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Abstrak :
Latar Belakang: Kontrol glikemik yang buruk merupakan kontributor utama terjadinya neuropati perifer diabetes (NPD), dan berkaitan dengan efikasi diri klien DM tipe 2. Penelitian ini bertujuan untuk mengetahui efektivitas model intervensi holistik terintegrasi cempaka terhadap efikasi diri, kontrol glikemik dan perbaikan NPD klien DM tipe 2. Metode: Disain penelitian ini menggunakan mix method dengan strategi pendekatan eksploratoris sekuensial yang dilakukan dalam dua tahap. Penelitian tahap satu menguraikan pengembangan model dan modul intervensi keperawatan. Penelitian tahap dua adalah uji efektivitas model dengan menggunakan desain quasi-experimental dengan pendekatan pretest-posttest kontrol group design melibatkan 92 responden. Uji efektivitas menggunakan Generalized Estimating Equations (GEE). Hasil: Hasil penelitian tahap satu menghasilkan model intervensi yang holistik terintegrasi dengan intervensi coching kesehatan, latihan mindfulness dan partisipasi keluarga. Hasil uji efektivitas menunjukan model intervensi cempaka efektif meningkatkan efikasi diri pada bulan ke-3 sebesar 9,89 dan bulan ke-6 sebesar 11,52; menurunkan nilai HbA1c pada bulan ke-6 sebesar 0,9%; dan meningkatkan perbaikan neuropati perifer pada bulan ke-3 sebesar 23,98 dan bulan ke-6 sebesar 24,25. Kesimpulan: Model intervensi Cempaka terbukti meningkatkan efikasi diri, kontrol glikemik, dan perbaikan neuropati perifer, sehingga model ini layak direkomendasikan untuk diterapkan secara luas pada populasi klien DM tipe 2 dengan NPD usia dewasa di Indonesia. ......Background: Poor glycemic control is a major contributor to diabetic peripheral neuropathy (NPD) and is related to the self-efficacy of type 2 DM clients. This study aims to determine the effectiveness of the Cempaka integrated holistic intervention model in improving self-efficacy, glycemic control, and peripheral neuropathy conditions in clients with type 2 diabetes mellitus. Methods: The design of this study used a mixed method with a sequential exploratory approach strategy carried out in two stages. Phase one study describes the development of nursing intervention models and modules, literature studies, preliminary studies, expert tests, and readability tests. The second phase of the study was to test the effectiveness of the model using a quasi-experimental design with a pretest-posttest control group design approach involving 92 respondents. Test effectiveness using Generalized Estimating Equations (GEE). Results: The first phase of the study resulted in a holistic intervention model integrated with health coaching interventions, mindfulness exercises and family participation. The results of the effectiveness test showed that the Cempaka intervention model was effective in increasing self-efficacy in the 3rd month by 9.89 and 11.52 in the 6th month; lowered the HbA1c value in the 6th month by 0.9%; and increased the improvement of peripheral neuropathy at the 3rd month of 23.98 and the 6th month of 24.25. Conclusion: The Cempaka intervention model has been proven to increase self-efficacy, and glycemic control, and improve peripheral neuropathy, so this model is worthy of being recommended for wide application in the adult population of type 2 DM clients with NPD in Indonesia.

Abstrak :
Peningkatan prevalensi diabetes menjadi tantangan bagi tenaga profesional kesehatan dalam meningkatkan kualitas hidupnya. Tujuan penelitian ini adalah mengembangkan model coaching dan menilai efikasinya terhadap kualitas hidup pasien diabetes. Desain penelitian ini adalah penelitian dan pengembangan. Tahapan penelitian terdiri dari pengembangan model coaching dilakukan dengan studi literatur, validitas konten dan ujicoba, sedangkan menilai efikasi dengan randomized control trial pada 134 pasien diabetes yang dibagi ke dalam dua kelompok, yaitu kelompok yang mendapat coaching dan edukasi. Intervensi diberikan empat kali, satu kali face to face dan tiga melalui telepon yang dilakukan selama 12 minggu. Outcome yang diukur adalah perubahan rerata skor kualitas hidup, literasi kesehatan, HbA1c dan kepatuhan.  Analisis yang dilakukan adalah differences in differences. Dihasilkan model coaching ICARE yaitu introduksi, cek outcome, asesmen faktor yang berpengaruh, rencanakan tindakan dan eksplorasi tanggungjawab. Hasil uji efikasi  menunjukkan adanya perbedaan perubahan rerata skor antara kelompok intervensi dan kontrol, perbedaan perubahan skor literasi kesehatan   2,52 (1,18 – 3,65),  kepatuhan  7,02 (5,58 – 8,85), HbA1c  -0,34 (-0,47 -- 0,18) dan kualitas hidup  2,9 (2,01-3,72). Coaching menjadi perubah  signifikan pada dimensi kemampuan menerapkan informasi kesehatan yang diterima. Coaching  model ICARE dapat meningkatkan kualitas hidup pada pasien diabetes melalui perubahan dimensi literasi kesehatan dan kepatuhan.  ......The increasing prevalence of diabetes was a challenge for health professionals to improving quality of life. The purpose of this study was to develop a coaching model and assess its efficacy on the quality of life of diabetic patients. The design of this research is research and development. The reseach stages consist of developing a coaching model with literature studies, content validity and testing. while assessing efficacy with a randomized controlled trial on 134 diabetic patients who were divided into two groups, namely the group that received coaching as intervention and standard care as a control. The intervention was given four times, once time face to face and three times by telephone which was carried out for 12 weeks. The outcomes measured were changes in the mean quality of life scores, health literacy, HbA1c and adherence scores. The analysis carried out is differences in differences. ICARE's coaching model was generated, namely introduction, check for outcome, assessment of influencing factors, rearrange the action plan and exploration of responsibilities. The results of the efficacy test showed that there were differences in changes in the mean scores between the intervention and control groups, differences in changes in health literacy scores 2.52 (1.18 – 3.65), adherence 7.02 (5.58 – 8.85), HbA1c -0.34 (-0.47 - -0.18) and quality of life 2.9 (2.01 – 3.72). Coaching is a significant change in the dimension of the ability to apply health information received. Coaching ICARE application model can improve the quality of life in diabetic patients through changes in the dimensions of health literacy and compliance.

