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Chapter 2

METHODOLOGY

Research Design

In this paper, the researcher use descriptive study

which according to Kumar (2011) claimed descriptive study

attempts to describe systematically a situation, problem,

phenomenon, service or programme, or provides information

about, say, the living conditions of a community, or

describes attitudes towards an issue. In other words, the

researcher will describe the self-care behavior of patients

diagnosed with diabetes mellitus as a basis for purpose

counseling program.

Respondents/Subjects of the Study

The participants of the study are those included in

the criteria inclusion. The criteria inclusion in this

study is following below:

1. Hospitalized in Labuang Baji Hospital and Pelamonia

Hospital Makassar.

2. Participants aged above18 years old.

3. Participants are willing to participate in the study.

4. Participants are suffering from diabetes mellitus

disease.
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5. Participants have limited information about control of

blood sugar.

6. Participants disposed to cooperate and willing to fill

the instrument which the researcher provided.

Participants who are reluctant to participate in the

study and those who have another disease besides diabetes

mellitus are excluded as participants.

Instrumentation

The primary data in this study is the profile of the

participants in terms of age, gender, blood sugar levels,

BMI, and history of smoking. In addition, the questions for

diabetes mellitus patients will use Diabetes Self-

Management Questionnaire (DSMQ) by Schmitt, et al. (2013).

The rating scale was designed as a four-point Likert

scale with the response options “applies to me very much’

(three points), ‘applies to me to a considerable degree’

(two points), ‘applies to me to some degree’ (one point),

and ‘does not apply to me’ (zero points). The responses

were converted such that higher scores are indicative of

more effective self-care. To enable individual adjustment

in items which assess aspects of self-monitoring of blood

sugar (SMBG) or medical treatment, boxes offering to tick

‘is not required as a part of my treatment’ were

added(Schmitt et al, 2013).

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Analysis of responses as part of study 1 led to the

identification of 16 items which formed the final scale for

full psychometric assessment. Seven of these items are

formulated positively and nine inversely with regard to

what is considered effective self-care. The questionnaire

allows the summation to a ‘Sum Scale’ score as well as

estimation of four subscales scores. In view of their

contents, the subscales were labeled ‘Glucose Management’

(items 1, 4, 6, 10, 12), ‘Dietary Control’ (items 2, 5, 9,

13), ‘Physical Activity’ (items 8, 11, 15), and “Health-

Care Use’ (items 3, 7, 14). One item (16) requests an

overall rating of self-care and is to be included in the

‘Sum Scale’ only. Scoring of the questionnaire involved

reversing negatively worded items such that higher values

are indicative of more effective self-care (Schmitt et al,

2013).

Scale scores were calculated as sums of item scores

and then transformed to a scale ranging from 0 to 10 (raw

score/theoretical maximum score * 10; for example, for the

subscale “Glucose Management’ a raw score of 12 leads to a

transformed score of 12 / 15 * 10 = 8). A transformed score

of then thus represented the highest self-rating of the

assessed behavior.Scale score of Diabetes Self-Management

Questionnaire (DSMQ) will calculate (Schmitt et al, 2013):

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Glucose management = (raw score/theoretical maximum*10)

= (raw score/15*10)

Dietary control = (raw score/theoretical maximum*10)

= (raw score/12*10)

Physical activity = (raw score/theoretical maximum*10)

= (raw score/9*10)

Health care use = (raw score/theoretical maximum*10)

= (raw score/9*10)

If ‘not required as a part of my treatment’ had been

marked in an item, it was not used, and the scale score

computation was adapted accordingly (by reducing the

theoretical maximum score by three points). However, in

case of more than half of the items of a scale missing, a

scale score should not be computed.Patients with HbA1c

values up to 7.5% were classified as ‘good glycaemic

control’, patients with values between 7.6 and 8.9% were

classified as ‘medium glycaemic control’, and patients with

values from 9.0% as ‘poor glycaemic control’(Schmitt et al,

2013).

