The Effects of a Health Mentoring Program in Community-dwelling Vulnerable Elderly Individuals with Diabetes

Ki wol Sung; Hye Seung Kang; Ji Ran Nam; Mi Kyung Park; Ji Hyeon Park

doi:10.4040/jkan.2018.48.2.182

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Sung, Kang, Nam, Park, and Park: The Effects of a Health Mentoring Program in Community-dwelling Vulnerable Elderly Individuals with Diabetes

Original Article

J Korean Acad Nurs 2018;48(2):182-194.

Published online: 15 January 2018

DOI: https://doi.org/10.4040/jkan.2018.48.2.182

The Effects of a Health Mentoring Program in Community-dwelling Vulnerable Elderly Individuals with Diabetes

Ki wol Sung¹, Hye Seung Kang^2,, Ji Ran Nam², Mi Kyung Park³, Ji Hyeon Park⁴

¹College of Nursing, Daegu Catholic University, Daegu

²Department of Nursing, Gumi University, Gumi

³College of Nursing, Yeungnam University College, Daegu

⁴Department of Nursing, Catholic Sangji College, Andong, Korea

Address reprint requests to : Kang, Hye Seung Department of Nursing, Gumi University, 37 Yaeunro, Gumi 39213, Korea Tel: +82-54-440-1312 Fax: +82-54-440-1219 E-mail: hskang21@gumi.ac.kr

Received 8 August 2017 Revised 20 March 2018 Accepted 20 March 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

This study aimed to estimate the effects of a health mentoring program on fasting blood sugar, total cholesterol, triglyceride, physical activity, self care behavior and social support changes among community-dwelling vulnerable elderly individuals with diabetes.

Methods

A non-equivalent control group pre-post-test design was used. Participants were 70 community-dwelling vulnerable elderly individuals with diabetes. They were assigned to the experimental (n=30) or comparative (n=30) or control group (n=28). The experimental group participated in the health mentoring program, while the comparative group participated in health education program, the control group did not participate in any program. Data analyses involved a chi-square test, Fisher's exact test, a generalized linear model, and the Bonferroni correction, using SPSS 23.0.

Results

Compared to the control group, the experimental and comparative groups showed a significant decrease in fasting blood sugar, total cholesterol, and triglyceride. Compared to the comparative and control groups, the experimental group showed significant improvement in self care behavior. However, there were no statistical differences in physical activity or social support among the three groups.

Conclusion

These findings indicate that the health mentoring program is an effective intervention for community-dwelling vulnerable elderly individuals with diabetes. This program can be used as an efficient strategy for diabetes self-management within this population.

Keywords: Aged, Diabetes mellitus, Mentoring, Self care, Vulnerable populations

References

1. Ministry of Health and Welfare. Elderly person survey 2014 [Internet]. Seoul: Korea Institute of Health and Social Affairs;c2015. [cited 2016 Nov 20]. Available from:. http://www.mohw.go.kr/react/gm/sgm0601vw.jsp?PAR_MENU_ID=13&MENU_ID=1304020701&CONT_SEQ=293292&page=1.

2. Lee TW, Ko IS, Lee KJ, Kang KH. Health status, health perception, and health promotion behaviors of low-income community dwelling elderly. Journal of Korean Academy of Nursing. 2005; 35(2):252–261.

3. Kang JH, Kim JA, Oh KS, Oh KO, Lee SO, Lee SJ, et al. Health status, depression and social support of elderly beneficiaries of the national basic livelihood security system. The Journal of Korean Academic Society of Adult Nursing. 2008; 20(6):866–882.

4. Korean Diabetes Association. Diabetes fact sheet in Korea 2016 [Internet]. Seoul: Korean Diabetes Association;c2017. [cited 2017 Jul 1]. Available from:. http://www.diabetes.or.kr/pro/news/admin.php?category=A&code=admin&number=1428&-mode=view.

5. Choi GA, Jang SM, Nam HW. Current status of self-management and barriers in elderly diabetic patient. Korean Diabetes Journal. 2008; 32(3):280–289. https://doi.org/10.4093/kdj.2008.32.3.280.

