Peer Review Article on Descriptive Epidemiology and Diabetes

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How people living with diabetes in Republic of indonesia learn about their illness: A grounded theory study

• Titan Ligita,
• Kristin Wicking,
• Karen Francis,
• Nichole Harvey,
• Intansari Nurjannah

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• Published: February 22, 2019
• https://doi.org/10.1371/journal.pone.0212019

Figures

Abstract

Background

Diabetes education has been constitute to touch on positively on self-management by people with diabetes although niggling is known virtually the procedure by which they assimilate information. The aim of this study was to generate a theory explaining the process past which people with diabetes learn about their disease in Indonesia.

Methods

This study employed a grounded theory methodology influenced past constructivism and symbolic interactionism. A total of xx-eight face-to-face or telephone interviews with participants from Indonesia that included people with diabetes, healthcare professionals, health service providers and families of people with diabetes were conducted in both Indonesia and Commonwealth of australia.

Results

This study discloses a cadre category of Learning, choosing, and acting: cocky-management of diabetes in Indonesia equally the bones social process of how people larn about their diabetes. The process includes five distinctive major categories. People with diabetes acted after they had received recommendations that they considered to be trustworthy. Factors that influenced their choice of recommendations to adopt are also identified.

Conclusions

Sensation of the complexity involved in their decision making volition assist healthcare professionals to engage finer with people living with diabetes.

Citation: Ligita T, Wicking K, Francis K, Harvey N, Nurjannah I (2019) How people living with diabetes in Indonesia learn well-nigh their disease: A grounded theory study. PLoS ONE 14(two): e0212019. https://doi.org/ten.1371/journal.pone.0212019

Editor: Olayinka O. Shiyanbola, University of Wisconsin Madison Schoolhouse of Chemist's shop, Us

Received: June xx, 2018; Accepted: January 25, 2019; Published: February 22, 2019

Copyright: © 2022 Ligita et al. This is an open access article distributed nether the terms of the Creative Eatables Attribution License, which permits unrestricted use, distribution, and reproduction in whatsoever medium, provided the original author and source are credited.

Data Availability: All relevant data are inside the paper.

Funding: Section of Foreign Affairs and Trade, Australian Government provides the Commonwealth of australia Awards Scholarship funding for Titan Ligita'south Doctor of Philosophy study at James Cook University. The Commonwealth of australia Awards Scholarship grant number thirteen/3377. world wide web.australiaawardsindonesia.org/.

Competing interests: The authors have declared that no competing interests be.

Introduction

Arable studies have shown that wellness education is critical for people living with diabetes, as the data provided assists them to self-manage their condition, maintain their blood glucose level (BGL) within a healthy range and prevent deterioration [1,2]. Health education improves people's wellness literacy [3]. Health literacy refers to people using their skills, knowledge, abilities and experiences to seek, empathise and accept activeness on health information and consequently brand a conclusion nigh health care also as notice and use health services [4]. Therefore, education allows people to become empowered and autonomous when making important decisions regarding their health [v]. When people engage in educational programs there is a positive link to meliorate wellness outcomes for that person, which enhances their overall health and wellbeing [6–9]. Conversely, people that do not appoint in health educational programs are more likely to make poor health decisions and engage in harmful self-management practices.

Educational programs provide data to highlight the importance of treatments to effectively manage diabetes and preclude complications, with the aim of promoting self-intendance management [7,10]. Educational guidelines help people with diabetes to understand the rationales for recommended interventions, such as: regular BGL monitoring; administration of insulin and oral hypoglycaemic medications; low sugar diet; and lifestyle changes [1].

Unfortunately, participation in diabetes educational programs is limited [7] because of financial, medical and logistical (admission) reasons [11]. This paper will explicate the procedure of how people with diabetes in Indonesia larn about their disease, which is crucial in trying to help improve the wellness outcomes for Indonesian peoples. Furthermore, an exploration of the experiences of people with diabetes will exist shared then that the process of how they receive and and then engage with educational activity can be better understood, with the aim of providing more effective diabetes educational programs in the future.

Background

Diabetes in Indonesia is considered a major health problem and has been a business organisation since the early 1980s [12]. With more than than 10 1000000 people living with diabetes, Indonesia has a prevalence charge per unit of 6.2% [thirteen] and diabetes is one major cause of expiry [fourteen]. Indonesia was rated as one of the top 10 countries globally with a high number of individuals living with diabetes in 2013 [fifteen]. It is predicted that the aforementioned blueprint will continue [15] unless interventions to prevent and manage diabetes are implemented.

To address the alarming numbers of Indonesian people with diabetes, diabetes experts have developed guidelines for preventing and managing diabetes [sixteen]. Managing diabetes is crucial to prevent people from experiencing severe complications such as neuropathy, nephropathy, retinopathy, microvascular and cardiovascular disease [17–20]. Pharmacologic therapies such as oral medications and insulin, and not-pharmacologic therapies such equally lifestyle modifications are still considered contemporary interventions for managing diabetes [21]. These interventions can just exist implemented and accomplished through diabetic educational programs that promote self-care management [22].

Healthcare services in Indonesia provide some constructive diabetes educational programs [6,8,23]. The availability of certified diabetic educators is limited in Indonesia [24] resulting in a dearth of skilled health care professionals (HCPs) to provide education to people with diabetes [25,26]. There is trivial evidence available about the process of how people with diabetes learn almost their disease after they take received diabetes related information informally or formally through structured educational interventions in the Indonesian context. We used a grounded theory methodology to gain insight into how people with diabetes learn about their illness and the processes past which they received and engaged in diabetes health instruction. Agreement this learning process has the potential to assist HCPs to develop and brand bachelor constructive, artistic and culturally-responsive diabetes health education to inform people with diabetes in their selection of appropriate self-management strategies.

Grounded theory study

Ethical approvals to conduct the study were obtained from the Human Inquiry Ethics Committee at James Cook University and from the local Research Ideals Board at the Faculty of Nursing, Universitas Indonesia. The research study avoided coercion considering only participants who volunteered to participate in the study were interviewed. Before the interviews were performed, we provided the participants with information sheets and written consent forms. The interviews started once the participants had read and signed the informed consent forms.

Methodology

This study employed a grounded theory methodology. Originally established by two scholars Barney Glaser and Anselm Strauss, grounded theory is a qualitative inquiry methodology aiming to generate a theory grounded from the information [27]. The generated theory then explains the study phenomena. Two philosophical stances influenced this grounded theory study. Firstly, symbolic interactionism whereby people's lives and behaviours were explored [28] and secondly constructivism, the process of how people understood their diabetes (meanings) and how that understanding subsequently informed their deportment [29]. In this grounded theory study, nosotros generated and concurrently analysed data. To rigorously use grounded theory methodology, nosotros used the essential methods of grounded theory in the selection of study participants (purposeful and theoretical sampling) and in the drove and analysis of data [30]. When using a purposeful sampling method, potential participants are targeted who are considered suitable to provide insights that volition allow exploration of the phenomenon of interest [31]. However, theoretical sampling is unique to grounded theory, and is a method in which more than data are gathered to define and refine the relevant developing categories or emerging theory [32].

