The results of this randomized controlled study, which was conducted to investigate the impact of educational self-efficacy enhancement programs on pain management, self-efficiency behaviors, quality of life and satisfaction among adult DPNP diabetic patients, revealed the educational self-efficacy enhancement program was effective.
In a pre-educational evaluation of the self-efficacy behaviors, results of the patients' evaluation levels revealed that the self-efficacy behaviors scores mean for both participant’s groups were showing low levels. These results were concordant with those from other epidemiological researches [7, 8, 10, 11, 12, 13, 14, 15], where patients with DM had significantly lower self-efficacy behaviors than those without DM. This might be attributed to the association with lower levels of self-efficacy behaviors by lower knowledge of the patients about the disease with uncontrolled of the complications and poor self-management skills practicing, which lead to the negative feedback that was frequently implemented among DPNP patients.
In our research, the research group participants who attended the educational self-efficacy enhancement program reported a positive enhanced self-efficacy behavior by comparing the posttest and pretest mean. The essential findings of this research suggest the importance of incorporating self-efficacy enhancing interventions in diabetes self-efficacy (DSE) programs, emphasizing the requirement to build confidence for a given self-management behavior such as a portion of the health care providers communication or a component of a counseling, educational and skill-building program that can enhance the likelihood of maintaining the preferred outcomes of DPNP. Diabetes nurse educators and other health care providers need to develop effective methods for promoting self-management among adult Jordanian individuals. Also, recent results analysis has reported that in the follow-up intervention, health-related improvements were obtained from self-management programs. The self-management methods increase participants’ symptom self-management, knowledge and other self-management behaviors such as testing blood glucose, weight control, self-efficacy and aspects of health status management, very effectively . Many clinical researches confirm the effect of the educational self-efficacy enhancing program interventions in DSE programs among T2DM patients [7, 8, 10, 11, 12, 13, 14, 15].
Results of a pre-educational evaluation of the patients' pain levels, showed that the majority of the participants in both groups were having different intensities of pain ranging from moderate to severe. According to a cohort research conducted in the U.K. by Abbott et al. (2011), the results revealed that the painful symptoms occurred in 60% of patients with severe neuropathy and 26% of patients without neuropathy . According to pain intensity, in a cross-sectional research that was conducted by Van Acker et al (2009), 61% of patients had moderate-intensity pain . While a research from the same region was conducted in French by Bouhassira et. al (2013) using the NRS revealed that 76.2% of patients are having moderate to severe intensity pain . The difference in the reported neuropathic pain characteristics from all over the world can be related to different populations of the researches and the different screening tools that are used to assess DPNP.
In our research, the research group participants who attended the educational self-efficacy enhancement program reported better pain management as perceived by comparing the pretest and posttest means showing improvement after exposure to the educational program. Foot care, control of HbA1c% and exercise and lifestyle behaviors affect diabetes multiuse patients in their good pain management, according to most researches [28, 29, 30, 31].
Quality of Life
In a pre-educational evaluation, results showed that the quality of life scores mean was showing a low QoL level. Also, the results of the research revealed that most DPNP participants have reported a problem in discomfort, mobility, usual activity, self-care and anxiety or/and depression. These results of this research were concordant with those from other epidemiological researches, where DPNP patients had significantly lower QoL than those without DPNP. For example, according to a research by Davies et al. (2006), they found that patients who developed DPNP had poorer quality of life . Similar results were found in a research by Van Acker et al (2009). The results revealed that DPNP patients were more likely to report problems in mental alterations and physical activities than those without DPNP, which may account for their lower QoL scores . In a more recent research conducted in France, the results showed that DPNP was associated with disturbances in sleep, depression and higher anxiety levels . Another recent research that agrees with the results of our research was performed in South Africa. In this research, the results reported that DPNP has a negative impact on QoL .
This research found that the research group participants who attended the educational self-efficacy enhancement program reported a positive impact on QoL. This finding was consistent with the relevant researches [32, 33, 34, 35, 36, 37, 38]. On the contrary, data obtained from a research in Saudi Arabia showed that results were not significantly associated with the effect of the educational program and QoL among T2DM diabetic patients . Similarly, a research was conducted in Taiwan failed to show any significant association between the effect of the educational program and QoL among T2DM patients . However, the variation in magnitude between these findings and others may be attributed to either the characteristics of the research's participants or the differences in sample size.
Patient satisfaction means that a score of the research group participants showed a high level of satisfaction from educational intervention. Numerous clinical researches confirm the effect of the educational self-efficacy enhancing program interventions in high levels of satisfaction among diabetic patients [16, 17, 18, 19]. Therefore, conscientious steps to improve patient engagement and satisfaction are vital for improving the quality of patient care and conveying the important message that healthcare providers are respected and valued as persons.
Some limitations may be recognized regarding the conduction of this research. Although the focus of this research was to investigate DPNP among adult patients, data collection lacks identifying if patients were taking pain pharmacological and non-pharmacological therapies.