6. Lim SC. Intervention strategies for older adults with diabetes. The Journal of Korean Diabetes. 2012; 13(1):52–55. https://doi.org/10.4093/jkd.2012.13.1.52.

7. Kim NH, Lee YJ, Kim HO, Oh CR, Park JR, Park SY, et al. Effects of comprehensive support on glycemic control using community networks in low-income elderly patients with diabetes. Korean Diabetes Journal. 2008; 32(5):453–461. https://doi.org/10.4093/kdj.2008.32.5.453.

8. Kang HY, Gu MO. Development and effects of a motivational interviewing self-management program for elderly patients with diabetes mellitus. Journal of Korean Academy of Nursing. 2015; 45(4):533–543. https://doi.org/10.4040/jkan.2015.45.4.533.

9. Sung KW, Lee JH. The effects of regular walking exercise on metabolic syndrome, cardiovascular risk factors, and depressive symptoms in the elderly with diabetic mellitus. Journal of Korean Academy of Community Health Nursing. 2010; 21(4):409–418. https://doi.org/10.12799/jkachn.2010.21.4.409.

10. De Greef K, Deforche B, Tudor-Locke C, De Bourdeaudhuij I. Increasing physical activity in Belgian type 2 diabetes patients: A three-arm randomized controlled trial. International Journal of Behavioral Medicine. 2011; 18(3):188–198. https://doi.org/10.1007/s12529-010-9124-7.

11. Dickens AP, Richards SH, Hawton A, Taylor RS, Greaves CJ, Green C, et al. An evaluation of the effectiveness of a community mentoring service for socially isolated older people: A controlled trial. BMC Public Health. 2011; 11:218. https://doi.org/10.1186/1471-2458-11-218.

12. Coull AJ, Taylor VH, Elton R, Murdoch PS, Hargreaves AD. A randomised controlled trial of senior lay health mentoring in older people with ischemic heart disease: The braveheart project. Age and Ageing. 2004; 33(4):348–354. https://doi.org/10.1093/ageing/afh098.

13. Gu MO, Eun Y, Kim ES, Ahn HR, Kwon IS, Oh HS, et al. Effects of an elder health promotion program using the strategy of elder health leader training in senior citizen halls. Journal of Korean Academy of Nursing. 2012; 42(1):125–135. https://doi.org/10.4040/jkan.2012.42.1.125.

14. Kim SH. Effects of a volunteer-run peer support program on health and satisfaction with social support of older adults living alone. Journal of Korean Academy of Nursing. 2012; 42(4):525–536. https://doi.org/10.4040/jkan.2012.42.4.525.

15. Park YS, Song JY, Hwang CJ. The effect of volunteer work commitment on psychological well-being for the profession retiree and retirement expectant men: Verification of the mediating effect of social resource and volunteer work activity. Journal of Welfare for the Aged. 2012; 56:33–59.

16. Chang SJ, Choi SY, Kim SA, Song MS. Intervention strategies based on information-motivation-behavioral skills model for health behavior change: A systematic review. Asian Nursing Research. 2014; 8(3):172–181. https://doi.org/10.1016/j.anr.2014.08.002.

17. Fisher WA, Fisher JD, Harman J. The information-motivation-behavioral skills model: A general social psychological approach to understanding and promoting health behavior. Suls J, Wallston KA, editors. Social Psychological Foundations of Health and Illness. Maiden, MA: Blackwell;2003. p. 82–106.

18. Osborn CY, Rivet Amico K, Fisher WA, Egede LE, Fisher JD. An information-motivation-behavioral skills analysis of diet and exercise behavior in Puerto Ricans with diabetes. Journal of Health Psychology. 2010; 15(8):1201–1213. https://doi.org/10.1177/1359105310364173.

19. Kim YJ, Seo NS, Kim SJ, Park IS, Kang SJ. Quality of life and its correlated factors among elderly people with diabetes in a community. The Korean Journal of Health Service Management. 2014; 8(1):75–86. https://doi.org/10.12811/kshsm.2014.8.1.075.