The data were analysed past using constant comparative analysis through three stages of the coding process: initial coding, intermediate coding and advanced coding. Information were managed and organised through the NVivo software version 10 [33]. The process of assay occurred through abiding comparative analysis, which is referred to every bit comparing the data, specifically, comparing incidents with incidents, incidents with codes, codes with codes, codes with categories and categories with categories [30]. The comparisons were also applied betwixt existing data and incoming data. For case, in the incoming data, new codes were developed. Then these new codes were compared with the formerly adult codes (existing data). Also, codes developed in ane interview extract were compared with codes developed in other excerpts of the same interview, or codes developed in other interview excerpts.

Coding is defined when the analyst applies labels to information fragments and as a upshot the data has a connection to theory development [29]. In the initial coding stage, raw data was cleaved down into fragments and labels were attached to the information. This process produced codes. A process code was labelled when coding conceptual deportment or appreciable activities and they are written by using the gerund grade or 'ing' words, for example 'seeking' [29,34]. Initial coding took place both during the first and second data generation field trips.

Codes developed during initial coding were collapsed in intermediate coding, which is sometimes referred to as focused coding. At this phase, significant codes were selected to form categories [32]. Categories were and then adult from these codes while standing to use constant comparative assay. During the next stage of analysis, advanced coding, i core category was selected and it comprised a theory entitled Learning, choosing, and interim: self-management of diabetes in Indonesia. This core category has five major categories that elucidate the process of how people with diabetes learn about their disease.

Additionally, essential inquiry aids such as: memo writing; concept mapping; field notes; and storyline were also employed to help with analysis and theoretical integration. This study employed concept mapping equally an analytical tool to explore the data and to link codes, categories and sub-categories. A storyline was crafted, equally a tool for explaining the theory and was regularly updated during data assay. Both the concept map and the storyline explain the theory entitled Learning, choosing, and acting: cocky-management of diabetes in Indonesia.

Participants and study settings

The study was conducted in Due west Kalimantan, which is one of the 34 provinces in Indonesia and inhabited by 3 major ethnic groups. West Kalimantan has a high prevalence rate of diabetes. Information technology was noted by the Indonesian Basic Wellness Survey that the prevalence rate of diabetes mellitus in that province rose from 0.8% in 2007 to 1% in 2013 [35,36]. A total number of 28 interviews were undertaken with participants from both inpatient and outpatient settings in and around Pontianak, the capital city of West Kalimantan province.

Report blueprint

This three stage study was undertaken betwixt April 2022 and July 2017. All interviews were carried out in the national Indonesian language. The Indonesian linguistic communication was also used during the three essential coding processes: initial; intermediate and advanced coding. Hence, a bilingual advisor was included on the research team to assist with the process of translating the interviews and analysing the data. For anonymity and confidentiality, pseudonyms are used when reporting participants' quotes.

Phase one.

Purposive sampling was used to select the participants in phase one and a scoping review also helped to inform which HCPs should be involved [25]. A scoping review is a framework that systematically reviews and scopes the available qualitative and quantitative literature to answer the questions and identify the nature of bear witness in research studies [37–39]. Participants consisted of a person with diabetes, a nurse academic, outpatient clinic nurses, a pharmacist, a dietician and a specialist md. They were recruited from 2 general hospitals, a public wellness centre (Puskesmas) and a nursing academic establishment in Indonesia. Each participant participated in a face-to-face interview, which was digitally recorded and conducted by the lead researcher in West Kalimantan. In this stage, concept mapping was employed.

Phase two.

Data from the first phase led to further information gathering. As the analysis proceeded, theoretical sampling was used to select the next data that included a wide range of participants and additional research settings. Ideals amendment blessing was obtained and a wider range of participants were recruited from additional settings, such every bit a individual wound care clinic and two other public health centres. Interviews with a further 17 participants were again performed in person in Indonesia. They included eight people with diabetes, a general practitioner, a ward nurse, a nursing student, three family members, a health promotion staff member, an exercise instructor and a kader (an Indonesian term for a lay health worker). In this phase, an initial version of the storyline was crafted.

Phase three.

Theoretical sampling directed stage three. The aim of this phase was to refine the storyline in order to facilitate the theory integration process. This process was to determine if the theory was suitable for the area from where it was generated and where it will be used [40]. Two participants were re-interviewed who were involved in the previous phases; an exercise teacher living with diabetes and a nurse academic. The two new participants were recruited and interviewed; a clinic nurse and a person with diabetes. All interviews were conducted via telephone from Australia to Indonesia with each of the 4 participants. Before the interviews, participants were provided with a storyline and a concept map written in the Indonesian language.

Results

Learning, choosing, and acting: Self-direction of diabetes in Indonesia

Learning, choosing, and acting: self-management of diabetes in Indonesia is the core category of this study that explicates the procedure of how people in Indonesia with diabetes learn about their disease. The process consists of five categories, which are the stages that people with diabetes navigate when learning about their illness: 'seeking and receiving diabetes related information'; 'processing received data'; 'responding to recommendations'; 'appraising the results'; and 'sharing with others'. The process is displayed in Fig 1.

This diagram represents a theory of Learning, choosing, and interim: self-management of diabetes in Indonesia, a bones social process of how people with diabetes in Indonesia learn virtually their disease. The numbers show the categories of the process that occur in chronological order. This process occurs dynamically, both in linear and cyclical movements.

Category one: Seeking and receiving diabetes-related data.

This category tin occur before and after people take been diagnosed with diabetes. Before the diagnosis, people with diabetes noticed or recognised their symptoms and gathered information about their disease through active and passive learning techniques. Active learning means that people asked questions of others or sought data from sources such as the internet, television or written materials. Once they were diagnosed, they actively sought data virtually the management of the affliction, description virtually therapies being used, and explanations nearly why they were experiencing actual changes related to the medication used. 1 example of this was Widya, an exercise instructor who has diabetes:

I asked questions nigh what diabetes is. … One [recommendation] that I got is to do exercise. I asked my friend who was in the nutrition division. She said, '"Exercise some exercise, try to practice exercise".

