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Chapter 4

SUMMARY OF FINDINGS, CONCLUSIONS AND RECOMMENDATIONS

Summary of Findings

The age of respondents in 2 hospitals is found

excessively more than 45 years old. Ages more than 45 years

old are 44 respondents with a percentage 61.1%. Meanwhile,

ages less than equal 45 years old are 28 respondents with a

percentage 38.9% in this study. This data is consistent

with statements from the American Diabetes Association

(ADA), that age above 45 years is one of the risk factors

for type 2 diabetes (ADA, 2008).

The gender of respondents in 2 hospitals is found

excessively female. Because, female is 47 respondents with

a percentage 65.3%. Meanwhile, male is 25 respondents with

a percentage 34.7% in this study. According Koja Hospital

stated that the prevalence of type 2 diabetes mellitus that

occurs in women is 62%, greater than the prevalence in men

(Santoso et al, 2004).

The blood sugar level respondents in 2 hospitals are

found excessively more than 200 mg/dl. Blood sugar level

more than 200 mg/dl are 53 respondents with a percentage

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73.6%. Meanwhile, blood sugar level less than equal 200

mg/dl are 19 respondents with a percentage 26.4%. In

addition, the weighted mean blood sugar level respondents

in 2 hospitals are 281.13 mg/dl in this study. Diabetes is

a serious life-long health condition that occurs when the

amount of glucose (sugar) in the blood is too high because

the body can’t use it properly (Diabetes UK, 2017).

The body mass index respondents in 2 hospitals are

found excessively normal weight. Body mass index

underweight is 3 respondents with a percentage 4.2%. In

addition, body mass index normal weight is 29 respondents

with a percentage 40.3%. Moreover, body mass index

overweight is 19 respondents with a percentage 26.4%.

Meanwhile, body mass index obese is 21 respondents with a

percentage 29.2%. Furthermore, the weighted mean body mass

index respondents in 2 hospitals are 26.35 in this study.

Obesity is the etiology of diabetes mellitus so that

experienced by patients before diabetes mellitus. However,

after suffering from diabetes, diabetes mellitus patients

sustained lose weight. Whereas, the patients in this study

who already had diabetes mellitus. As well, patients who

suffer from obesity have been reduced to normal weight and

even underweight. This is in line with Magee’s theory

(2004) which stated diabetes type 2 is metabolic

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interference cause by inability body to use insulin

appropriately.

The history of smoking respondents in 2 hospitals is

found excessively do not smoke. Because, respondents who

had history of smoking is 19 respondents with a percentage

26.4%. Meanwhile, respondents who had not history of

smoking is 53 respondents with a percentage 73.6% in this

study. Furthermore, researcher interpretation history of

smoking male respondents caused all of them are male

respondents. The history of smoking male respondents in 2

hospitals is found excessively smoke. Because, respondents

who had history of smoking is 19 respondents with a

percentage 76%. Meanwhile, respondents who had not history

of smoking is 6 respondents with a percentage 24% in this

study. In accordance with Hillson (2015) claimed people

with diabetes who smoke have at least the same risk of

morbidity and mortality as non-diabetics who smoke,

probably greater.

The self-management scores respondents in 2 hospitals

is found excessively low degree. Self-management scores

very high degree is 9 respondents with a percentage 12.5%.

In addition, self-management scores high degree is 9

respondents with a percentage 12.5%. Moreover, self-

management scores moderate degree is 15 respondents with a

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percentage 20.8%. Meanwhile, self-management scores low

degree is 39 respondents with a percentage 54.2%.

Furthermore, the weighted mean body mass index respondents

in 2 hospitals are 4.9781 in this study. According to

Schmitt et al. (2013) stated patients with good glycaemic

control reported significantly more glucose management,

dietary control, physical activity, and health-care use

than those with poor control.

The glucose management respondents in 2 hospitals are

found excessively low degree. Glucose management very high

degree is 12 respondents with a percentage 16.7%. In

addition, glucose management high degree is 9 respondents

with a percentage 12.5%. Moreover, glucose management

moderate degree is 12 respondents with a percentage 16.7%.

Meanwhile, glucose management low degree is 39 respondents

with a percentage 54.2%. Furthermore, the weighted mean

body mass index respondents in 2 hospitals are 4.9072 in

this study. The goal of blood glucose management is to keep

patient’s blood glucose levels in the target range that

prevents complications and helps patient feel the best (May

& Fletcher, 2012).