20. Jang SH, Kim CS, Kim MR. An effect the social support on the self-esteem and life satisfaction in elderly. Journal of Ease-West Nursing Research. 2008; 14(2):39–46.

21. Chin YR, So ES, Lee HY. A meta-analysis of Korean diabetes patient studies from 1977 to2008. Journal of Korean Public Health Nursing. 2011; 25(1):5–16.

22. Shin SY, Lee S, Park HI, Kim M, Kim Y. Evaluation of analytical performance of two point-of-care analyzers for lipid testing. Song JH, editor. Proceedings of the 54th Fall Conference of The Korean Society for Laboratory Medicine; 2013 Oct 24-25. Daegu: The Korean Society for Laboratory Medicine;c2013. p. S33.

23. Byun S, Han JW, Kim TH, Kim KW. Test-retest reliability and concurrent validity of a single tri-axial accelerometer-based gait analysis in older adults with normal cognition. Public Library of Science One. 2016; 11(7):e0158956. https://doi.org/10.1371/journal.pone.0158956.

24. Kim YO. A study of factors predicting self-care behavior in diabetics. Journal of Korean Academy of Nursing. 1998; 28(3):625–637. https://doi.org/10.4040/jkan.1998.28.3.625.

25. Sherbourne CD, Stewart AL. The MOS social support survey. Social Science and Medicine. 1991; 32(6):705–714. https://doi.org/10.1016/0277-9536(91)90150-B.

26. Lim MK, Shin YJ, Yoo WS, Yang BM, Kim MH. Social support and self-rated health status in a low income neighborhood of Seoul, Korea. Korean Journal of Preventive Medicine. 2003; 36(1):54–62.

27. Lee HK, Cho MK. A study of mentor competence scale development to measure effectiveness of group mentoring program: Focusing on the college student. Studies on Korean Youth. 2012; 19(12):61–87.

28. Bae JM, Park GH. An illustrated guide to medical statistics using SPSS. Seoul: Hannarae Publishing Co.;2012. p. 1–367.

Figure 1.

Flow chart of participants.

Figure 2.

Conceptual framework of the health mentoring program based on Information-motivation-behavioral skills (IMB) model.

Table 1.

