Original Research

Improving Self Care in Diabetes through implementation

Covid-19 Prevention Education Videos (EPIC-19) In
Pandemic

Abstract

Introduction: Diabetes is one of the comorbidities that are susceptible to infection due to
chronic hyperglycemia that affects immune dysfunction, where which could be prevented
by increasing self-care. Self-care is increased by providing adequate education regarding the
prevention of diabetes transmission, video education is believed to help facilitate the
provision of information. This study aims to determine the effect of providing educational
video innovations for the prevention of covid 19 infection (EPIC-19) on the self-care of
diabetic patients during the pandemic.

Methods: The design of this research is a quasi-experimental design with a one-group

pretest-posttest design. The population in this study were all the Diabetes with ulcers in
East of Denpasar District, Denpasar Regency as many as 97patient and the number of
samples was 36 respondents using a consecutive sampling according to the inclusion
criteria. Collecting data using a summary diabetes self care activities (SDSCA)
questionnaire modified with several statements adapted to the behavior of preventing
Covid-19 infection. Data analysis using Wilcoxon test with an alpha of 0.05
Results: The results showed there was an effect of giving EPIC-19 video on respondents'
self-care regarding the behavior of preventing covid 19 infection, with a p-value of 0.0001 (p
<0.05).
Conclusion: The conclusion in this study Video is one of the media that can be used to
provide health education during a pandemic. In addition to its attractive shape, video media
makes it easier for patients to understand the information needed. The EPIC-19 video is
designed with animated moving images accompanied by sound and can be easily accessed
by patients. The development of health education media in the field of technology during the
pandemic needs to be done to make it easier for nurses to carry out their role as patient
educators, especially in helping to improve the quality of life for diabetes.

Keywords: Self-care, covid 19, diabetes, EPIC-19, video

*Corresponding Author:
e-mail: megayanti.pande28@gmail.com

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INTRODUCTION

The World Health Organization (WHO) declared Coronavirus disease 2019

(COVID-19) a global pandemic in March 2020. COVID-19 is caused by a virus known
as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) [1]. Individuals
with diabetes have a high risk of transmission of Covid-19, diabetes is one of the
comorbidities of Covid-19 infection [2]. Diabetes in Indonesia in 2021 ranks fifth
highest in the world, currently, around 19.46 million people in Indonesia have
diabetes [3]. Diabetes is one of the comorbidities that are prone to infection due to
chronic hyperglycemia which affects immune dysfunction
Prevention that can be done for diabetes to avoid transmission of Covid-19
infection is to control glycemic levels in the body. So far, adequate self-care in
diabetes can affect glycemic conditions to prevent chronic hyperglycemia [4][5][6].
Self-care for diabetes helps them control the complications that arise so that
individuals with diabetes can maintain a good quality of life. Interventions can be
carried out to help improve diabetes self-care by providing information related to
the prevention of diabetes transmission [7]. Increasing health knowledge will
usually have an impact on improving a person's attitude and behavior in caring for
himself.
The government has been promoting health education through the health
ministry about preventing the transmission of Covid 19 for diabetes. This
information is provided through health services in each region, however, this is not
felt to be optimal because diabetic patients are afraid to control their diabetes
during a pandemic. This is evident from the distribution data on the official
government website covid19.go.id, it was found that 9.8% of Covid 19 deaths were
people with Diabetes.
Optimizing the prevention of transmission of infection in diabetes effectively
and efficiently needs attention in order to help the government reduce the Covid
19 death rate from vulnerable groups, especially diabetes [8]. Therefore,
researchers are interested in conducting a study on providing educational video
innovations to prevent Covid-19 infection (EPIC-19) to improve self-care in
diabetes during a pandemic. Educational video is education that is given through
audio-visual media which contains animated pictures accompanied by sound so

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that it will look more attractive. This study aims to determine the effect of
providing educational video innovations to prevent Covid-19 infection (EPIC-19)
on self-care of diabetes patients during a pandemic. It is hoped that this research
can assist health care workers in disseminating information on preventing
infection in diabetes and being able to reduce morbidity/death rates due to Covid
19 from vulnerable groups, especially diabetes.