The dietary control respondents in 2 hospitals are

found excessively low degree. Dietary control very high

degree is 13 respondents with a percentage 18.1%. In

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addition, dietary control high degree is 4 respondents with

a percentage 5.6%. Moreover, dietary control moderate

degree is 19 respondents with a percentage 26.4%.

Meanwhile, dietary control low degree is 36 respondents

with a percentage 50.0%. Furthermore, the weighted mean

body mass index respondents in 2 hospitals are 4.7342 in

this study. The beneficial effect of the dietary pattern on

diabetes mellitus and glucose metabolism in general and

traditional food pattern was associated with a significant

reduction in the risk of developing type-2 diabetes

(Bannard et al, 2005).

The physical activity respondents in 2 hospitals are

found excessively low degree. Physical activity very high

degree is 6 respondents with a percentage 8.3%. In

addition, physical activity high degree is 14 respondents

with a percentage 19.4%. Moreover, physical activity

moderate degree is 12 respondents with a percentage 16.7%.

Meanwhile, physical activity low degree is 40 respondents

with a percentage 55.6%. Furthermore, the weighted mean

body mass index respondents in 2 hospitals are 4.8915 in

this study. In addition, increasing physical activity can

reduce the risk of type 2 diabetes. The protective effect

of physical activity was observed in subjects with an

excessive BMI and elevated glucose levels. Physical

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activity and weight control are critical factors in

diabetes prevention in subjects with both normal and

impaired blood glucose regulation (Hu et al, 2004).

The health-care use respondents in 2 hospitals are

found excessively low degree. Health-care use very high

degree is 5 respondents with a percentage 6.9%. In

addition, health-care use high degree is 6 respondents with

a percentage 8.3%. Moreover, health-care use moderate

degree is 27 respondents with a percentage 37.5%.

Meanwhile, physical activity low degree is 34 respondents

with a percentage 47.2%. Furthermore, the weighted mean

body mass index respondents in 2 hospitals are 5.2008 in

this study. In accordance with Williams et al (1998)

applied the self-determination theory of human motivation

to examine whether patient perceptions of autonomy

supportiveness (i.e., patient centeredness) from patient’s

diabetes care providers related to improved glucose control

over a 12-month period.

There is a significant difference in the self-

management behaviors of the participants when grouped

according to age with p-value 0.035 through Kruskal-Wallis

Test. In addition, it shows also less than equal 45 years

old respondents with self-management behaviors low degree

are 60.7%; meanwhile, more than 45 years old respondents

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with self-management behaviors low degree are 50.0%. It

indicates young people less than equal 45 years old have

more self-management behaviors low degree than above 45

years old.

There is no significant difference in the self-

management behaviors of the participants when grouped

according to gender with p-value 0.982 through Kolmogorov

Smirnov Test. In addition, it shows also male respondents

with self-management behaviors low degree are 52.0%;

meanwhile, female respondents with self-management

behaviors low degree are 55.3%. It indicates female

respondents have more self-management behaviors low degree

than male respondents.

There is a significant difference in the self-

management behaviors of the participants when grouped

according to blood sugar levels with p-value 0.000 through

Kruskal Wallis Test. In addition, it shows also blood sugar

levels below 200 mg/dl respondents with self-management

behaviors low degree are 5.3%; meanwhile, blood sugar

levels above 200 mg/dl respondents with self-management

behaviors low degree are 71.7%. It indicates blood sugar

levels above 200 mg/dl respondents have more self-

management behaviors low degree than blood sugar levels

below 200 mg/dl respondents.

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There is a significant difference in the self-

management behaviors of the participants when grouped

according to body mass index with p-value 0.015 through

Kruskal Wallis Test. In addition, it shows also body mass

index underweight respondents with self-management

behaviors low degree are 66.7%; meanwhile, body mass index

normal weight respondents with self-management behaviors

low degree are 41.4%; while, body mass index overweight

respondents with self-management behaviors low degree are

52.6%; whereas, body mass index obese respondents with

self-management behaviors low degree are 71.4%. It

indicates body mass index obese respondents have more self-

management behaviors low degree than others.

There is no significant difference in the self-

management behaviors of the participants when grouped

according to history of smoking with p-value 0.985 through

Kolmogorov Smirnov Test. In addition, it shows also

respondents who have history of smoking with self-

management behaviors low degree are 63.2%; meanwhile,

respondents who have not history of smoking with self-

management behaviors low degree are 50.9%. It indicates

respondents who have history of smoking have more self-

management behaviors low degree than respondents who have

not history of smoking.

