In this randomized controlled research that was performed to investigate the impact of educational self-efficacy enhancement program on quality of life, pain management, self-efficiency behaviors, and satisfaction among adult diabetic patients with DPNP, results showed the effectiveness of the educational self-efficacy enhancement program.
In a pre-educational evaluation of the self-efficacy behaviors evaluation levels of the patients, results showed that the mean self-efficacy behaviors scores for both group participants were showing low levels. These results of this study were concordant with those from other epidemiological studies [11–12, 10, 8, 13, 7, 14–15], where patients with DM had significantly lower self-efficacy behaviors than those without DM. This might be attributed to the that was associated with lower levels of self-efficacy behaviors by poor self-management skills practicing, and lower knowledge of the patients about the disease with uncontrol of the complications, which leads to negative feedback was frequently implemented among patients with DPNP.
In our study, the study group participants who attended the educational self-efficacy enhancement program reported a positive enhanced self-efficacy behavior by comparing the pretest and posttest mean. The essential findings of this study suggest the importance of incorporating self-efficacy enhancing interventions in diabetes self-efficacy (DSE) programs, emphasizing the requirement to build confidence specific to a given self-management behavior as a portion of the health care providers communication or as a component of an educational, counseling, 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. Recent results analyses also have reported that in the follow-up intervention, health-related improvements gained from self-management programs. The self-management methods effectively increase participants’ knowledge, symptom self-management, other self-management behavior such as weight control, self-efficacy, testing blood glucose, and aspects of health status management significantly . Many clinical studies confirm that the effect of the educational program self-efficacy enhancing interventions in DSE programs among T2DM patients [11–12, 10, 8, 13, 7, 14–15].
In a pre-educational evaluation of the pain levels of the patients, results 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 study in the U.K. study by Abbott et al. (2011), the results showed that the painful symptoms occurred in 26% of patients without neuropathy and 60% of patients with severe neuropathy . According to pain intensity, 61% of patients had a pain of moderate-intensity in a cross-sectional study was done by Van Acker et al (2009) . While a study from the same region was conducted in French by Bouhassiraet.al (2013) using the NRS showed that 76.2% of patients are having a pain of moderate to severe intensity . The difference in the reported pain neuropathic characteristics from all over the world can be related to different populations of the studies and the different screening tools that are used to assess DPNP.
In our study, the study group participants who attended the educational self-efficacy enhancement program reported better management pain as perceived by comparing the pretest and posttest means showing improvement after exposure to the educational program. Congruent to the results of the majority of the studies found that control HbA1c%, dietary regimen, foot care, and exercise and lifestyle behavior does affect their good management of pain in patients with diabetes multiuse [30–31,29 − 28].
Quality of life
In a pre-educational evaluation, results showed that the quality of life means the scores were showing a low QoL level. Also, the results of the study showed that most of the participants who have DPNP reported have a problem in mobility, self-care, usual activity, discomfort, and anxious or depressed. These results of this study were concordant with those from other epidemiological studies, where patients with DPNP had significantly lower QoL than those without DPNP. For example, according to a study by Davies et al. (2006), they found that patients who developed DPNP had poorer quality of life . Similar results were found in a study by Van Acker et al (2009), the results revealed that patients with DPNP were higher likely to report problems physical activities and mental alterations than those without DPNP, which may account for their lower QOL scores . In a more recent study conducted in France, the results showed that DPNP was associated with disturbances in sleep, higher anxiety levels, and depression . Another recent study that agrees with the results of our study was performed in South Africa. In this study, the results suggested that DPNP has a negative impact on QoL. .
The findings of this study found that the study group participants who attended the educational self-efficacy enhancement program reported a positive impact on QoL. This finding was consistent with the relevant studies [32–38]. While data obtained from a study in Saudi Arabia on contrary to our study, this was not significantly associated with the effect of the educational program and QOL among diabetic patients with T2DM . Similarly, a study was done in Taiwan failed to show any significant association between the effect of the educational program and QOL among T2DM . However, the variation in magnitude between these findings and others may be attributed to either the differences in sample size or the characteristics of the study participants.
Patient satisfaction means a score of the study group participants showed a high level of satisfaction from educational intervention. Numerous clinical studies confirm that the effect of the educational program self-efficacy enhancing interventions in high levels of satisfaction among diabetic patients [16–19]. Conscientious steps to improve patient satisfaction and engagement are therefore vital for improving the quality of patient care and conveying the important message that healthcare providers are respected and valued as persons.