METHODS

This research is included in a quasi-experimental design with a one-group pretest-

posttest design approach. The independent variable in this study was the
educational video on the prevention of covid-19 infection (EPIC-19) which refers to
the 2020 American Diabetes Association guidelines and 2020 PERKENI regarding
diabetes self-management education as well as the 2020 Revised Guidelines for
Prevention and Control of Corona Virus Disease (COVID-19). 4 of 2020 concerning
steps to prevent the transmission of Covid-19. This video is tested by an expert to
assess the feasibility of the display and the quality of the information provided.
Expert is carried out by information system experts and diabetes experts in health
services.
The dependent variable is diabetes patient self-care as measured using a
summary diabetes self-care activities (SDSCA) questionnaire modified with several
statements adapted to the behavior of preventing Covid-19 infection, transmission,
and methods of prevention [9][10]. The self-care questionnaire consisting of 18
statement items has been carried out by expert judgment and declared
appropriate for measuring diabetes self-care during a pandemic. Data analysis
used SPSS 2.0, univariate analysis by describing each research variable with
descriptive statistics, and bivariate analysis using the Wilcoxon test analysis, to
determine the effect of providing educational videos on the prevention of Covid-19
infection (EPIC-19) on self-care of diabetic patients. The research was conducted at
the Denpasar Regional Private Health Clinic. The population in this study were all
diabetic patients who visited. The sample in this study used a consecutive
sampling approach, determined using the Slovin formula. Samples were obtained
from as many as 36 people. The sample inclusion criteria were respondents
diagnosed with type 2 diabetes who owned and were able to operate an android.
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Exclusion criteria, respondents with visual and hearing impairments and had foot
ulcers grade 3-4. Before data collection, the researcher had submitted an ethical
clearance with the number: 03.0480/KEPITEKESBALI/VII/2022.
The univariate analysis of this study identified the characteristics of each
research variable, namely age, gender, level of education and length of time
diagnosed with type 2 DM, and the respondent's self-care level. The bivariate
analysis aims to determine the effect of providing educational video innovations to
prevent Covid-19 infection (EPIC-19) on the self-care of diabetic patients. The
statistical test used was the Wilcoxon test. The test used SPSS for windows version
20, with a 95% confidence interval or a p-value smaller than 5% alpha (<0.05)
then Ho was rejected with a 95% CI.

RESULTS

The results of this study consisted of univariate and bivariate analysis.

Univariate analysis describe the respondents based on the characteristics of the
respondents such as age, gender, level of education and duration of DM type 2 and
the level of self-care of the respondents. Bivariate analysis of Epic-19 variables and
diabetes self-care during a pandemic.
Characteristics of Respondents
Table 1
Frequency distribution and percentage of respondent characteristics

Category Frequency (f) Percentage (%)

Gender
Man 21 58.3
Woman 15 41.71
Age
31 – 40 7 19.4
41 – 50 8 22.2
51 – 60 21 58.3
Level of education
Primary school 1 2,8
Junior high school 5 13.9
Senior high school 11 30.6
College 19 52.8
Duration Of Diabetes
< 5 year 13 36.1
>5 year 23 63.9
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 In the table of the characteristics of the respondents above, it can be explained
that the results of the study showed that the majority of respondents aged 51-60
years were 58.3% and were male, namely 58.3%. Based on the type of education,
about 52.8% of respondents had a college education level and 63.9% had diabetes
for more than 5 years.

Table 2
Distribution level of self care diabetes in respondent
Variable Video EPIC-19
Pre test Post test
Self Care n % n %
Good 2 5.6 32 88.9
Moderate 8 22.2 4 11.1
Poor 26 72.2 0 0
Total 36 100 36 100

The self- care level category is based on the Bloom cut point where it is
classified as good, moderate, and poor. If the score is between 80% and 100%
(13.6–17 points) it is in the good category, 60% and 79% (10.2-13.6 points) is in
the moderate category, and less than 60% (<10.2 points ) is included in the less
category [8]. From the table. 2 to respondents before and after giving the EPIC-19
video intervention, self care was obtained before giving the EPIC-19 video as many
as 26 respondents (72.2%) had a poor self-care level, 8 respondents (5.6%) had a
moderate self-care level and as many as 2 respondents (22.2 % ) with a good level
of self care. After being given the EPIC-19 video intervention, the majority of self-
care data were obtained, namely as many as 32 respondents (88.9%) with good
self-care levels, as many as 4 respondents (11.1%) moderate self-care levels and
no one had a poor self-care level.

Effects Of Video EPIC-19 On Diabetes Self-Care During A Pandemic

Table 3 Effect of Video EPIC-19 on self care before and after intervention

Mean p value
Video EPIC-19 Pre Intervensi Post Intervensi 0.000
43.61 91.61

The hypothesis test used was the Wilcoxon test, self-care assessment was
carried out before and after giving the EPIC-19 video, and it obtained a p-value of
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0.000 (p <0.05), which means Ho was rejected. There was an effect of giving EPIC-
19 video on respondents' self-care about infection prevention behavior. covid-19.