Health Mentoring Program

Session	Theme	Program Content	Pedagogy strategies	IMB Model component
Mentor training program (12 sessions)
1	Program orientation	− Opening ceremony	Expert lecture
		− Understanding the Health mentoring program
2	Educator's attitude	− Attitudes of educators	Expert lecture
		− Guidelines for mentoring
3	How to use educational	− Writing education plan	Expert lecture
	materials	− How to use educational materials	Mentor practice
4	Understanding diabetes	− Symptoms and treatment of diabetes	Expert lecture
		− Prevention of diabetic complications
5	Understanding diabetes	− How to measure blood glucose	Expert lecture
		− How to use diabetes diary	Mentor practice
6	Diabetes medication	− Diabetes medication	Expert lecture
		− Diabetes self- management
7	Diabetic diet therapy	− Dietary guidelines for diabetes management	Expert lecture
		− Visit the nutrition department of public health center	Field practice
8	Diabetic diet therapy	− Using the food exchange table to plan meals	Expert lecture
		− Calculation of daily calories	Mentor practice
9	Diabetic exercise therapy	− Exercise guidelines for diabetes management	Expert lecture
		− Warm up, main exercise, cooling down	Mentor practice
		− Stretching, walking exercise
10	Diabetic exercise therapy	− Learning healthy exercise	Expert demonstration
		− ‘Be confident at 90’ health exercise	Mentor practice
11	Diabetic exercise therapy	− Learning healthy exercise	Expert demonstration
		− ‘Up to 99 youthfully’ health exercise	Mentor practice
12	Completion ceremony	− Mock demonstration of mentors on learned concepts	Mentor demonstration
		− Ceremony for program completion
Health mentoring program (24 sessions)
1	Program orientation	− Opening ceremony	Group mentoring	Motivation
		− Understanding the health mentoring program
		− Mentor-mentee matching
2	Diabetes self-management	− Symptoms and treatment of diabetes	Mentor lecture	Information
		− Reflecting and sharing experienceson diabetes management	Group mentoring	Motivation
3	Diabetes self-management	− Prevention of diabetic complications	Mentor lecture	Information
		− Reflecting and sharing experiences to improve lifestyle	Group mentoring	Motivation
4	Diabetes self-management	− Learning to measure blood glucose	Mentor demonstration	Information
		− Supporting health goals	Mentee practice	Motivation
				Behavioral skills
5	Diabetes self-management	− Learning to use the diabetes diary	Mentor lecture	Information
		− Proper management of diabetes	Mentee practice	Motivation
				Behavioral skills
6	Diabetes foot care	− Diabetes foot care	Mentor lecture	Information
		− Promoting diabetes self-management	Mentee practice	Motivation
				Behavioral skills
7	Diabetes medication	− Medication compliance	Mentor lecture	Information
		− Reflecting and sharing experiences on medication management	Group mentoring	Motivation
8	Diet management	− Dietary guidelines for diabetes management	Mentor lecture	Information
		− Reflecting and sharing experiences on diet management	Group mentoring	Motivation
9	Diet management	− Creating a healthy diet	Mentor lecture	Information
		− Reflecting and sharing experiences on diet management	Mentee practice	Motivation
				Behavioral skills
10	Community resource utilization	− Introduction of available vulnerable utilities at community	Mentor lecture	Information
		resources, welfare services	Group mentoring	Motivation
11	Social networking	− Reinforcement of social networking: forming a self-help group	Mentor lecture	Information
			Mentee practice	Motivation
				Behavioral skills
12	Exercise management	− Exercise guidelines for diabetes management	Mentor lecture	Information
		− Reflecting and sharing experiences on diet management and	Group mentoring	Motivation
		exercise management
13~23	3 Exercise management	− Learning healthy exercise	Mentor demonstration	Information
		− Warm up exercise, main exercise, cooling down exercise	Mentee practice	Motivation
		− Stretching, walking exercise		Behavioral skills
		− ‘Be confident at 90’ health exercise
		− ‘Up to 99 youthfully’ health exercise
24	Completion ceremony	− Prize for achieving health goals	Group mentoring	Information
		− Taking photos		Motivation
		− Ceremony for program completion

IMB=Information-Motivation-Behavioral Skills.

Table 2.

Homogeneity Test of General Characteristics and Outcome Variables in Pre-Test (N=70)

Characteristics	Categories	n (%) or M±SD			χ²/F	p
		Exp. (n=25)	Comp. (n=23)	Cont. (n=22)
Gender	Male	2 (8.0)	1 (4.3)	0 (0.0)	1.66^†	.769
	Female	23 (92.0)	22 (95.7)	22 (100.0)
Age (yr)	65~74	12 (48.0)	8 (34.8)	12 (54.5)	1.85	.414
	≥75	13 (52.0)	15 (65.2)	10 (45.5)
	Mean age	75.44±5.65	75.22±4.78	73.59±4.56
Religion	Buddhist	6 (24.0)	13 (56.6)	10 (45.5)	6.60^†	.363
	Catholic	5 (20.0)	3 (13.0)	5 (22.7)
	Protestant	6 (24.0)	3 (13.0)	2 (9.1)
	None or others	8 (32.0)	4 (17.4)	5 (22.7)
Education level	≤Elementary school	16 (64.0)	18 (78.3)	17 (77.3)	1.55	.501
	≥Middle school	9 (36.0)	5 (21.7)	5 (22.7)
Living status	Alone	13 (52.0)	12 (52.2)	10 (45.4)	0.56^†	.983
	With spouse	8 (32.0)	8 (34.8)	8 (36.4)
	With others	4 (16.0)	3 (13.0)	4 (18.2)
FBS (mg/dL)		159.00±32.85	145.74±13.37	145.64±17.57	2.63	.080
TC (mg/dL)		225.28±38.17	209.57±34.16	228.68±34.31	1.87	.162
TG (mg/dL)		220.28±70.97	245.57±56.17	213.32±38.58	1.99	.145
Physical activity	Daily energy expenditure (kcal)	172.04±73.94	196.87±73.42	200.95±193.89	0.38	.686
	Daily exercise intensity (METs)	1.10±0.06	1.14±0.03	1.14±0.15	1.30	.280
	Moderate intensity exercise (min)	10.16±16.12	11.61±9.88	12.18±18.22	0.11	.893
Self care behavior	r	61.56±9.97	64.43±13.26	65.64±15.35	0.63	.539
Social support		68.72±13.85	74.30±13.50	68.36±10.62	1.56	.217