(Widya: G2P14)

Passive learning refers to receiving and listening to data from other people, unremarkably HCPs, without requesting the data themselves. This situation usually occurred when people with diabetes visited healthcare facilities such equally an outpatient clinic or during hospitalisation. Information was so offered equally part of the clinic consultation or in the example of hospitalisation, by HCPs caring for the person. For instance, a pharmacist reflected on the explanations he provided:

…to [make people with diabetes] understand almost the effect of taking medicine regularly and irregularly. We provide the explanation as such. In educating [them], we provide information in order to prevent complications from diabetes

(Cahyo: G1P10).

The source of the information (i.e. who delivers the information) and the place the information was given, varied. Sources of information, from HCPs, included: doctors (e.one thousand. general practitioners and medical specialist doctors); nurses (eg. ward nurses, outpatient care nurses); dieticians; and pharmacists. In improver, non-HCPs may as well be sources of information: kaders; wellness promotion staff at hospitals; nursing students; family members; friends; people with diabetes; and/or individuals who have a relative living with diabetes. The places where information was received included: healthcare facilities such as hospitals and outpatient clinics; within their communities when interacting with others; and/or attending wellness seminars. Haris is an example of someone who sought data from a not-HCP, his little brother:

I was eating and drinking enough… [but] the torso was limp, no energy. I just wanted to have a rest. … I asked my little brother. He has diabetes before me. So I asked my brother why I have this unwell condition. He brought me to the medical [dispensary]. I was checked up… everything was checked up. My blood carbohydrate level was 488 [mg/dL]…very high. My little blood brother brash me. So, from in that location I started to learn how…yep…I accept care of information technology [eating or drinking] until now.

(Haris: G2P1)

Category 2: Processing received data.

The second category is processing the information received. Before the person could trust the information, they examined the information based on their prior knowledge, ain experiences and personal judgement, as well every bit asking for a 2nd opinion from who or what they believed to be a reliable source. Side by side, they had a pick, to trust or distrust the data. The distrusted information was dismissed while the trusted information was accepted. Larisa, a person living with diabetes, did not trust data given to her by friends and she decided to dismiss information technology:

They [friends] usually accept alternative therapies. I do non trust the culling therapies. I exercise not know the measurement, the amount, [and] the dosage. If we have over dosage, we'll have difficulties. … And then when my friends said "take this…take that". I simply said "yes…yep…", but I did non have it. Unless it is authentic and there is a written report/research on it, then I tin empathise it. If not, I do not trust it. I do not easily trust something

(Larisa: G2P7).

Zeta, some other person with diabetes, also sought additional information to clarify her understanding of what medication could be used to manage her diabetes:

I received other people's stance and advice or friends' communication. … I do not just directly execute any received advice. No. I have to look at Google, [for instance, nigh] the function of leaves A or leaves B. The side effect of them.

(Zeta: G3P1)

Category 3: Responding to recommendations.

Individuals responded in either of ii means; they followed the recommendations suggested by either HCPs and/or non-HCPs or they did not follow recommendations from the HCPs or non-HCPs. The HCPs recommended conventional therapeutic interventions while not-HCPs suggested both conventional and non-conventional therapeutic interventions. There were a number of influencing factors that afflicted a person's determination to follow or not to follow recommendations. These were: fiscal state of affairs; time; geographical location; recommendations from relatives and friends; physiological reasons such as changes in the body or worsening symptoms; psychological reasons such as fear of side effects from the medication, fear of having to inject medication and underestimating the disease severity; and issues of convenience and practicality (See Fig ii).

This effigy shows how people with diabetes responded to recommendations by either post-obit or non post-obit the recommendations. Their decisions were influenced by 3 factors: physical, psychological and availability of resource. People with diabetes selected one of 4 variations of responding to the recommendations.

Utama, a diabetic of 8 years, offered that he was influenced by his older sister who told him he would become dependent on insulin, and then and so he did not follow the HCPs' recommendations:

I am agape of becoming dependent on the medication, my sister said 'don't you lot apply that insulin. If you utilize once, it volition be forever'. My sister continued to say that right up until her death [from diabetes complications].

(Utama: G2P5)

The above quote shows that Utama followed his (older) sister's recommendation rather than the recommendations from his HCP. He respected his sis's experiential insight gained from living with the disease, but he also demonstrated respect for someone older than himself, which is a norm in Indonesian civilization [41]. Utama was afraid of taking his prescribed insulin for two reasons: the above fear of becoming dependent as per his older sister's recommendation, and an additional fear of injecting insulin:

I have been prescribed insulin simply I don't employ it. I have never [used it]. I have been prescribed [insulin] when existence discharged from the hospital. … I am afraid to inject it [the needle].

(Utama: G2P5)

Betty, a diabetic of xiii years, delayed commencing insulin injections for a year considering of cost, inconvenience and fright of having to give herself an injection:

Firstly I didn't want to. For a yr I didn't desire to. I was really agape of [injection]. Doctor B who keeps talking to me a lot. It has been a yr [since] he told me to have an insulin injection. … I did not want to because insulin is troublesome. I have to check my blood carbohydrate by myself. Then if [the blood sugar] decreases [too much], [I volition have] faintness, [and] I cannot go anywhere. I thought for a year. I did not want. Just [I was] getting thinner.

(Betty: G2P2,3,v)

Another reason to filibuster treatment was when people with diabetes underestimated the severity of the affliction when comparison their experience of diabetes with other people's. They ofttimes perceived that their diabetes was 'not too bad' compared to other people whose diabetes they believed was more astringent. Utama explained his diabetes was not as significant compared to his sis who had died as a result of a diabetic foot ulcer:

…in the last four years, I just gainsay [the disease]. People say that we don't need to…worry about this disease. If I think as well much, it will be harder so I don't think nearly it too much. At present, I retrieve my affliction is not too severe. I oasis't got the one that my sister had. My sis had a hole [diabetic foot ulcer]… I am not that astringent. I simply have these boils. It hasn't been severe. Non similar other people who accept a small wound then it gets bloated…. No, I am not like that [not that severe].

(Utama: G2P2)

Ranti, a diabetic of 4 years, was concerned about the drug's side effects on her body:

She [the doctor] gave me a medication…. I exercise non take doctor's medication [anymore]… [because of] the chemical [materials]. I took the medication from the medico only for one week.

(Ranti: G2P1)

In addition to individuals who chose not to follow recommendations, there were individuals who but followed recommendations that they trusted, but did and then with varying levels of commitment. Under the umbrella of following recommendations in their ain mode (encounter Fig ii), they either fully followed conventional therapeutic interventions; partially followed conventional therapeutic interventions; used non-conventional therapeutic interventions exclusively; and/or followed conventional and non-conventional therapeutic interventions concurrently.

People who fully followed conventional therapeutic interventions reported adherence to medication(s), exercise, nutrition and BGL monitoring. People who partially followed conventional therapeutic interventions tended to attach to one or two interventions simply. Kevin, a person with diabetes, stated he but took the medication.

