Abstract
Diabetes Mellitus (DM) is ubiquitous and affects millions of individuals worldwide. The disease tremendously impacts health care systems and warrants efficacious interventions to obviate deleterious consequences. Didactic educational approach is widely used to deliver DM self-care management knowledge. However, this approach is limited in its ability to facilitate active patients' engagement in the learning process. Guided reflection is a novel approach that has the potential to facilitate learning through reflection on past experience and positively impact self-care outcomes. The purpose of this study was to evaluate the effects of guided reflection on self-care behaviors (maintenance, monitoring, and management) and confidence and diabetes knowledge among adults with DM using a prospective, randomized controlled trial, two-group, pretest posttest design. A convenience sample of 62 adults was recruited from a single DM care site. After confirming eligibility and obtaining baseline data participants viewed a 30-minute patient education video that consisted of short, succinct video clips on how to effectively manage DM. Subsequently, they were systematically randomized to an intervention (n = 31) or control group (n = 31). In addition to the patient education videos, the intervention group participated in a 15-minute education session that concentrated on the benefits of reflection and the reflection protocol which required participants to isolate diabetes-related events weekly, critically analyze them using Gibbs' reflective questions and record their analysis in a journal. Participants received follow up phone calls for eight weeks. Post study, participants shared their perspective relative to using the reflection journal in an audiotaped interview. Study data were analyzed using t-test, chi-square, repeated measures analysis of variance, and Wilcoxon Signed Ranks test as appropriate. Descriptive analysis revealed no statistically significant differences in demographic data including age, gender, ethnicity, income, education status, and DM type and duration. There was no statistically significant interaction between intervention and control groups over time on the four self-care measures. Although the results were not statistically significant between the groups, they trended in the anticipated direction, indicating the potential of statistically significant results with a larger sample. Importantly, both groups had statistically significant improvement in all self-care scores at posttest. Findings also revealed significant improvement in DM knowledge among those who engaged in the guided reflection exercise (z = -3.237, p = .001). Furthermore, participants critically analyzed 147 diabetes-related events using Gibbs' reflective cycle. Intervention acceptability was demonstrated. Statistically significant differences between groups may be determinable in a larger sample. Combined education and reflection and education only interventions are effective approaches for improving DM self-care outcomes among adults with DM. Findings may have implications for clinical practice and future research. Research concentrating on purposeful patient reflection is warranted in a larger sample paying careful attention to study limitations..