Transcript ภาพนิ่ง 1

Research presentation:
The diabetic caregivers' role in
type II Diabetes mellitus
patients' eating behavior
6th Nov 2012
Authors
• Mr. Raksit Chinnarakbumrung
• Ms. Suwannika Palee
• Mr. Harit Vanakiatkul
Advisor
• Sarinya Sutthanon, M.D.
Researchable Questions
• Primary research question
– How do the role of family nutritional support in
patients with type II diabetes mellitus ?
• Secondary research question
– Controlling of eating behavior of the caregivers
makes blood glucose level of Diabetic patients
improved ?
Researchable Questions
•
•
•
•
P : Type II diabetes mellitus patients
I : The eating behavior of the caregivers
C : none
O : The eating behavior of diabetes mellitus
patient
Contents
•
•
•
•
•
Unit 1 :
Unit 2 :
Unit 3 :
Unit 4 :
Unit 5 :
suggestion
• References
Introduction
Review literature
Methodology
Results
Discussion, conclusion and
Unit 1 Introduction
• Diabetes mellitus is a chronic illness that
requires significant behavior change in the
family, because the demands of adhering to the
patient's healthcare regime are associated with
psychosocial conflicts for the patient and the
family environment.
Unit 1 Introduction (cont.)
• Diabetes mellitus is a major problem for health
system in Thailand.
• Some of studies have showed that DM patient
also had a problem with controlling their blood
sugar level and their eating behavior.
Unit 1 Introduction (cont.)
• Because the incidence of DM is dramatically
increased when they’re growing older. The goal
of treatment DM is to control blood sugar level
within the normal range to reduce risk for
microvascular complications such as diabetic
retinopathy, diabetic nephropathy and diabetic
neuropathy, the other is macrovascular
complications.
Unit 1 Introduction (cont.)
• Nowadays there are some research about factors
that affect to their eating behavior but the
research about socioeconomic status and the
behavior of the caregiver that were contributing
factors making DM patient control their eating
behavior, were not too much.
• So, we had noticed about this problem and try
to study about this problem.
Unit 1 Introduction (cont.)
• Objective
– To find out and explain the caregivers’ role in eating
behavior about their konwlodge, attitude, feeling and
limitation for caring diabetes patients
Unit 1 Introduction (cont.)
• Scope of interest
– Populations : Diabetic patients who came with their
caregiver and had gone to health service system in
diabetic clinic, department of Internal Medicine,
Naresuan university hospital
– Timing : 7th – 30th November 2011
Unit 1 Introduction (cont.)
• Benefits
– To clarify the role of the caregivers for controlling
blood sugar level of the diabetic patients
Unit 2 Review literature
• Family support for nutritional management had a
beneficial effect on HbA1c − Koin Watanabe, Takeshi
Kurose, Naomi Kitatani, et al. The Role of Family
Nutritional Support in Japanese Patients with Type 2
Diabetes Mellitus: Inter Med 49: 986, 2010
• In a previous report of predominantly older African
American adults with diabetes, it was found that family
support is related to a pattern of diet self-care behaviors
− Dye CJ, Haley-Zitlin V, Willoughby D. Insights from
older adults with type 2 diabetes: making dietary and
exercise changes. Diabetes Educ 29: 116-127, 2003.
Unit 3 Methodology
• Researchable question
• How does the eating behavior of the caregiver affect blood sugar
level of diabetic patient?
• Population
– Diabetic patients, who were diagnosed type II diabetes
mellitus for more than 1 year, came with their caregivers
to the DM clinic between 21st to 25th November 2011
– The caregivers of diabetic patients who were more than
20 years of age and did not diagnose for type II DM
before
Unit 3 Methodology (cont.)
• Sample
– Thirteen diabetes mellitus patients who were
established DM type II for at least 1 year, without
psychiatric problems and 13 diabetes’ caregiver who
were age 20 or more and did not neither established
DM type II nor psychiatric problems.
Unit 3 Methodology (cont.)
• Places for collecting the data
– Out-patient department (OPD), department of
Internal medicine, Naresuan university hospital
– DM clinic, department of Internal medicine,
Naresuan university hospital
Unit 3 Methodology (cont.)
• Source of information
– Observation and in-depth interview
– OPD card
• Study method
– Qualitative study
Unit 3 Methodology (cont.)
• Methodology
– Qualitative method
– Observation and in depth interview
Unit 3 Methodology (cont.)
• Content in interviewing
– Knowledge about controlling the diet
– Factors that affect the controlling blood sugar level
– Do they control their eating and how
– How do you feel about taking good care to DM
patient
– Some restrictions for controlling the diet
Unit 3 Methodology (cont.)