I cannot restrict my diet. I still have appetite to consume. [I do] regularly [accept my medication]. … [I] never had [diabetes exercise]. It'southward in PHC just I do non want to, [because] I am lazy to do [so].

(Kevin: G2P2,5)

People who used non-conventional therapies exclusively did not take prescribed medication of any kind or whatever other conventional therapeutic interventions. These people relied on non-conventional therapies such as herbal or traditional medication, mill-made herbal medication or a device worn on their body. One person wore a magnetic girdle, equally she believed it to be beneficial in helping with her diabetes.

I wear this supporting device. [It is similar a corset/waist belt]. For what I have known, information technology repairs …Diabetes occurs because our pancreas is damaged… The pancreas cells are damaged. Or kidneys [are damaged]… If we take many medications [and] drink less water, information technology can damage the kidneys. And so, I am helped by buying this device and so that my kidneys will be good. This device only contains [a] magnet.

(Ranti: G2P4)

The final subset of people used both conventional and non-conventional therapeutic interventions, or alternatively chose to follow the recommendations, only in their own way. This subset of people chose to trial both therapies either consecutively or concurrently for a short catamenia of time. Kevin, a diabetic of five years, indicated that he sometimes took both conventional and non-conventional therapies meantime:

I take prescribed medication by turns [intermittently], sometimes I also take herbals.

(Kevin: G2P1)

The phenomena of taking conventional and non-conventional therapies concurrently was a business concern for HCPs, who feared that people may exist at take a chance of hypoglycaemia. Aditya, a nurse academic and clinician, explained that he occasionally consulted with people with diabetes who took both therapies in the same day. He stated:

At that place were also some patients telling us "I have taken this [non-conventional therapy] merely I took medication from the doctor meantime. I separated it by approximately 2 hours". After we tested the BGLs, information technology showed that the BGLs were stable. The almost of import thing that we brainwash about is the hypoglycaemia. "If you take the therapy and you lot have these symptoms [hypoglycaemia symptoms], information technology ways that you have to end the herbal".

(Aditya: G3P2,3)

Category four: Appraising the result.

Regardless of whether the person followed or did not follow recommendations advocated by HCPs and non-HCPs, these people appraised the results to determine if what they were doing was making any difference to their health. There are iii sub-categories of 'appraising the result': measurement, progress and further actions. People with diabetes observed their trunk changes either subjectively or objectively for positive and negative changes or for no changes. For instance, Oscar demonstrated appraising the issue past objective measurement:

I tried [herbal therapy] from browsing the internet. It really decreased it [the BGL]. Then I became more motivated to take it [the therapy]. It decreased it [the BGL] once again.

(Oscar: G2P3,4)

In the following quote, Zeta plant desirable (positive) changes related to her diabetes status:

Zeta: I was suggested to have herbal, a product from New Zealand. It's a capsule… I was observed [by optometrist] regularly on my eyes. Alhamdulillah [thank you be to God] the [blurred optics] are gone. I feel comfort in my body.

(Zeta: G3P3,iv)

Whereas, Haris expressed that he had been taking traditional medication, only when he reflected on how it was working he constitute it had made no divergence to his condition:

I firstly didn't want to have chemical medication. By taking the traditional medication that I fabricated past myself, I might find the solution, but in fact, there wasn't. No alter [progress].

(Haris: G2P5)

People in this category used their experience to determine whether they would continue with what they were doing or not, to manage their diabetes. Viola, a spouse of a person with diabetes recounted her conclusion to modify how they managed her married man's diabetes:

Nosotros tried a herbal medication for several years. No progress. And so, we decide to be managed by a medico. To regularly go to doctor consultations so that he [the husband] can get ameliorate.

(Viola: G2P8)

The outcomes that people identified were based on their lived experiences. The category of processing received information refers to the 'experiential insight' that people developed, that in turn then helped them decide whether to proceed or discontinue their current treatment and whether or not to return to category 1 to seek further data or recommendations, thus illustrating the cyclic nature of the process.

Category 5: Sharing with others.

The last category is 'sharing with others'. Sharing with others encompasses what data to share and with whom to share it. People tended to share their experiences with people they knew best, particularly family members such equally children or spouses. Haris recounted:

I keep looking forward and prepare myself. I said to my married woman and children. 'I have this disease. This affliction [can] bear upon anywhere [inside the body].' I inform them so that they know. I am non frightening them. One day information technology will happen. With or without the disease, we will all die. But with [me having] this affliction, I said, 'you must be enlightened of… y'all must modify your life concept. Yous must proceed salubrious. Don't be careless'.

(Haris: G2P8,9)

Through interactions in the community, people with diabetes shared their own insights with other diabetics and too with people in the community who may have a loved one with diabetes. When people with diabetes shared their experiences with another person, that chat was often the beginning of that side by side person starting their ain procedure of Learning, choosing, and acting: self-management of diabetes in Indonesia. Fig 3 displays the phenomenon of a person with diabetes sharing insight or feel with another person living with diabetes.

This figure shows how the process of Learning, choosing, and acting: self-management of diabetes in Republic of indonesia occurs from i person with diabetes to another person with diabetes. The process starts when a person with diabetes shares their experience or information with another person with diabetes. The process of sharing information continues from one person, to the next, to the side by side, etc.

Utama shared his own experiences with other people he knows who are also living with diabetes:

I ofttimes inform them. It is about the symptoms. They do not know what diabetes looks similar. I said, 'if you want to prove whether you lot have diabetes or no, yous collect your urine. If there are ants in there, yous may have diabetes. The symptoms are dizzy, fatigue, weakness and thirsty. Y'all just want to drinkable water or sweet drink.' Those are the symptoms [that] I said to them.

(Utama: G2P10)

Word

Where is diabetes related information sourced from?

It is not uncommon for people with diabetes, especially those who experience severe symptoms, to seek information and recommendations from HCPs [42]. People with diabetes involved in our study also sought information from a diverseness of people other than HCPs, namely: friends, acquaintances and family unit members. This result is coinciding with a study conducted in Republic of india, where people with diabetes learned about their affliction through a variety of sources such every bit books, media and friends [43]. When a diversity of sources are used, there is a high hazard for people to be exposed to less reliable or unreliable recommendations.

Recommendations from others may influence people's decisions to stop, alter or to maintain their electric current diabetes care. In this present study, people sometimes discontinued practices subsequently receiving data from not-HCPs. They as well may take changed from using conventional therapies to non-conventional therapies, or vice versa. Hjelm and Atwine [42] reported that people seek non-conventional therapies, such as herbal medications or traditional healers, when they perceive that conventional therapy has failed them. This study found that receiving recommendations from HCPs does not foreclose people from likewise seeking information elsewhere, similar to Mendenhall et al.'south [43] findings in Republic of india.