Comp.=Comparative group; Cont.=Control group; Exp.=Experimental group; FBS=Fasting blood sugar; METs=Metabolic equivalents; M±SD=Mean standard deviation; TC=Total cholesterol; TG=Triglyceride.

^† Fisher's exact test.

Table 3.

Comparison of Variables among 3 Groups Using Generalized Linear Model (N=70)

Variables	Group	M±SD			Sources	χ² (p)	Post hoc
		Pre-test	Post-test	Follow-up test (4 m)
FBS (mg/dL)	Exp.	159.00±32.85	135.00±20.41	128.04±15.44	Group	19.40 (<.001)
	Comp.	145.74±13.37	139.91±11.63	134.61±10.80	Time	11.26 (.004)
	Cont.	145.64±17.57	145.95±15.82	165.14±17.01	G×T	48.14 (<.001)	a,b<c
TC (mg/dL)	Exp.	225.28±38.17	187.52±23.21	186.76±21.03	Group	74.60 (<.001)
	Comp.	209.57±34.16	201.48±34.06	199.43±26.06	Time	6.26 (.044)
	Cont.	228.68±34.31	243.82±27.06	244.09±25.40	G×T	26.45 (<.001)	a,b<c
TG (mg/dL)	Exp.	220.28±70.97	180.44±55.31	178.12±30.13	Group	12.18 (.002)
	Comp.	245.57±56.17	207.48±47.73	198.39±41.84	Time	16.57 (<.001)
	Cont.	213.32±38.58	212.27±26.97	217.95±30.65	G×T	9.70 (.046)	a,b<c
Physical activity
Daily energy	Exp.	172.04±73.94	196.48±88.08	202.80±100.70	Group	0.06 (.969)
expenditure (kcal)	Comp.	196.87±73.42	202.78±108.75	184.83±76.04	Time	0.08 (.959)
	Cont.	200.95±193.89	186.64±192.63	182.05±188.07	G×T	1.23 (.873)
Daily exercise intensity	Exp.	1.10±.06	1.12±.05	1.13±.05	Group	1.01 (.603)
(METs)	Comp.	1.14±.03	1.13±.06	1.12±.05	Time	0.72 (.697)
	Cont.	1.14±.15	1.11±.07	1.11±.07	G×T	5.75 (.219)
Moderate intensity	Exp.	10.16±16.12	14.28±14.48	17.60±20.41	Group	1.63 (.443)
exercise (min)	Comp.	11.61±9.88	13.61±14.89	9.30±11.59	Time	0.47 (.790)
	Cont.	12.18±18.22	11.41±19.33	9.14±14.13	G×T	3.74 (.443)
Self care behavior	Exp.	61.56±9.97	69.68±10.98	80.68±7.18	Group	16.66 (<.001)
	Comp.	64.43±13.26	66.39±12.71	70.48±12.50	Time	12.98 (.002)
	Cont.	65.64±15.35	61.09±12.62	61.09±11.80	G×T	24.38 (<.001)	b,c<a
Social support	Exp.	68.72±13.85	70.36±14.95	72.60±12.53	Group	15.12 (.001)
	Comp.	74.30±13.50	76.22±11.76	75.91±8.90	Time	0.48 (.788)
	Cont.	68.36±10.62	66.82±16.56	71.27±12.93	G×T	5.58 (.233)

Comp.=Comparative group; Cont.=Control group; FBS=Fasting blood sugar; Exp.=Experimental group; G×T=Group×Time; METs=Metabolic equivalents; M±SD=Mean standard deviation; TC=Total cholesterol; TG=Triglyceride. a=Experimental group; b=Comparative group; c=Control group. 4 m=after 4 months of intervention.

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