• Triangulation
– Observe and in-depth interview
– The patient and the caregiver will be interviewed
separately for reducing to the bias from embarrassed
so they’ll feel free to answer to the question to make
the research more reliable
Unit 3 Methodology (cont.)
• Instruments
– Voice recorder
– Notebook
Unit 3 Methodology (cont.)
• Method
– Design the research topic and present to the contentexpert and methodology-expert advisors
– Review the literature
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–
–
–
Present the research topic
Adjust and develop the topic
Present the research proposal
Performing the research
Observe and in-depth interview
Analyze and evaluate the data
– Present the research
Unit 3 Methodology (cont.)
• Collecting procedure
– Get permission for data collecting
– Explain to the health service provider in the OPD
and DM clinic for co-operating
– Collecting the data by observation and in-depth
interview to the participants
– Analyze, discuss and conclude the data
Time table
7th November – 2nd December 2011
1st week 2nd week 3rd week 4th week
MTWT FMTWT FMTWT F MTWT F
Reviewing
literature
Present the
topic proposal
Data collecting
Analyzing the
data
Research
presentation
Unit 3 Methodology (cont.)
• Data analyzing and statistical tools
– Observation and in-depth interview
Unit 4
Result
Unit4.Result
1. Eating Behaviors.
2. Knowledge of diabetes.
3. Family roles.
4. Attitude.
5. Feeling on Diabetes Mellitus.
6. Difficulties and Limits that affect the diet
control.
7. Observing the nutritionist.
1. Eating Behaviors.
.
1.1 Caregivers' behavior.
1.1.1 Some cargivers have a need to
control eating.
1.1.1.1 Appropriated control.
"In the morning,We eat no more than 2
ladles with tofu soup and the same in the
evening. No fried food."
1.1 Caregivers' behavior.
1.1.1.2 inappropriated control.
"Eating about 2 ladles with boiled
vegetable and fruit such as one or two
kilograms of orange. Some time we eat
fried foods."
1.1 Caregivers' behavior.
1.1.2 Some caregivers do not have a need
to control eating.
"Eating same as other, no specific foods
for patient."
1.2 Patients' behavior.
1.2.1 Some patient have a need to control eating.
1.2.1.1 Appropriately control
"No sweets, no fats. I eat vegetables such as
lettuce, morning glory but no roots“
1.2.1.2 inappropriately control
"One milk, 2 ladles of rice, with salts fish, rarely
fruits, but no sweets."
1.2 Patients' behavior.
1.2.2 Some patient do not have a need to
control eating.
"I eat everything, sweets, fruits."
2. Knowledge of diabetes.
2.1 Cause of Diabetes Mellitus.
2.1.1 Some participles do not have any
knowledge.
"I do not know. None diabetes in my
family.“
"I know only not to eat sweets."
2.1 Cause of Diabetes Mellitus.
2.1.2 Some participles think that Diabetes
Mellitus cause from eating behaviors.
"It cause from cabohydrate.“
"I usually not eat sweets, but I do not know
why it affects me."
2.1 Cause of Diabetes Mellitus.
2.1.3 Some participles think that other
chronic disease cause Diabetes Mellitus.
"It cause from Hypertension and Lipids“
"First my father does not have Diabetes.
He has Hypertension and Dyslipidemia.
These cause Diabetes."
2.2 Controlling blood sugar.
2.2.1 Some participles think that dietary
affects blood sugar level.
"Eat less. Less salts. Less sweets."
2.2 Controlling blood sugar.
2.2.2 Some participles think that drugs
affects blood sugar level.
"I watch TV, it said that contraception
affects blood sugar.“
"The Diabetes is controllable beacause my
father used oral drugs, not injected."
2.3 Symptoms of Diabetes Mellitus.
"Fatigue, bored with food, moody“
"My father has thirsty, fatigue, frequent
micturition."
2.4 Complication of Diabetes
Mellitus.
“it is serious. Difficult wound healing and
more.“
“If you have wounds, it will get bigger.“
“If not control, it will affect the eyes.“
3. Family roles.
3. Family roles.
3.1 Some families do not involve in
diabetic cares beacause of they do not
know how to cares and they do not realize
how important of family roles.
"He do not control. he do not know much
and not aware."
3. Family roles.
3.2 Some families give an instructive,
exhort and encourage.
“I tell my mother not to eat sweets but eat
vegetable and fruits“
“My father usually drink soft drink. I always
criticize him."
3. Family roles.
3.3 Some families provide food for patient
but do not give advices.
“My daughter prepare the foods. I just eat
and sleep.“
3. Family roles.
3.4 Some families provide food for patient
and give advices.
“It important to prepare the foods and
advice him what to eat. If I am not prepare,
he do not choose what to eat.“
3. Family roles.
3.5 Some families control eating as same
as the patients.
“I diet with hers. I do not want to have
diabetes.”