Choosing data

People with diabetes selected information based on their prior noesis, lived experience personal judgementand/or other people'south opinions. Additionally, the level of expertise of HCPs and the lived feel of other people with diabetes were as well taken into account. People with diabetes trusted the opinions of other people living with diabetes and were sceptical of the recommendations of people who were non diabetic. Sometimes, people with diabetes accepted recommendations from their relatives, who were living with diabetes, rather than the recommendations of their HCPs. The recommendation from the HCPs that people with diabetes in this study chose non to follow commonly centred around taking prescribed medications. Many of the study participants believed that the chemical substances in prescribed medications would cause more impairment than good, thus they decided not to follow the HCP's recommendation. In contrast, some participants who did follow the recommendation from their HCPs rather than from other people, did so because they acknowledged their HCP'south level of expertise. Therefore, they put more trust in their HCPs rather than in non-HCPs.

Building trust between people with diabetes and HCPs is crucial during the provision of care. A previous study did observe that in general, satisfaction and adherence with diabetes treatment is associated with better communication between people with diabetes and their HCP [44]. All the same, this present study provides additional explication of that advice process, past showing how people with diabetes selectively cull which HCP information they will or will not trust and follow. White et al. [45] besides institute that a high level of mistrust can develop because of poor HCP advice skills and not including people in conclusion making almost their own health. When HCPs do non involve people in their intendance, it may impair the development of a positive partnership between the person and their HCP.

Following or not following recommended therapeutic interventions

Individuals in this study chose to adopt conventional and/or not-conventional therapies. This phenomenon is similar to that described by Mendenhall et al. [43], where some people reported using medical treatment (conventional) while others likewise reported using not-allopathic (non-conventional) therapies such equally herbal medications, yoga and foods. Notwithstanding, the findings of this study are distinctive in showing that some people with diabetes elected to partially follow recommended conventional therapeutic regimes. Some people sometimes follow the recommendation in their own mode by modifying the recommended therapeutic authorities based on their own understanding. Their modifications could render the treatment ineffective or even harmful. This finding aligns with those of Webster et al. [46] who plant people can develop questionable strategies to manage their diabetes when advice with their HCPs has failed. This phenomenon should be acknowledged by HCPs to ensure people with diabetes understand and are able to implement the therapeutic strategies proposed past the HCP rather than their interpretation or modification of that proposed strategy.

Resources issues, such every bit affordability and accessibility of therapies, were found to be factors influencing peoples' decisions to follow recommendations in this nowadays study. Others factors were physiological and psychological reasons. Even though people in this report could and did brand their own decisions, they ideally should be guided by a HCP so that appropriate therapies are implemented. Therefore, our findings point that HCPs need to place what challenges people with diabetes have encountered in following the recommendations from their HCPs and to and then work together to see how those challenges can exist resolved. Lee et al. [47] likewise plant that during consultation, the HCP needs to consider each person's knowledge level, personal traits, family supports too equally their awareness of diabetes medications and available treatment options. Our findings echo the Australian College of Nursing'south argument that involving the person in decision making demonstrates the HCP's respect for the person and exemplifies a person-centred approach to care [48]. Our findings are congruent with those of Herlitz et al. [49] and Ramsay Wan, Vo and Barnes [50] who found that people who trust their HCPs and feel empowered to inquire questions and make informed decisions are more probable to finer manage their diabetes [49,fifty].

Respecting i's cultural background should exist acknowledged when HCPs work with people with diabetes. Due to cultural influences, some people with diabetes in this report still believed in and preferred the use of natural substances, either solely or in combination with prescription medicines, as their way of managing their diabetes. The use of natural substances has been adept by Indonesian people for generations for disease treatment [51]. The use of natural substances for disease direction may even so exist practiced by people who live in rural areas and have limited access to prescription medication [52]. The cultural context must exist taken into account when working with Indonesian people with diabetes. It is recommended that HCPs provide data regarding the evidence for the effective apply, dosage, and the route of administration of natural substances to people with diabetes who use these to manage their disease. Identifying culturally-influenced practices can assist HCPs to empathise the rationale for people with diabetes choosing illness management methods. This information will ensure that HCPs are able to provide appropriate health didactics and back up people's diabetes direction regimes.

Evaluating the care

Experiential insight gained from this action is a distinctive feature of the theory of Learning, choosing, and acting: self-direction of diabetes in Indonesia. Learning about diabetes led to people gaining insight in this present study. This finding reflects those of Quandt et al. [53] who claimed that what people acquire influences their diabetes related beliefs and their capacity to manage their diabetes.

People in this study appraised their current therapy to decide whether to continue or discontinue their current regime. The literature highlights that people experience positive and negative outcomes following initiation of handling [54,55]. This current written report demonstrated that people with diabetes evaluated their treatment using objective and subjective measurements. They observed their body changes subjectively and objectively to determine desirable and undesirable outcomes. This appraisal action is part of their learning virtually their diabetes and its management, and resulted in their newfound experiential insight.

People relied on a subjective measurement, which was based on how their torso felt, rather than objective biometric assessment. Purchasing a BGL monitor is an expense that many Indonesian people with diabetes were unable to afford. The cost of buying a BGL monitor would currently equate to 25% of the average monthly income of an Indonesian person [56]. Participants reported that access to services such as a customs pharmacist that provides BGL monitoring was non always locally bachelor. Every bit a effect, regular monitoring of their BGL was not possible.

People in this written report compared their feel of diabetes to other people'south experience of diabetes. This comparison caused them to underestimate their own disease severity, since they had not all the same experienced complications such as foot ulcers or diabetic retinopathy. This finding is confirmed by Pitaloka and Hsieh [57] who institute that people with diabetes in Indonesia considered diabetes was not life threatening as they were able to perform every day tasks. Underestimation of the severity of diabetes by participants in our study led to them delaying implementation of treatment or to modifying their treatment plans. Participants who experienced secondary complications subsequently sought medical assistance, although for some people the extent of deterioration limited the therapeutic interventions that could and so be implemented. For these people, death was inevitable.

People in the electric current study altered their diabetes direction regimes if undesirable outcomes were experienced, new information regarding their electric current therapy was received and if they were unable to secure medications or necessary equipment such as insulin or BGL monitors. This study'southward findings concur with that of Hjelm and Atwine [42] who identified that people may modify their therapeutic regimes when they are not satisfied with the outcome.

Other studies accept establish that experiences of implementing diabetes self-direction tin can exist exhausting and frustrating because people with diabetes accept difficulties in balancing their everyday life especially when dealing with medication regimes, meal planning, compensating for a sedentary working life and avoiding self-care exhaustion [54,58,59]. Participants in the nowadays study also reported similar challenges and frustrations. Therefore, it is recommended that HCPs appoint early in a thorough, respectful and sensitive discussion with people with diabetes to discuss their understanding and direction of diabetes and the difficulties they run into in following treatment recommendations. These conversations should include provision of information to accost knowledge deficits and adaptations if advisable to treatment recommendations or assistance with addressing identified difficulties.

