowledge of

people with diabetes about their illness and increase

their active role in modifying DM treatment.

Controlling blood glucose is paramount in the control

and management of DM in addition to education.

Poor DM control can lead to long-term

672

Mubarrok, A., Kurdi, F., Priyanti, R. and Praningsih, S.

Empowerment of Posbindu Cadres in Improving Self-Care Activity in Diabetes Mellitus Based on Levine Conversation.

DOI: 10.5220/0008330706720675

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 672-675

ISBN: 978-989-758-336-0

hyperglycemia, which triggers some serious

macrovascular or microvascular complications such

as heart disease, peripheral vascular disease, renal

failure, neurological damage and blindness

(PERKENI 2011).

One of the nursing models that has been

developed in nursing care is the conservation model

developed by Mira E. Levine. The model is oriented

towards energy conservation, structural integrity,

personal integrity, and social integrity, which focuses

on enhancing the client's ability to adapt as closely as

possible to achieve optimal quality of life. The

conservation model approach pioneered by Myra

Estrin Levine is appropriate to improve self-care

behavior of patients so that management of diabetes

can be optimal.

This conservation model enables nurses to help

individuals achieve their own integrity. This model

provides guidance on how nurse-client relationships

focus on the influence and response of clients to

promote client integrity through conservation

principles. Interventions to maintain network

integrity, energy conservation, personal and

psychosocial integrity (Levine 1966).

2 METHODS

2.1 Study Design

This research type was quasi experiment research

with design of Nonequivalent Control Group Design

or Non-Randomized Control Group Pretest-Postest

Design, which was pseudo experiment by dividing

the existing group without distinguish control and

group significantly by still referring to the existing

natural form.

2.2 Study Population, Sampling and

Variables

Population in this research was all patient of type 2

DM who registered to member of Prolanis at

Puskesmas Kesamben that is as much as 38. Based on

formula of sample for analytical numerical pairs

obtained sample 16 respondents for each group. This

research used purposive sampling method.

Variable in this research consist of two variables,

namely independent variable (free) and dependent

variable (dependent). The independent variable in this

research is Levine Conservation model application.

While the dependent variable is self-care activity.

2.3 Intervention

The study was conducted in two stages, i.e. by

allocating the sample into two groups (treatment

group and control group). Furthermore, the

researchers conducted pre-test of self-efficacy and

quality of life in the treatment group and control

group. The study was conducted for 2 months.

According to research conducted by Shi (2010)

changes in self-care activity can be seen immediately

after the implementation of an intervention and

changes in quality of life can be seen after 1-2 weeks

after the implementation of the intervention.

2.4 Data Analysis

The data analysed by using Kolmogorov–Smirnov

Test for normality testing and Paired T test and

Independent T test for different test with α=0.05.

3 RESULTS

The result showed that the level of self-care

activity of respondents in the treatment group before

the intervention, mostly in the medium category, i.e.

9 respondents (56.3%). After intervention, the level

of self-efficacy of respondents increased, i.e. most

respondents i.e. 8 people (50%) had self-efficacy

level in high category. While for the level of self-care

activity responder in control group during pre-test

mostly were in medium category that were 9

respondent (56.3%). While at post-test, most of self-

care activity level of respondent was in high category

as many as 15 respondents (93.8%) (see table 1).

While in table 2 it can be seen that the increase of

self-care activity that occurs in the treatment group

was higher than in the control group, that is the

average increase of self-efficacy value in the

treatment group by 19 compared to the control group

which was only 0.15.

Based on the results of normality test by using

Kolmogorov-Smirnov test on Self-care activity

variable in treatment group and control group it can

be seen that p> α (0.05) so it can be stated that all data

is normally distributed. Meanwhile, based on

homogeneity test results as listed in table 5.16 using

Levine's Test on self-efficacy and quality of life in the

treatment group and control group, it can be seen that

p> α (0.05) so it can be stated that all data is

homogeneous.