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The researcher suggested to the hospital for make

counseling program towards diabetes mellitus patients. The

counselors who are registered counselors which must have

licensed from PEDI. Perhimpunan Edukator Diabetes Indonesia

(PEDI) is Educator Diabetes Association of Indonesia who is

giving education through counseling or health promotion

concern diabetes. In addition, the researcher prompted to

the hospital also to make bed teaching from PEDI counselors

which expert in diabetes mellitus disease. In addition, the

researcher suggested to the public health for willing

infrastructure especially counseling about diabetes

mellitus. One of the suggest from the researcher is support

counseling program through build counselors PEDI from

health workers. Furthermore, the researcher prompted also

to the hospital for make health promotion and health

education especially diabetes mellitus disease. The

researcher added also health promotion and health education

must to having knowledge about self-management behaviors.

Conclusions

The conclusion on this study detailed in the below as

following:

1. The profile of the participants

1.1. The age of respondents in 2 hospitals is found

excessively above 45 years old are 44 respondents

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(61.1%) meanwhile, ages less than equal 45 years old

are 28 respondents (38.9%).

1.2. The gender of respondents in 2 hospitals is found

excessively female respondents are 47 respondents

(65.3%) meanwhile, male respondents are 25

respondents (34.7%).
1.3. The blood sugar level respondents in 2 hospitals are

found excessively more than 200 mg/dl are 53

respondents (73.6%) meanwhile, blood sugar level

less than equal 200 mg/dl are 19 respondents

(26.4%). In addition, the weighted mean blood sugar

level respondents in 2 hospitals are 281.13 mg/dl

(more than 200 mg/dl).

1.4. The body mass index respondents in 2 hospitals are

found excessively normal weight. Body mass index

underweight is 3 respondents (4.2%). In addition,

body mass index normal weight is 29 respondents

(40.3%). Moreover, body mass index overweight is 19

respondents (26.4%). Meanwhile, body mass index

obese is 21 respondents (29.2%). Furthermore, the

weighted mean body mass index respondents in 2

hospitals are 26.35 (normal weight).

1.5. The history of smoking respondents in 2 hospitals is

found excessively do not smoke is 19 respondents

(26.4%) meanwhile, respondents who had not history

of smoking is 53 respondents (73.6%).

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2. The degree of manifestation of the self-management

behaviors of the participants

2.1. The self-management scores respondents in 2

hospitals is found excessively low degree. Self-

management scores very high degree is 9 respondents

(12.5%). In addition, self-management scores high

degree is 9 respondents (12.5%). Moreover, self-

management scores moderate degree is 15 respondents

(20.8%). Meanwhile, self-management scores low

degree is 39 respondents (54.2%). Furthermore, the

weighted mean body mass index respondents in 2

hospitals are 4.9781 (low degree).

2.2. The glucose management respondents in 2 hospitals

are found excessively low degree. Glucose management

very high degree is 12 respondents (16.7%). In

addition, glucose management high degree is 9

respondents (12.5%). Moreover, glucose management

moderate degree is 12 respondents (16.7%).

Meanwhile, glucose management low degree is 39

respondents (54.2%). Furthermore, the weighted mean

body mass index respondents in 2 hospitals are

4.9072 (low degree).

2.3. The dietary control respondents in 2 hospitals are

found excessively low degree. Dietary control very

high degree is 13 respondents (18.1%). In addition,

dietary control high degree is 4 respondents (5.6%).

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Moreover, dietary control moderate degree is 19

respondents (26.4%). Meanwhile, dietary control low

degree is 36 respondents (50.0%). Furthermore, the

weighted mean body mass index respondents in 2

hospitals are 4.7342 (low degree).

2.4. The physical activity respondents in 2 hospitals are

found excessively low degree. Physical activity very

high degree is 6 respondents (8.3%). In addition,

physical activity high degree is 14 respondents

(19.4%). Moreover, physical activity moderate degree

is 12 respondents (16.7%). Meanwhile, physical

activity low degree is 40 respondents (55.6%).

Furthermore, the weighted mean body mass index

respondents in 2 hospitals are 4.8915 (low degree).

2.5. The health-care use respondents in 2 hospitals are

found excessively moderate degree. Health-care use

very high degree is 5 respondents (6.9%). In

addition, health-care use high degree is 6

respondents (8.3%). Moreover, health-care use

moderate degree is 27 respondents (37.5%).