Informing others about their experiences

A person often acquired information well-nigh diabetes from hearing about other people's experiences with diabetes. Consequently, that person then went on to share his/her own experiences of diabetes with other people. In this study, the most likely people that a person shared their experience with were significant others, such as family or friends, and more rarely, acquaintances. People with diabetes volition share information nigh their diabetes to others that they believe can provide feedback including HCPs [lx].

People with diabetes can besides learn from the stories of others who as well have diabetes [61]. For instance, AlQarni, Yunus and Househ [62] found that sharing stories or experiences and information related to diabetes with each other and/or their caregivers occured via electronic mediums such as social media [62]. Withal, people in this current study still shared their experiences in person, during social interactions with families, friends, neighbours and customs groups. In Indonesia, living in a neighbourhood allows people to gather and collaborate with each other on social occasions, either formally or informally. These occasions provide an opportunity for people with diabetes to discuss with others their experiences of living with diabetes. Consequently, people can both share their experiences and hear experiences from others most diabetes and how others manage it. The information shared may exist appropriate or erroneous. Both social media and face to face social interaction can be useful mediums to share experiences. Even so, HCPs need to be aware that incorrect or misleading data may also be shared in these non-moderated contexts, as was also reported by Edwards et al. [63].

Study limitations

Participation in the study was voluntary, and as in any qualitative study, the use of volunteers may introduce a volunteer bias. The results therefore may non be applicable to the entire population in the study setting. Additionally, the study participants came only from two of the 3 principal ethnic groups in West Kalimantan, which may limit generalisability to all Indonesian people with diabetes.

Conclusion

This written report produced a theory entitled Learning, choosing, and acting: self-management of diabetes in Indonesia, which helps explain how people with diabetes learn about their illness and appoint in wellness education in the Indonesian context. The process involves 5 categories which interact with each other in both a linear and cyclical manner. The first of the five categories demonstrates how people with diabetes initially sought out information; oftentimes from family and friends who also had experiences with diabetes. Side by side the person proceeded to process this received information to brand sense of it. From hither people responded to the processed information by either post-obit the recommendations or not. This written report uncovered evidence of a number of factors that influenced whether a person followed or did not follow recommendations. Some of these factors were related to their financial situation, where they lived, what relatives and friends were advising and psychological reasons such equally fright of having to inject medication. The fourth category involved people appraising their results and determining what time to come actions to take. The final category, sharing with others, was based on sharing information based on their own experiences.

Evidence from this report can inform HCPs to increase their awareness to focus non just on what people with diabetes have to do for managing their diabetes but also to evaluate how people with diabetes can exercise so, given the unique availability of resources they take, thus exemplifying person-centred diabetes care. The theory of Learning, choosing, and acting: self-direction of diabetes in Indonesia tin can be a basis for HCPs to develop a feasible approach in health didactics that considers people's own prior knowledge, personal judgement and own experience, as these factors tin can influence their decisions to employ advisable diabetes cocky-management. Thus, to enhance monitoring and support of peoples' self-management practices, HCPs need to take close and regular interactions with people with diabetes. Programs of diabetes specialisation in each discipline of wellness intendance should include the skills of close ascertainment and detailed evaluation to ascertain how each individual with diabetes has arrived at their ain electric current self-management approach, and how it is currently working for them (or not).

Farther enquiry is required to develop and evaluate a viable model of diabetes care involving various related health disciplines in the provision of wellness didactics that exemplifies person centred intendance. Enquiry could also investigate whether aspects of the theory of Learning, choosing, and acting: self-management of diabetes in Indonesia can be applied to other chronic diseases or to people with diabetes in other like geographical locations.

Acknowledgments

This paper is part of a doctoral caste plan. The authors acknowledge the Department of Foreign Affairs and Merchandise, Australian Government, for the funding provided for Titan Ligita's Doc of Philosophy study at James Cook University, Australia. The authors would like to give thanks the participants for their contributions to this study and appreciate the admission to report settings for participant recruitment.