This 16 item questionnaire to assess self-care

activities associated with glycaemic control was developed,

based on theoretical considerations and a process of

empirical improvements(Schmitt et al, 2013).

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Four subscales, glucose management, dietary control,

physical activity, and health-care use, as well as a ‘Sum

Scale’ (SS) as a global measure of self-care were derived.

To evaluate its psychometric quality, 261 patients with

type 1 or 2 diabetes were assessed with the DSMQ and an

established analogous scale, the Summary of Diabetes Self-

Care Activities Measure (SDSCA). The DSMQ’s item and scale

characteristics as well as factorial and convergent

validity were analyzed, and its convergence with HbA1c was

compared to the SDSCA. So that, the conclusion provided

preliminary evidence that the DSMQ is a reliable and valid

instrument and enables an efficient assessment of self-care

behaviors associated with glycaemic control. The

questionnaire should be valuable for scientific analyses as

well as clinical use in both type 1 and type 2 diabetes

patients(Schmitt et al, 2013).

According to Fatimah (2016) asserted diabetes self-

management questionnaire (DSMQ) in Indonesian language

which valid and reliable already. The validity and

reliability test conducted data retrieval from 30

respondents who are people with diabetes mellitus in

Posbindu Working Area PuskesmasPisangan. The validity test

results of the DSMQ questionnaire or self-management

questionnaire are as follows: test results validity and

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reliability with degree of freedom 30-2 = 28 (r table

0,312), in self-management questionnaire there are 7 item

of invalid statement that is 3, 4, 5, 8, 9, 13, and 14, but

statement at Invalid numbers are important in diabetes

self-management, then those statements are discarded but

the structure of the word is fixed. While the results of

reliability test questionnaire is alpha cronbach's r 0.635

so that the questionnaire is declared reliable.

Furthermore, self-management instruments that have been

improved are used for data retrieval. Total score of the

lowest respondent is 0 and the highest is 48.

Ultimately, based on validity and reliability tests

conducted abroad by Schmitt et al (2013) and in Indonesia

by Fatimah (2016) is already declared valid and reliable

for utilize in this study.

Data Gathering Procedure

This study will be conducted by seeking permission

from hospital administrator for the conduct of research.

After that, the researcher will seek informed consent from

participants. To serve as baseline data, the

researcheradministers the assessment of the self-management

behaviors. The assessment will be done for two months in

LabuangBaji Hospital and Pelamonia Hospital Makassar, South

Sulawesi, Indonesia. Thereafter, the researcher will

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analyze the Diabetes Self-Management Questionnaire

(DSMQ).Lastly, the researcher will conduct basis for

apropose counseling program.

Data Analysis

The data will be analyzed using the Statistical

Package for the Social Sciences (SPSS 21.0). The following

statistical tools and measurements will be used to analyze

and interpret the data gathered as follows:

1. Frequency and percentage distribution (%) will be used to

present the age, gender, and history of smoking.

2. Weighted mean (M) will be used to describe the blood

sugar level, BMI and self-management degree. To interpret

the means, given scale of interpretation will be used:

Sugar Level Interpretation

200 mg/dl or more Diabetes

Below 200 mg/dl Normal

BMI Interpretation

Less than 18.5 Underweight

18.5 to 24.9 Normal weight

25 to 29.9 Overweight

30 or more Obese
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Self-Management Scores Interpretation

9.00 – 10.00 Very high degree

7.00 – 8.99 High degree

5.00 – 6.99 Moderate degree

0.00 – 4.99 Low degree

3. Analysis of variance (ANOVA) will be used to determine

the significant difference on self-management behaviors

of the participants when grouping according to profile

variables (age, blood sugar levels, and body mass index).

If data distribution is abnormal, researcher will be used

Kruskal Wallis. And then, Chi-Square will be used to

determine the significant difference on self-management

behaviors of the participants when grouping according to

profile variables (gender and history of smoking). If

data distribution is abnormal, researcher will be used

Kolmogorov Smirnov.