International Journal of Health and Pharmaceutical Implementation of The Five Pillars Diabetes Education on Knowledge and Self-Care Behavior Among Patients With Type 2 Diabetes Fiolenty B.
Sitorus1*.
Putri Valerie Gaudiosa Noija 2.
Wulan Patricia Nikita Pusung3.
Renova O.
Br.
Sibuea4
1,2,3,4
Fakultas Keperawatan.
Universitas Pelita Harapan.
Tangerang.
Indonesia *Corresponding Author:
Email: fiolenty.
sitorus@uph.
Abstract Type 2 diabetes mellitus (T2DM) management requires effective self-care, which can be strengthened through structured education.
The Five Pillars of Diabetes Self-Care including nutrition, physical activity, medication adherence, blood glucose monitoring, and foot care provide a comprehensive framework for patient with T2DM.
This study evaluated the effects of an educational program based on these five pillars on the knowledge and self-care behaviors of patients with T2DM.
A quasi-experimental onegroup pretestAeposttest design was used.
A total of 24 patients with T2DM from the Jalan Emas Community Health Center in Tangerang were recruited using accidental The intervention consisted of four weekly interactive educational sessions that covered all five pillars.
Valid and reliable instruments .
he Five Pillars Knowledge Questionnaire and the Summary of Diabetes Self-Care Activities/ SDSCA) were used for data collection.
Data were analyzed using the Wilcoxon Signed-Rank Test.
Postintervention analysis showed significant improvements in knowledge related to nutrition management .
= 0.
, blood glucose monitoring .
= 0.
, and foot care .
= Overall self-care behavior also increased significantly .
= 0.
However, no significant improvements were observed in knowledge related to physical activity .
= .
and antidiabetic medication .
= 0.
The Five Pillars Diabetes Education program was effective in improving key areas of knowledge and self-care behavior among patients with T2DM.
These findings support the adoption of structured, comprehensive, and practical educational interventions, while also emphasizing the need for more targeted strategies to enhance physical activity engagement and medication adherence.
Keywords: Diabetes self-care.
Diabetes education.
Five Pillars of diabetes self-care.
Self-care behavior and Type 2 diabetes mellitus.
INTRODUCTION
Type 2 Diabetes Mellitus (T2DM) has become one of the leading public health challenges worldwide due to its continuously increasing prevalence and severe complications that affect patientsAo quality of life .
According to the International Diabetes Federation .
, approximately 537 million people worldwide are living with diabetes and Indonesia ranks fifth globally, with an estimated 19.
4 million cases and over 236,000 diabetes-related deaths each year.
At the national level, the 2018 Basic Health Research reported a diabetes prevalence of 1.
6% in Banten Province, while in Tangerang Regency, the rate reached 39%, affecting approximately 46,600 people.
These figures indicate that diabetes remains a serious and growing concern that not only burdens the healthcare system but also reduces the productivity and wellbeing of affected individuals.
Effective diabetes management requires patients to engage in consistent and appropriate self-care practices .
Health education plays an important role in strengthening patientsAo knowledge, attitudes, and skills for independent disease management.
Education that is well-structured and relevant can empower patients to make informed decisions and take an active role in their care .
To support self-care management, the Indonesian Endocrinology Association (PERKENI) developed the Five Pillars of Diabetes Self-Care, which include: .
dietary management, .
physical activity, .
adherence to antidiabetic medication, .
blood glucose monitoring, and .
foot care .
This approach aligns with OremAos Self-Care Theory, which emphasizes that individuals can maintain their health when provided with adequate information and support .
However, in practice, diabetes education in many healthcare settings does not comprehensively address all five pillars.
Preliminary study at the Jalan Emas https://ijhp.
International Journal of Health and Pharmaceutical Community Health Center in Tangerang revealed that patient education primarily focuses on dietary management, physical activity, and medication adherence, with limited emphasis on blood glucose monitoring and foot care.
This incomplete approach contributes to gaps in knowledge and self-care behavior among patients with T2DM.
