Introduction
Type 2 diabetes mellitus (T2DM) is a chronic condition that requires patients to constantly control their blood sugar levels, which leads to significant changes in their lifestyles. The number of people having T2DM is increasing throughout the world, and, according to the predictions of the World Health Organization, in 2030, it will reach 370 million people, compared to 170 million in 2000 (Ebrahimi et al., 2018). The chronic nature of diabetes becomes a burden for patients and their families because of high treatment costs, lifestyle modifications, and an overall decrease in the quality of life (Ebrahimi et al., 2018). Therefore, there is a strong need for healthcare teams, including nurses, to find the best strategies to enhance patients’ self-management of the disease, thus improving patient outcomes and health-related quality of life. One strategy is family-based education, which includes educating patients and their families about diabetes risk factors and symptoms, physical activity, diet, glycemic control, and family support. The purpose of this review is to determine whether family-based education, as compared to routine care, improves glycemic control and health-related quality of life in adult patients with T2DM.
Methods
In order to identify relevant studies assessing the effectiveness of family-based education for patients with T2DM, the PubMed and Google Scholar databases were searched. The keywords used for the search were as follows: “family-based education,” “family-centered education,” “family involvement,” “type 2 diabetes,” and “quality of life.” In PubMed, the publication date was set to 5 years, and the filters were applied to find clinical trials and randomized controlled trials. The search returned four results. In Google Scholar, only articles published in 2016 and later were included in the search, which resulted in 44 articles. Titles and abstracts were scanned, and eight articles were chosen for a closer examination, five of which were included in the review. The inclusion criteria were the publication date within the last five years and the focus on adult patients with T2DM and family-based education. The review included only original articles; therefore, systematic reviews were excluded, although their references were looked through to search for potential sources meeting the inclusion criteria. Studies focused on pediatric patients were also excluded since they did not meet the purpose of the review.
Results
Five studies examined the effects of family-based education on adult diabetic patients’ outcomes, including health-related quality of life and self-managed glycemic control. The interventions included education sessions for patients and their families. The selected articles included one follow-up study, one semi-experimental single-group study, two quasi-experimental studies, and one randomized clinical trial. Two of the studies were conducted in Iran, two in China, and one in the United States.
The randomized clinical trial conducted by Ebrahimi et al. (2018) aimed at studying the impact of a family-based training program on the quality of life in patients with T2DM. The study involved two groups of participants, each consisting of 40 members. In the experimental group, training sessions were provided to patients and one of their family members, while in the control group, only patients received patient education. All participants were selected out of patients of an Iranian endocrinology clinic, using block randomization sampling. The patients’ quality of life was assessed using pretest and posttest questionnaires. The results indicated that patients with T2DM who received family-based training significantly improved their quality of life in terms of physical, social, mental, and disease dimensions, but not in the economic area (Ebrahimi et al., 2018). The researchers concluded that family support was crucial for patients’ self-management of T2DM (Ebrahimi et al., 2018). The strength of this study is that it proved the positive effect of family-based education on patients with T2DM using a reliable and unbiased research method. The limitation is that researchers could not perform a comprehensive assessment of the laboratory results.
The study by Cai and Hu (2016) aimed at investigating the impact of a family-based self-management training intervention on T2DM self-management in adult patients. The researchers used a quasi-experimental research design with repeated measures. In this study, 57 Chinese patients with T2DM, selected using a convenience sample, and their family members were divided into two groups. The experimental group received a 7-session family-based educational intervention, while the control group received routine care. Data were collected before and after the training program, as well as at the end of the 3-month follow-up. The results showed that the members of the intervention group had a decreased BMI, A1C, and waist circumference (Cai & Hu, 2016). Apart from that, these patients and their families increased their knowledge of diabetes management as compared to the members of the control group (Cai & Hu, 2016). The limitations of the study include using a convenience sample, small sample size, short-term period, and possible bias during face-to-face interviews.
Another quasi-experimental study conducted by Hu et al. (2016) focused on the effects of a family-based, culturally-tailored educational program for Hispanics with T2DM. The study involved 186 participants: 51 Hispanic patients and 52 family members in the intervention group and 41 patients and 42 family members in the control group. The researchers used a convenience sample, recruiting participants from community clinics and ethnic churches. The intervention group received an 8-session culturally-tailored education, while the control group received an 8-session general health training. Data were collected via face-to-face interviews before and after the intervention, as well as at 1-month and 6-month follow-ups. The findings indicated the intervention group’s patients’ improved self-efficacy in diabetes management, which, however, did not sustain at 6-month follow-up (Hu et al., 2016). In both groups, family members increased their diabetes knowledge, but in the intervention group, the increase was higher. The strength of the study is that it shows the importance of culturally-tailored family based-education. The limitation is the use of a convenience sample, which excludes randomization.
