People with diabetes have high levels of morbidity, mortality, a relatively poor quality of life and psychological distress. Diabetes self-management is recognised as the cornerstone of diabetes care, but diabetes self-management education has not yet been implemented in Malaysia. This thesis aims to develop and examine the feasibility of a group-based culturally tailored Malaysian diabetes education intervention using motivational interviewing for adults newly diagnosed with Type 2 diabetes (T2DM), the MY DEUMI intervention. Firstly, a systematic review was conducted to identify current literature and randomised controlled trials (RCT) to support diabetes self-management for people with T2DM in the Asian Western Pacific region. The review suggested that the groupbased educational approaches delivered with longer total contact hours are associated with improvement in metabolic control. There was also a suggestion that the use of practical or hands-on activities are associated with positive outcomes particularly on blood glucose control. Secondly, a qualitative study of personal experiences of diabetes selfmanagement for adults with T2DM in Malaysia was conducted using semi-structured interviews (N=17) in a primary care setting. The results revealed that there is a need for psychological support in diabetes care. Barriers to effective diabetes selfmanagement include social factors (shame/stigma), attitude towards food and beliefs in complementary medicine. Thirdly, findings from the systematic review, semi-structured interviews and a scoping study to identify available culturally sensitive materials were then integrated to inform the development of the intervention. The intervention is underpinned by the Theory of Planned Behaviour and Social Cognitive Theory. The intervention manual was further adapted to be delivered using the motivational interviewing techniques. Following recruitment of people with newly diagnosed T2DM from primary care clinics and community centres in Malaysia, the MY DEUMI intervention was evaluated in a small pre-post feasibility study (N=30). The result indicates evidence of feasibility for the intervention and a positive impact on metabolic control and selfefficacy. Moreover, the study suggests that the group-based approach for the delivery of diabetes education is acceptable among the multicultural community in Malaysia. Exit interviews suggested that participants valued the psychological approach which helped improve self-efficacy for their diabetes self-management.
The development and feasibility of a culturally tailored Malaysian Diabetes Education Intervention using Motivational Interviewing (MY DEUMI) for people newly diagnosed with type 2 diabetes mellitus
Mohamed, A. M. (Author). 1 Jul 2019
Student thesis: Doctoral Thesis › Doctor of Philosophy