References

1. 1. Brunisholz KD, Briot P, Hamilton South, Joy EA, Lomax G, Barton N, et al. Diabetes cocky-management education improves quality of care and clinical outcomes determined by a diabetes bundle mensurate. Journal of multidisciplinary healthcare. 2014;vii:533–42. pmid:25473293
   • View Article
   • PubMed/NCBI
   • Google Scholar
2. ii. Klein HA, Jackson SM, Street M, Whitacre JC, Klein Grand. Diabetes self-management education: miles to go. Nursing enquiry and practice. 2013;2013:581012–15. pmid:23577243
   • View Commodity
   • PubMed/NCBI
   • Google Scholar
3. 3. Nutbeam D, Kickbusch I. Wellness promotion glossary. Wellness Promotion International. 1998;thirteen(4):349–64.
   • View Commodity
   • Google Scholar
4. 4. National argument on wellness literacy [Internet]. 2022 [cited 14 May 2018]. https://www.safetyandquality.gov.au/our-work/patient-and-consumer-centred-intendance/health-literacy/.
5. five. Eyuboglu E, Schulz PJ. Practise health literacy and patient empowerment touch self-intendance behaviour? a survey study among Turkish patients with diabetes. BMJ Open. 2016;6(3):e010186. pmid:26975936
   • View Commodity
   • PubMed/NCBI
   • Google Scholar
6. 6. Hartayu TS, Izham Yard, Suryawati S. Improving type 2 diabetes patients' quality of life past using a community based interactive approach—diabetes mellitus strategy in Yogyakarta, Indonesia. Periodical of Pharmaceutical Health Services Research. 2012;3(2):95–102.
   • View Article
   • Google Scholar
7. seven. Powers MA, Bardsley J, Cypress M, Duker P, Funnell MM, Fischl AH, et al. Diabetes cocky-management education and support in blazon two diabetes: a joint position argument of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. The Diabetes Educator. 2017;43(one):forty–53.
   • View Article
   • Google Scholar
8. viii. Mahdalena K, Ningsih ESP. Effectivity of foot care education program in improving knowledge, cocky-efficacy and human foot care behavior of diabetes mellitus patients in Banjarbaru, Indonesia. Kesmas: National Public Wellness Journal. 2016;eleven(2).
   • View Article
   • Google Scholar
9. 9. Naccashian Z. The touch on of diabetes self-direction education on glucose management and empowerment in ethnic Armenians with blazon 2 diabetes. The Diabetes Educator. 2014;40(five):638–47. pmid:24872385
   • View Article
   • PubMed/NCBI
   • Google Scholar
10. 10. Murray CM, Shah BR. Diabetes self-management education improves medication utilization and retinopathy screening in the elderly. Main Care Diabetes. 2016;x(3):179–85. pmid:26620389
    • View Article
    • PubMed/NCBI
    • Google Scholar
11. eleven. Horigan One thousand, Davies K, Findlay-White F, Chaney D, Coates V. Reasons why patients referred to diabetes pedagogy programmes choose non to attend: a systematic review. Diabetic Medicine. 2017;34(i):14–26. pmid:26996982
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
12. 12. Waspadji S, Ranakusuma AB, Suyono S, Supartondo S, Sukaton U. Diabetes mellitus in an urban population in Jakarta, Indonesia. The Tohoku Journal of Experimental Medicine. 1983;141 Suppl:219.
    • View Article
    • Google Scholar
13. thirteen. International Diabetes Federation. IDF Diabetes Atlas. Brussels, Belgium: International Diabetes Federation; 2017.
14. fourteen. World Health Organization. Indonesia: diabetes country profile. Geneva; 2016.
15. xv. Guariguata 50, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Research and Clinical Practise. 2014;103(2):137–49. pmid:24630390
    • View Article
    • PubMed/NCBI
    • Google Scholar
16. 16. Rudijanto A, Soewondo P, Waspadji S, Yunir Due east, Purnamasari D. The Indonesian guild of endocrinology'south summary article of diabetes mellitus national clinical practice guidelines. Journal of the ASEAN Federation of Endocrine Societies. 2011;26(1):17–9.
    • View Article
    • Google Scholar
17. 17. Sja'bani G, Asdie AH, Widayati K, Subroto Y, Kariadi SH, Arifin AYL, et al. Microalbuminuria prevalence written report in hypertensive patients with blazon two diabetes in Indonesia. Acta Medica Indonesiana. 2005;37(4):199–204. pmid:16354940
    • View Article
    • PubMed/NCBI
    • Google Scholar
18. 18. Soebardi Due south, Purnamasari D, Oemardi Grand, Soewondo P, Waspadji S, Soegondo S. Dyslipidemia in newly diagnosed diabetes mellitus: the Dki jakarta main not-catching disease run a risk factors surveillance 2006. Acta Medica Indonesiana. 2009;41(4):186–90. pmid:20124614
    • View Article
    • PubMed/NCBI
    • Google Scholar
19. nineteen. Soegondo South, Prodjosudjadi Due west, Setiawati A. Prevalence and risk factors for microalbuminuria in a cross-exclusive study of type-two diabetic patients in Republic of indonesia: a subset of DEMAND written report. Medical Journal of Republic of indonesia. 2009;18(two):124–30.
    • View Commodity
    • Google Scholar
20. 20. Soewondo P, Soegondo S, Suastika K, Pranoto A, Soeatmadji DW, Tjokroprawiro A. The DiabCare Asia 2008 written report: outcomes on control and complications of type 2 diabetic patients in Indonesia. Medical Journal of Republic of indonesia. 2010;nineteen(4):235–44.
    • View Commodity
    • Google Scholar
21. 21. Soewondo P, Kshanti IA, Pramono RB, Langi YA, Dalem-Pemayun TG. Clinical experience with insulin detemir: results from the Indonesian accomplice of the international A₁chieve study. Diabetes Enquiry and Clinical Practice. 2013;100:S47–S53.
    • View Article
    • Google Scholar
22. 22. Funnell MM, Brown TL, Childs BP, Haas LB, Hosey GM, Jensen B, et al. National standards for diabetes cocky-management education. Diabetes Care. 2010;33(1):S89–S96.
    • View Commodity
    • Google Scholar
23. 23. Hartayu TS, Izham Grand, Suryawati S. Improving of blazon 2 diabetic patients knowledge, attitude and exercise towards diabetes cocky-intendance past implementing community-based interactive approach-diabetes mellitus strategy. BioMed Central Research Notes. 2012;five(one):315-.
    • View Article
    • Google Scholar
24. 24. Sutanegara D, Budhiarta AAG. The epidemiology and management of diabetes mellitus in Indonesia. Diabetes Inquiry and Clinical Practice. 2000;50:S9–S16. pmid:11024578
    • View Article
    • PubMed/NCBI
    • Google Scholar
25. 25. Ligita T, Wicking K, Harvey North, Mills J. The contour of diabetes healthcare professionals in Indonesia: a scoping review. International Nursing Review. 2018.
    • View Commodity
    • Google Scholar
26. 26. Malini H, Copnell B, Moss C. Considerations in adopting a culturally relevant diabetes wellness education programme: an Indonesian case. Collegian. 2017;24(two):183–ninety.
    • View Article
    • Google Scholar
27. 27. Glaser BG, Strauss AL. The discovery of grounded theory: strategies for qualitative inquiry. Hawthorne, NY: Aldine de Gruyter; 1967.
28. 28. Blumer H. Symbolic interactionism: Perspective and method. Berkeley: University of California Printing; 1969.
29. 29. Charmaz K. Constructing grounded theory: a applied guide through qualitative analysis. London: SAGE; 2006.
30. 30. Birks M, Mills J. Grounded theory: a practical guide. M Oaks, CA: SAGE; 2015.
31. 31. Creswell JW. Qualitative enquiry and research design: choosing among five approaches. Thousand Oaks, Calif: SAGE Publications; 2013.
32. 32. Charmaz Yard. Amalgam grounded theory. 2nd ed. London: SAGE; 2014.
33. 33. QSR International Pty Ltd. NVivo Qualitative data anlysis software2016.