The study by Sheikhi et al. (2019) aimed at assessing the impact of family-centered education on self-care in patients with T2DM. The research design was a pre- and post-semi final experimental single-group study. The study used a sample of 35 patients of the Zabol Diabetic Clinic. Data were collected using questionnaires before and after the intervention, which consisted of five 60-minute training sessions. The results showed a statistically significant increase in diabetic patients’ self-care (Sheikhi et al., 2019). The limitation of the study is a lack of randomization and small sample size.
The purpose of a follow-up study carried out by Shi et al. (2016) was to explore the effect of family involvement in health education for patients with T2DM. The study involved two groups, each consisting of 60 patients with newly diagnosed T2DM. Participants in the test group received education together with their family members, and members of the control group were individually involved in health education. The findings indicated that family involvement in the health education of patients with T2DM improved patients’ quality of life and helped them better control their blood glucose levels and weight (Shi et al., 2016). The limitation of the study is that the researchers did not control family involvement; nevertheless, the results showed significant distinctions in patient outcomes in the two groups.
Discussion
Diabetes can hardly be considered an individual disease; it changes patients’ lifestyle, but it also influences the lives of their families. Therefore, it is assumed that family members should also be informed about diabetes management to be able to provide support for patients and aid them in their self-care. The present literature review confirmed the importance of family-based education for improving the quality of life and health outcomes of patients with T2DM. The reviewed studies were of good research design and provided evidence of the beneficial effects of family involvement in patient education for T2DM.
Diabetic patients often encounter various barriers to the self-management of T2DM. These barriers may include difficulties in changing behavior, a lack of social support, a lack of trust in information sources, and insufficient communication between the patient and the provider (Cai & Hu, 2016). The reviewed literature indicated that family involvement in patient education provided family members with the information necessary for understanding the special needs of patients with T2DM. Family-based education also provided patients with family support, which was needed to improve self-care in patients with T2DM. The results of this review are consistent with the findings of the systematic review conducted by Sinawang et al. (2020), who found that the family was the main source of social support for patients with T2DM and contributed to their emotional well-being and compliance with treatment. Thus, family-based education is more efficient for patients with T2DM than routine care in the community.
Conclusion
This review found that, in adult patients with T2DM, family-based education leads to better health outcomes and patients’ quality of life than routine care. The implication of this finding is that healthcare teams should involve patients’ families in health education. Furthermore, when it comes to providing family-based patient education to individuals of different ethnic backgrounds, healthcare teams should consider culturally-tailored training programs since they are more effective than a standard education.
References
Cai, C., & Hu, J. (2016). Effectiveness of a family-based diabetes self-management educational intervention for Chinese adults with type 2 diabetes in Wuhan, China. The Diabetes Educator, 42(6), 697-711. Web.
Ebrahimi, H., Ashrafi, Z., Rudsari, D. M., Parsayekta, Z., & Haghani, H. (2018). Effect of family-based education on the quality of life of persons with type 2 diabetes. Journal of Nursing Research, 26(2), 97-103. Web.
Hu, J., Amirehsani, K. A., Wallace, D. C., McCoy, T. P., & Silva, Z. (2016). A Family-Based, Culturally Tailored Diabetes Intervention for Hispanics and Their Family Members. The Diabetes Educator, 42(3), 299-314. Web.
Sheikhi, H. R., Heydari, M. A., Soleimani, M., Sheikhi, A. R., Mastaelizadeh, H., & Naderyanfar, F. (2019). The effect of family-centered education on self-care rate in patients with type 2 diabetes. Journal of Advanced Pharmacy Education & Research, 9(S2), 89-93.
Shi, M., Xu, M.-Y., Liu, Z.-L., Duan, X.-Y., Zhu, Y.-B., Shi, H.-M., Jiang, B., Zhang, X.-M., & Yu, X.-H. (2016). Effectiveness of family involvement in newly diagnosed type 2 diabetes patients: a follow-up study. Patient Education and Counseling, 99(5), 776-782. Web.
Sinawang, G. W., Kusnanto, K., & Pratiwi, I. N. (2020). Systematic review of family members in improving the quality of life of people with T2DM. Jurnal Ners, 15(2), 107-112. Web.