Research presentation: The diabetic caregivers' role in type II Diabetes mellitus patients' eating behavior

1. Research presentation:The diabetic caregivers' role in type II Diabetes mellitus patients' eating behavior 6th Nov 2012

2. Authors • Mr. RaksitChinnarakbumrung • Ms. SuwannikaPalee • Mr. HaritVanakiatkul Advisor • SarinyaSutthanon, M.D.

3. 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 ?

4. 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

5. Contents • Unit 1 : Introduction • Unit 2 : Review literature • Unit 3 : Methodology • Unit 4 : Results • Unit 5 : Discussion, conclusionand suggestion • References

6. 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.

7. 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.

8. 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.

9. 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.

10. 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

11. 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

12. Unit 1 Introduction (cont.) • Benefits • To clarify the role of the caregivers for controlling blood sugar level of the diabetic patients

13. 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.

14. 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

15. 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.

16. 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

17. Unit 3 Methodology(cont.) • Source of information • Observation and in-depth interview • OPD card • Study method • Qualitative study

18. Unit 3 Methodology(cont.) • Methodology • Qualitative method • Observationandin depth interview

19. 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

20. 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

21. Unit 3 Methodology(cont.) • Instruments • Voice recorder • Notebook

22. Unit 3 Methodology(cont.) • Method • Design the research topic and present to the content-expert and methodology-expert advisors • Review the literature • 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

23. 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

24. Time table

25. Unit 3 Methodology(cont.) • Data analyzing and statistical tools • Observation and in-depth interview

26. Unit 4Result

27. 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.

28. 1. Eating Behaviors. .

29. 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."

30. 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."

31. 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."

32. 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."

33. 1.2 Patients' behavior. 1.2.2 Some patient do not have a need to control eating. "I eat everything, sweets, fruits."

34. 2. Knowledge of diabetes.

35. 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."

36. 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."

37. 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."

38. 2.2 Controlling blood sugar. 2.2.1 Some participles think that dietary affects blood sugar level. "Eat less. Less salts. Less sweets."

39. 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."

40. 2.3 Symptoms of Diabetes Mellitus. "Fatigue, bored with food, moody“ "My father has thirsty, fatigue, frequent micturition."

41. 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.“

42. 3. Family roles.

43. 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."

44. 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."

45. 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.“

46. 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.“

47. 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.”

48. 4. Attitude

49. 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."

50. 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."