Meanwhile, physical activity low degree is 34

respondents (47.2%). Furthermore, the weighted mean

body mass index respondents in 2 hospitals are

5.2008 (moderate degree).

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3. Significant difference in the self-management behaviors

of the participants when grouped according to profile

variables

3.1. There is a significant difference in the self-

management behaviors of the participants when

grouped according to age (p-value=0.035) through

Kruskal-Wallis Test. In addition, it shows also less

than equal 45 years old respondents with self-

management behaviors low degree are 60.7%;

meanwhile, more than 45 years old respondents with

self-management behaviors low degree are 50.0%.

3.2. There is no significant difference in the self-

management behaviors of the participants when

grouped according to gender (p-value=0.982) through

Kolmogorov Smirnov Test. In addition, it shows also

male respondents with self-management behaviors low

degree are 52.0%; meanwhile, female respondents with

self-management behaviors low degree are 55.3%.

3.3. There is a significant difference in the self-

management behaviors of the participants when

grouped according to blood sugar levels (p-

value=0.000) through Kruskal Wallis Test. In

addition, it shows also blood sugar levels below 200

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mg/dl respondents with self-management behaviors low

degree are 5.3%; meanwhile, blood sugar levels above

200 mg/dl respondents with self-management behaviors

low degree are 71.7%.

3.4. There is a significant difference in the self-

management behaviors of the participants when

grouped according to body mass index (p-value=0.015)

through Kruskal Wallis Test. In addition, it shows

also body mass index underweight respondents with

self-management behaviors low degree are 66.7%;

meanwhile, body mass index normal weight respondents

with self-management behaviors low degree are 41.4%;

while, body mass index overweight respondents with

self-management behaviors low degree are 52.6%;

whereas, body mass index obese respondents with

self-management behaviors low degree are 71.4%.

3.5. There is no significant difference in the self-

management behaviors of the participants when

grouped according to history of smoking (p-

value=0.985) through Kolmogorov Smirnov Test. In

addition, it shows also respondents who have history

of smoking with self-management behaviors low degree

are 63.2%; meanwhile, respondents who have not

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history of smoking with self-management behaviors

low degree are 50.9%.

4. Counseling program can be purposed to enhance self-

management behaviors

4.1. The hospital supports counseling program through

build counselors PEDI (Perhimpunan Edukator Diabetes

Indonesia/Educator Diabetes Association of

Indonesia) from health workers.

4.2. The hospital concerns to having the counselors who

are registered counselors which must have licensed

from PEDI.

4.3. The hospital also makes bed teaching from PEDI

counselors which expert in diabetes mellitus

disease.

4.4. The hospital makes health promotion and health

education especially diabetes mellitus disease about

self-management behaviors, such as glucose

management, dietary control, physical activity, and

health-care use.

Recommendations
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Department of Health. The researcher recommended

department of health to be an input for the preparation of

health development policies and programs especially

counseling program for diabetes mellitus patients. In

addition, the department of health capable the results of

this study to be used as input for the development of

science particularly diabetes mellitus disease.

Hospital. The researcher suggested hospital to

adherence training diabetes mellitus education for the

health workers which the training held by Association of

Diabetes Indonesia or Persatuan Diabetes Indonesia. And

then, the researcher prompted health workers must be more

aware toward counseling approach for diabetes mellitus

patients. In addition, the researcher recommended hospital

to increase health service both diabetic treatment and

counseling programs. So, the diabetes mellitus patients

bring something from hospital to home for increase well-

being degree.

Nursing Education Institution. The researcher prompted

science schools to train the students better than before

which concerns counseling especially about diabetes

mellitus patients, such as self-management behaviors.

Diabetic Patients. The researcher recommended for

people with diabetes who need counseling to control blood

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sugar in diabetes mellitus patients especially for young

people, females, blood sugar levels more than 200 mg/dl,

have history of smoking for male respondents, and self-

management behaviors low degree. In other words, the

researcher redound to the benefit of diabetes mellitus

patients considering that ability to control blood sugar

for diabetes mellitus patients is an important role in

having a healthy lifestyle. The greater demand for diabetes

mellitus patients with diabetes mellitus theory background

justifies the need for more effective and life-changing

approaches.

Future Researcher. The researcher suggested to the

future researchers within improves and ascertains cognition

to the future researcher concerning counseling of diabetes

mellitus patients. In addition, the researcher helped

future researchers discover critical areas in the

educational diabetes counseling process in which

researchers before were not able to explore yet in general

hospitals. The researcher prompted towards future

researchers also towards utilizes another research designs.