The result of paired t test in the treatment group

with t value of -8.061 and p 0.000 <0.05 (α), meaning

there is difference of self-care activity before

Empowerment of Posbindu Cadres in Improving Self-Care Activity in Diabetes Mellitus Based on Levine Conversation

673

intervention with after intervention. The negative

value at t indicates that the pre-test value was lower

than the post-test value. Based on table 5 also known

result of paired t test in control group obtained t value

arithmetic -0.051 and p 0.960> 0.05 (α), meaning

there was no difference of self-care activity during

pre-test and post-test.

Where the negative value on t arithmetic shows

that the value of pre-test is lower than the post-test

value. The results of independent t test of self-care

activity variable between treatment and control

group, that was t value 25.055 with p 0.000 <0.05

meaning there were difference of self-care activity

significant between treatment group and control

group. A positive value on t shows that the value of

self-care activity in the treatment group is higher than

in the control group.

4 DISCUSSION

The results showed that self-care activity in the

treatment group increased after intervention

(Conservation Levine). The Levine Conservation

Model focuses on individuals as holistic beings that

interact with the environment. In patients with DM

there is a decrease in quality of life, it is caused by the

consequences of the physical illness, the treatment

process, and the complications it causes. DM may

decrease physical functioning due to long-term

complications arising, because of the disease itself,

and the health conditions associated with DM.

Another thing is due to the frequent therapeutic

demands that cause a patient to feel restricted in his

life.

The results showed that there was a difference of

self-care activity level in both groups during pre-test,

i.e. in treatment group was lower than control group

(treatment group mostly in medium category, control

group mostly in high category). This was due to

differences in predisposing factors in both groups, i.e.

differences in length of sickness and income levels in

both groups, the average length of illness in the

control group was longer and the average income was

greater than the treatment group. This difference

makes the difference in self-care activity between the

two groups at the pre-test. In addition, higher income

levels also contribute to self-care activities as they

will have the economic resources to access health

services. In addition, in the treatment group, the

number of male respondents was less than the control

group, so this had an effect on the difference of self-

care activity in both groups. This is in accordance

with research (Mystakidou et al. 2010) said that men

have higher self-care activity than women.

Increased self-care activity that occurred in the

control group, although lower than the treatment

group was caused because the control group also

received health education at the Puskesmas. Although

health education is given only slightly for 1 month,

but still there is information about the disease and

management of the disease. So it will contribute in

improving the patient's self-care activity in the

control group.

5 CONCLUSIONS

Implementation of Levine Conservation-based health

education has a significant effect on increasing self-

care activity of DM type 2 patients because Levine

Conservation improves the ability to adapt to the

conservation of energy, structural, personal and social

integrity in achieving wholeness through change

process. Implementation of Levine conservation-

based health education also has a significant effect on

improving the quality of life of patients with type 2

DM, because Levine Conservation affects the way

individuals think (cognitive), feel (affective),

motivational, and selection of behavioral care chosen

by individuals.

Nurses can apply Levine conservation in

conducting health education in patients with type 2

diabetes so that it will further improve the

management of diabetes independently by patients

and families. Longer follow-up studies, such as

longitudinal or randomized control trial studies with

larger samples, may be performed to evaluate the

Table 1: the level of self-care activity.

Self-Care

Activity

Intervention Control

Pre

test

Post

test

Pre

Test

Post test

% % % %

Ver

wea

- - - -

Weak

Moderate

31.2

56.3

37.5

56.3

93.8

High

Very high

12.5

18.8

6.2

Total 100 100 100 100

Table 2: The increasing of self-efficacy value.

Variabel Mean Mean

Difference

Awal Akhi

Self-care activity

intervention

rou

106 125 19

Self-care activity

Control

rou

106.75 106.9 0.15

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

674

effect of Levine conservation on self-care activity and

quality of life for type 2 DM patients.

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Empowerment of Posbindu Cadres in Improving Self-Care Activity in Diabetes Mellitus Based on Levine Conversation

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