Effectiveness of Patients' Education and Telenursing Follow-Ups on Self-Care Practices of Patients With Diabetes Mellitus: Cross-Sectional and Quasi-Experimental Study.

Abstract

Background: Information and communications technology can be used in telenursing to facilitate remote service delivery, thereby helping mitigate the general global nursing shortage as well as particular applications (eg, in geographically remote communities). Telenursing can thus bring services closer to end users, offering patient convenience and reduced hospitalization and health system costs, enabling more effective resource allocation.

Objective: This study aims to examine the impact of patients' education and telenursing follow-ups on self-care indicators among patients with type I and type II diabetes mellitus (DM).

Methods: In phase I, a cross-sectional descriptive analysis was conducted to evaluate the self-care practices of 400 patients with DM at Kafr El Sheikh University Hospital in Egypt. In phase II, a pretest-posttest experiment was applied with a selected group of 100 patients purposively recruited from phase I due to their low self-care practice knowledge to ascertain the impacts of a 4-week intervention delivered via telenursing. They were reminded via telephone follow-up communication of the importance of adhering to recommendations on physical activity, nutritional intake, and the management of blood sugar (ie, insulin). Data collection was undertaken using a structured quantitative questionnaire, encompassing sociodemographic characteristics, medical symptoms and history, and knowledge of DM. Paired t test analysis was applied to study pre- and postintervention self-care behaviors.

Results: Participants had a mean age of 49.7 (SD 11.5) years. More than one-third received their DM diagnosis over a decade previously (135/400, 33.8%) and were obese (147/400, 36.8%). Almost half (176/400, 44%) received insulin, and the majority had cardiac disease (231/400, 57.7%) and the DM symptom of elevated blood sugar levels while fasting (365/400, 91.3%). A relatively high score of DM knowledge was reported (255/400, 63.7%). Males exhibited significantly lower knowledge levels (102/200, 51%) compared to females (153/200, 76.5%; P<.001). The intervention was effective in improving knowledge of DM (t99=30.7, two-tailed; P<.001), self-care practices (t99=53.7, two-tailed; P<.001), and self-care skills (t99= 47, two-tailed; P<.001) among patients with DM.

Conclusions: The emergent evidence suggests that patients' education and telenursing follow-ups have the potential to improve self-care behavior in patients with DM. The delivery of frequent nursing reinforcement via telenursing enables improved self-management while contemporaneously reducing the need for patients to visit clinical settings (ie, improving patient condition and reducing net health system costs). The outcomes of this research underscore the need to integrate telenursing within conventional care for DM, and more research is needed to longitudinally assay its efficacy and sustainability over the long term and in different clinical and geographical contexts.