4. Attitude
4.1 Diabetes Mellitus.
4.1.1 Diabetes Mellitus is a common disease.
“In these day, everyone has diabetes.“
“It is a millionaire disease.“
“Everyone has diabetes when they grow up."
4.1 Diabetes Mellitus.
4.1.2 Diabetes Mellitus is a serious disease.
"It serious but if we control it, no matter.“
4.1.3 Diabetes Mellitus is not a serious
disease.
"At first I worried but now it dose not matter."
4.2 Eating.
4.2.1 Family roles is important to the diet
control.
"Family is important in the control of
diabetes because he do not know what to
eat.“
"It is a duty to care him."
4.2 Eating.
4.2.2 Family roles is not affects the diet
control.
“Families do not matter much. We take
care of ourselves.“
“Control or not depends on yourself.“
4.2 Eating.
4.2.3 Diet control is difficult.
"It difficult but depends on yourself.“
"If not eat when hungry, I will palpitate.
Then I eat."
4.2 Eating.
4.2.4 Diet control is unnecessary or do not
important.
"Let's the doctors do, and follow them. if
not eat sweet much, It does not matter.“
"Fear but still eating."
5. Feeling on Diabetes
Mellitus.
5.1 Some participle fear the complications
of Diabetes Mellitus.
“I fear blindness then I do not eat sweet.”
“Fear it involve the eyes.”
5.2 Some participle worry about Diabetes
Mellitus affects their live.
"Very nervous because he can not work
and frequently fatigue."
5.3 Some participle tire of the medications.
"Bored to go to the hospital.“
"Bored to take drugs"
5.4 Some participles do not aware.
"Fear in the past but now it is normally"
6. Difficulties and Limits that affect
the diet control.
6.1 Some participle can not choose what
they eat.
“My children buy foods for us. We can not
choose what they brought.”
“We live in countryside. We can not
choose what to eat. We eat what we have”
6. Difficulties and Limits that affect
the diet control.
6.2 Some participle do not take an
advices.
“She dose not live long. Let’s she eat what
she want.”
“I can not force him. He is father the he
does not listen to his children.”
6. Difficulties and Limits that affect
the diet control.
6.3 Occupation of Some participle is and
difficulty.
“We sell foods. So we eat the leftovers.”
“Sometime I busy with my job then I can
not go to hospital.”
6. Difficulties and Limits that affect
the diet control.
6.4 Some participles think that other
disease is more serious than Diabetes
Mellitus so they do not control eating.
“If I do not eat I will weak. Then I can not
fight the cancer.”
7. Observing the nutritionist.
7.1 Some participles ignore the nutritionist.
7.2 Types of food nutritionist presented does
not match what the patient ate.
7.3 Some caregivers did not attend the
nutritionist with the patient.
7.4 Some participles didi not attend the
nutritionist.
Unit 5
Conclusions,Discussion&Suggestion
s
Conclusion
• Eating behavior
– Some of the participants
• Appropriated diet control
• Diet control but unappropriated
• No diet control
Conclusion
• Knowledge about DM type 2
– Some of participants
• No knowledge about cause of DM type 2
• Know that eating behavior ,chronic diseases and
drugs are risk factors of the disease
• Know about symptoms and complications of the
disease
Conclusion
• The caregivers’role in type 2 DM patient’s
eating behavior
– Almost caregivers of DM patients are their
families.
– Advice for treatment and encourage the
patient
– Prepare food for the patients but not the DM
food
– Some of the caregiver control their eating
behavior with the patient
Conclusion
• Attitude about type 2 DM
– Some of the participants think that
• The disease is common and not severe.
• The family is important for the patients’ diet
control.
• Diet control for type 2 DM patients is not necessary
and difficult to practice .
Conclusion
• Feelings about type 2 Diabetes mellitus
– Some of the participant concern about
complications and treatment of the diseases.
• Obstacles and constraints that affect diet
control
– The family doesn’t control eating behavior
with the patients.
– The occupation
Discussion
• Appropriately control their eating behavior
• Have a diet control but doesn’t valid.
• No diet control
Discussion
• No knowledge about the disease
• Have a knowledge but cannot be applied
• No family support
Suggestions
• Communications and Cooperations
– For Medical team ,Patients and Caregivers
• Knowledge and attitude about
–
–
–
–
The disease
Diet control
Treatment
Complications
Acknowledgement
• Our project could not successfully completed
without the kindness of our advisors for the
valuable assistance in supporting our project.
• I would like to express my sincere thanks to my
research advisor, Sarinya Sutthanon, M.D. for her
invaluable help and constant encouragement
throughout the course of this research.
• In addition, I am grateful for the teachers of our
research method: Dr.Suwit Leartkajonsin, M.D., and
Dr.Taweesak Nopkesorn, M.D. for suggestions and
all their help.