DISCUSSION
Based on age, the majority of research respondents (58.3%) were aged 51 to
60 years. The results of this study are in line with other studies which show that
people aged >45 years have 9 times the risk of developing type 2 DM compared to
people aged <45 years [11]. These results are also supported by a research study
with 134 respondents who stated that the majority of type 2 diabetes mellitus
patients were aged 46-65 years (69.4%) [12]. The older a person's age will affect
the body's metabolic system and ability. The aging process that occurs in
individuals can have an impact on decreased sensitivity and changes in insulin
production. Aging also causes a compensatory decrease in pancreatic β-cell protein
that is insufficient in the face of increasing insulin resistance [13]. According to the
American Diabetes Association (ADA) that DM is related to risk factors that cannot
be changed including a family history of DM (first-degree relative), and age ≥45
years. The prevalence of DM in the old age group is three times higher than in the
younger group.
Based on gender characteristics, most of the respondents in this study were
male. Although there is no significant relationship between gender and the
incidence of type 2 DM, this could be due to factors such as habits and daily
lifestyle, men and women have the same risk of developing DM [12]. Gender does
not affect the increase or decrease in blood sugar levels in people with type 2
diabetes mellitus because both men and women have the same risk of developing
diabetes mellitus and blood sugar levels according to gender vary widely and what
distinguishes them is due to other factors that affect blood sugar levels [14].
Based on the type of education the respondents were around 52.8% with a
higher education level (PT). The results of this study have different results from
other studies which state that people with low education have a higher risk of
developing diabetes mellitus [15]. However, other studies state that there is no
relationship between education level and the occurrence of type 2 DM [16]. A
person with higher education is associated with dense physical activity. This has
an impact on changes in lifestyle and eating habits that affect their health.
The duration of suffering from type 2 DM, the majority in this study 63.9%

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were diagnosed with type 2 DM > 5 years. The duration of suffering from DM has
associated with the length of time that glucose binds to Hb which will cause
chronic hyperglycemia. Chronic hyperglycemia conditions can trigger micro and
macrovascular disorders as a factor causing complications [17]. This study is in
line with other studies regarding the correlation between self-care and the
glycemic index and diabetic ulcers, where the majority of respondents (58.3%)
have been diagnosed with DM > 5 years [6]. This is supported by the condition of
respondents who visited health services who had experienced complications.

Effect of EPIC-19 Video on Self-Care for Prevention of Covid-19 Infection in

Diabetes
In this study, a p-value of 0.000 was obtained (p <0.05), and there was an
effect of giving EPIC-19 videos on respondents' self-care regarding the behavior of
preventing Covid-19 infection, there was an increase in the level of self-care after
being given EPIC-19 videos. These results are in line with other studies that
mentioned that there was an increase in the behavior of preventing covid infection
in the community after being given video education [18]. In this study the aim was
to evaluate education with videos on people's behavior in dealing with COVID-19,
education using videos can change people's behavior in a healthier direction in
dealing with COVID-19. It is also supported by other research which states that
there are significant differences between attitudes before and after being given
education using video media[19].
Providing video-based education also influences a person's behavior in
complying with health protocols in preventing Covid-19 infection. There is a
significant influence between video-based education on the level of compliance
with 5M as self-protection for Covid-19 in the community, video is one of the
audio-visual media in providing health education which has the advantage of
combining audio and visual media functions so that the information presented is
more attention-grabbing [20]. From the results of the study, it was also found that
the majority of respondents (72.2%) had a low level of self-care before being given
the EPIC-19 video. pandemic so that information related to the prevention of
Covid-19 is not effective.
Providing education through videos that can be accessed by diabetes patients

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when they are at home makes it easier for them to obtain information about
preventing the transmission of Covid-19 infection. This is supported by data in this
study that there was an increase in self-care for diabetic patients after being given
the EPIC-19 video, namely 88.9% with good self-care and no respondents who had
less self-care. Providing education with video media can increase patient interest
in receiving information that has an impact on changes in patient knowledge[21].
The increase in knowledge occurs due to the interest, sense of interest, and
curiosity that respondents get from videos and can emphasize important material
for respondents to know [22].
In this study, the video consisted of moving animations supplemented with
sound effects so as to enable people with visual impairments to receive the
information contained in the video. Video can be used as an educational medium,
stimulating thoughts, feelings, attention, creativity and innovation and providing
direct experience to the audience, the learning process involving more than one
sense will be more easily accepted and remembered by someone [23].

CONCLUSION

The majority in this study had a good level of self-care after being given the
EPIC-19 video. It is necessary to develop media in providing health education in
health services to facilitate the role of nurses as educators. Education using video
media displays audio and visual elements to convey health information so that it
attracts the patient's attention in listening to the education provided. Besides that,
the videos used in this study can be accessed by respondents anytime and
anywhere so that patients can easily get information about preventing COVID-19
infection. elderly to regularly check uric acid levels with health workers.
This study provides empirical evidence about the attitudes and behavior of the
elderly in preventing an increase in uric acid. The results of this study imply the
importance of attitudes and behavior in preventing an increase in uric acid levels in
the elderly. The importance of changing attitudes and behavior in preventing an
increase in uric acid so that even though they are old they are still in good health.

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