34. 34. Saldana J. The coding manual for qualitative researchers. 2nd ed. London: Sage Publications; 2013.
35. 35. National Institute for Health Research and Development. 'Riset Kesehatan Dasar'. Division HRaD, editor. Jakarta: Ministry building of Health of Republic of indonesia; 2008.
36. 36. National Institute for Health Enquiry and Development. 'Riset Kesehatan Dasar'. Division HRaD, editor. Jakarta: Ministry of Health Republic of Indonesia; 2013.
37. 37. Arksey H, O'Malley 50. Scoping studies: towards a methodological framework. International Journal of Social Inquiry Methodology. 2005;eight(1):nineteen–32.
    • View Article
    • Google Scholar
38. 38. Grant MJ, Berth A. A typology of reviews: an analysis of fourteen review types and associated methodologies. Wellness Information & Libraries Periodical. 2009;26(ii):91–108.
    • View Commodity
    • Google Scholar
39. 39. Mays N, Pope C, Popay J. Systematically reviewing qualitative and quantitative evidence to inform direction and policy-making in the health field. Journal of Health Services Research and Policy. 2005;10(i):vi–20.
    • View Article
    • Google Scholar
40. 40. Corbin JM, Strauss AL. Basics of qualitative research: techniques and procedures for developing grounded theory. Los Angeles: Sage Publications, Inc; 2008.
41. 41. Moffatt A. Indonesian culture profile. W End, Queensland: Diversicare; 2012.
42. 42. Hjelm K, Atwine F. Health-intendance seeking behaviour among persons with diabetes in Uganda: an interview report. BMC International Wellness and Human being Rights. 2011;11(i):xi-.
    • View Article
    • Google Scholar
43. 43. Mendenhall E, McMurry HS, Shivashankar R, Narayan KMV, Tandon Northward, Prabhakaran D. Normalizing diabetes in Delhi: a qualitative report of wellness and wellness care. Anthropology & Medicine. 2016;23(3):295–310.
    • View Article
    • Google Scholar
44. 44. White RO, Eden South, Wallston KA, Kripalani Due south, Barto S, Shintani A, et al. Health advice, self-care, and treatment satisfaction among low-income diabetes patients in a public health setting. Patient Educational activity and Counseling. 2015;98(2):144–ix. pmid:25468393
    • View Article
    • PubMed/NCBI
    • Google Scholar
45. 45. White RO, Chakkalakal RJ, Presley CA, Bian A, Schildcrout JS, Wallston KA, et al. Perceptions of provider communication amid vulnerable patients with diabetes: influences of medical mistrust and wellness literacy. Journal of Wellness Advice. 2016;21(sup2):127–34. pmid:27662442
    • View Article
    • PubMed/NCBI
    • Google Scholar
46. 46. Webster E, Johnson C, Kemp B, Smith V, Johnson Grand, Townsend B. Theory that explains an Aboriginal perspective of learning to understand and manage diabetes. Australian and New Zealand Journal of Public Health. 2017;41(1):27–31. pmid:27868348
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
47. 47. Lee YK, Low WY, Lee PY, Ng CJ. Factors influencing decision-making function preferences: a qualitative report of Malaysian patients with type 2 diabetes during insulin initiation. International Journal of Nursing Practice. 2015;21:125–31.
    • View Article
    • Google Scholar
48. 48. Person-centred care [Internet]. 2022 [cited xiv February 2018]. https://www.acn.edu.au/sites/default/files/advocacy/submissions/PS_Person-centered_Care_C2.pdf.
49. 49. Herlitz A, Munthe C, Törner 1000, Forsander M. The counseling, cocky-care, adherence approach to person-centered care and shared conclusion making: moral psychology, executive autonomy, and ethics in multi-dimensional intendance decisions. Health Communication. 2016;31(eight):964–73. pmid:26756477
    • View Article
    • PubMed/NCBI
    • Google Scholar
50. 50. Ramsay Wan C, Vo Fifty, Barnes CS. Conceptualizations of patient empowerment among individuals seeking treatment for diabetes mellitus in an urban, public-sector clinic. Patient Pedagogy and Counseling. 2012;87(3):402–4. pmid:22005710
    • View Article
    • PubMed/NCBI
    • Google Scholar
51. 51. Tanto A, Syarfina F, Dimas Abdul Azis F, Alifian PH, Adilla S, editors. Tackling Indonesia'due south diabetes challenge with indonesian traditional herbs as dietary supplementation to reduce evolution of cardiovascular complications: promotion the use of natural product. Asian Academic Guild International Briefing Proceeding; 2017; Khon Kaen, Thailand.
52. 52. Pramono LA. Plants and herbs for therapy of diabetes. Medical Journal of Indonesia. 2015;24(two):67–9.
    • View Article
    • Google Scholar
53. 53. Quandt SA, Reynolds T, Chapman C, Bell RA, Grzywacz JG, Ip EH, et al. Older adults' fears about diabetes: using common sense models of disease to understand fear origins and implications for self-management. Journal of Practical Gerontology. 2013;32(7):783–803.
    • View Commodity
    • Google Scholar
54. 54. Bockwoldt D, Staffileno BA, Coke L, Hamilton R, Fogg L, Calvin D, et al. Understanding experiences of diabetes medications among African Americans living with type 2 diabetes. Journal of Transcultural Nursing. 2017;28(4):363–71. pmid:27215757
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
55. 55. Vos RC, Hermans TGT, Zuithoff NPA, Müller Due north, Khunti K, Rutten GEHM, et al. What determines treatment satisfaction of patients with type 2 diabetes on insulin therapy? an observational report in eight European countries. BMJ Open. 2017;7(7).
    • View Article
    • Google Scholar
56. 56. Regional/province minimum wages in 2022 [Internet]. 2022 [cited 17 October 2018]. https://world wide web.bps.go.id/linkTableDinamis/view/id/917.
57. 57. Pitaloka D, Hsieh Due east. Health as submission and social responsibilities: embodied experiences of Javanese women with type 2 diabetes. Qualitative Health Research. 2015;25(viii):1155–65. pmid:25810467
    • View Article
    • PubMed/NCBI
    • Google Scholar
58. 58. Youngson A, Cole F, Wilby H, Cox D. The lived experience of diabetes: conceptualisation using a metaphor. The British Periodical of Occupational Therapy. 2015;78(1):24–32.
    • View Article
    • Google Scholar
59. 59. Rehackova 50, Araújo-Soares V, Adamson AJ, Steven S, Taylor R, Sniehotta FF. Acceptability of a very-low-energy nutrition in type 2 diabetes: patient experiences and behaviour regulation. Diabetic Medicine. 2017;34(11):1554–67. pmid:28727247
    • View Article
    • PubMed/NCBI
    • Google Scholar
60. 60. Peng Westward, Yuan S, Holtz BE. Exploring the challenges and opportunities of health mobile apps for individuals with type two diabetes living in rural communities. Telemedicine and e-Wellness. 2016;22(9):733–8. pmid:26982017
    • View Article
    • PubMed/NCBI
    • Google Scholar
61. 61. Greenhalgh T, Collard A, Begum North. Sharing stories: complex intervention for diabetes didactics in minority ethnic groups who do not speak English. BMJ. 2005;330(7492):628–31. pmid:15774990
    • View Article
    • PubMed/NCBI
    • Google Scholar
62. 62. AlQarni ZA, Yunus F, Househ MS. Health information sharing on Facebook: an exploratory report on diabetes mellitus. Journal of Infection and Public Health. 2016;9(6):708–12. pmid:27618634
    • View Article
    • PubMed/NCBI
    • Google Scholar
63. 63. Edwards DJ, Wicking Grand, Smyth W, Shields L, Douglas T. Information needs of parents of infants diagnosed with cystic fibrosis: results of a pilot written report. Periodical of Child Health Care. 2018;22(3):382–92. pmid:29486591
    • View Article
    • PubMed/NCBI
    • Google Scholar

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