Abstrak :
Latar Belakang. Hanya sepertiga pasien DM tipe 2 yang mencapai target HbA1c yang diharapkan. Beberapa studi menunjukkan bahwa health coaching terbukti mampu menurunkan kadar HbA1c secara bermakna, namun belum banyak diketahui pengaruh health coaching dalam jangka panjang setelah coaching dihentikan. Tujuan. Tujuan penelitian ini adalah untuk mengetahui pengaruh edukasi dan health coaching dalam perbaikan kendali glikemik jangka panjang pada pasien DM tipe 2 rawat jalan di pusat kesehatan nasional tersier. Metode. Penelitian ini merupakan penelitian observasional lanjutan dari 6 bulan RCT yang dilaksanakan di dua pusat kesehatan nasional tersier untuk membandingkan kombinasi edukasi dan health coaching dengan edukasi saja pada pasien DM tipe 2 dengan diabetes yang tidak terkontrol. Subjek penelitian diikuti pada bulan ke-6 dan ke-18 dari RCT awal. Keluaran primer adalah beda rerata HbA1c antar kedua kelompok, dan keluaran sekunder adalah beda proporsi subjek yang mengalami penurunan HbA1c ≥1% dari baseline dan beda proporsi subjek yang mencapai target HbA1c <7%. Analisis data menggunakan uji-T independen dan uji Chi-square. Hasil. Penelitian ini berhasil mengumpulkan 42 dari 60 subjek (70%) yang mengikuti penelitian hingga bulan ke-18. Tidak ada perbedaan yang bermakna rerata HbA1c antara kelompok intervensi dibandingkan kelompok kontrol (8,70 [±2,00] vs 9,02 [±1,71], p=0,334); dengan rerata HbA1c yang meningkat secara bermakna jika dibandingkan dengan rerata HbA1c bulan ke-6 (8,70 [±2,00] vs 7,83 [±1,80], p=0,016). Keluaran sekunder didapatkan perbedaan yang bermakna proporsi subjek yang mengalami penurunan kadar HbA1c ≥1% antara kelompok intervensi dibandingkan kelompok kontrol (41,4% [n=12] vs 10,3% [n=3], p=0,015); serta tidak ada perbedaan yang bermakna proporsi subjek yang mencapai target HbA1c <7% (13,8% [n=4] vs 6,9% [n=2], p=0,670). Kesimpulan. Health coaching tidak mampu mempertahankan perbaikan kendali glikemik pada pasien DM tipe 2 untuk jangka panjang jika coaching dihentikan, diperlukan pemberian coaching ulang agar perbaikan kendali glikemik dapat menetap. ......Background. Only one-third of type 2 DM patients achieved the expected HbA1c target. Several studies have shown that health coaching has been shown to be able to significantly reduce HbA1c levels, but it is not widely known the effects of long-term health coaching after coaching is stopped. Aim. This study was to determine the effect of education and health coaching in improving long-term glycemic control in outpatients with type 2 diabetes at a tertiary national health center. Method. This study is a follow-up observational study of 6 months RCT conducted in two tertiary national health centers to compare the combination of education and health coaching with education alone in type 2 diabetes mellitus patients with uncontrolled diabetes. Study subjects were followed at 6 and 18 months of baseline RCT. The primary outcome was the difference in the mean HbA1c between the two groups, and the secondary outcome was the difference in the proportion of subjects who experienced a decrease in HbA1c ≥1% from baseline and the difference in the proportion of subjects who achieved the HbA1c target <7%. Data analysis used independent T-test and Chi-square test. Result. This study managed to collect 42 out of 60 subjects (70%) who attended the study until the 18th month. There was no significant difference in the mean HbA1c between the intervention group and the control group (8.70 [± 2.00] vs 9.02 [± 1.71], p = 0.334); with the mean HbA1c which increased significantly when compared with the mean HbA1c at 6 months (8.70 [± 2.00] vs 7.83 [± 1.80], p = 0.016). Secondary outcomes showed a significant difference in the proportion of subjects who experienced a decrease in HbA1c levels ≥1% between the intervention group and the control group (41.4% [n = 12] vs 10.3% [n = 3], p = 0.015); and there was no significant difference in the proportion of subjects who achieved the HbA1c target <7% (13.8% [n = 4] vs 6.9% [n = 2], p = 0.670). Conclusion. Health coaching is unable to maintain improved glycemic control in type 2 DM patients for the long term when coaching is stopped, re-coaching is needed so that improved glycemic control can persist.