Therefore, this study aims to evaluate the implementation of the Five Pillars Diabetes Education and its relationship with patientsAo knowledge and self-care behavior.
The findings are expected to provide evidence-based insights for healthcare professionals in promoting comprehensive diabetes education at the community level.
II.
METHODS
This study employed a quasi-experimental design using a one-group pretestAeposttest approach.
total of 24 respondents living within the working area of the Jalan Emas Community Health Center in Tangerang participated and completed the diabetes health education program.
Participants were selected based on the following inclusion criteria: .
diagnosed with Type 2 Diabetes Mellitus for more than one year, .
willing to participate in all educational sessions.
Exclusion criteria included:
patients with severe complications of diabetes such as diabetic ulcers or neuropathy, .
patients with hearing or visual impairments, .
patients with cognitive or communication disorders, and .
those who were unable to complete all educational sessions.
The intervention implemented in this study was a structured diabetes health education program based on the Five Pillars of Diabetes Self-Care developed by the Indonesian Endocrinology Association (PERKENI).
The program aimed to improve participantsAo knowledge and self-care behaviors related to the five key components of diabetes management:
dietary management, .
physical activity, .
adherence to antidiabetic medication, .
blood glucose monitoring, and .
foot care.
The intervention was conducted over a four-week period, consisting of four face-to-face educational sessions held once a week.
Each session lasted approximately 45Ae60 minutes and included a combination of lectures, demonstrations, and discussions to facilitate participantsAo understanding and engagement.
The sessions covered the following topics:
C Week 1: Introduction to diabetes and dietary management C Week 2: Physical activity C Week 3: Blood glucose self-monitoring and anti-diabetic medication management.
C Week 4: Foot care education All educational sessions were delivered by nursing lecturers from the Faculty of Nursing.
Universitas Pelita Harapan, who were trained in diabetes self-management education.
The sessions were conducted face to face at the Jalan Emas Community Health CenterAos education room, with attention to participantsAo comfort and privacy.
Each educational session was designed to be interactive and practical, combining short lectures, discussions, and live demonstrations.
The education on nutrition management and foot exercise was further supported through follow-up interactions via a whatsapp group, where participants shared photos or videos of their meal portions and foot exercise practices.
Throughout the program, the research team-maintained communication with participants to provide feedback, encouragement, and clarification as needed.
To enhance participant engagement, a motivational challenge was organized.
Participants who consistently demonstrated correct plate composition and portion control .
or nutrition managemen.
and proper foot exercise techniques .
or foot car.
throughout the four-week program were https://ijhp.
International Journal of Health and Pharmaceutical At the final session, one participant from each activity category received a small souvenir as appreciation for their commitment and effort.
This approach aimed to foster active participation, strengthen motivation, and support behaviour change beyond the educational sessions.
Data collection instruments included the Five-Pillar Diabetes Knowledge Questionnaire and the Summary of Diabetes Self-Care Activities (SDSCA) scale.
Both instruments were tested for validity and reliability prior to use.
The validity test conducted using itemAetotal correlation analysis, yielded correlation coefficients greater than 0.
Reliability testing using CronbachAos Alpha produced coefficients of 0.
87 for the knowledge instrument and 81 for the SDSCA.
Data were analyzed using the Wilcoxon Signed-Rank Test.
Data were collected in two stages - pretest and posttest the educational intervention - through questionnaires read aloud by the researcher to ensure comprehension.
The study obtained ethical approval from the Health Research Ethics Committee of the Faculty of Nursing.
Universitas Pelita Harapan, under approval number 155/KOMETIK/FKep/UPH/V/2024.
RESULT AND DISCUSSION
Table 1 presents the demographic characteristics of the respondents.
The majority of respondents were female .
7%).
The most common age group was 55Ae65 years .
5%), and the most frequent education level was senior high school .
8%).
Most respondents were unemployed .
= 22, 91.
8%), and 19 respondents .
2%) had been diagnosed with diabetes mellitus for less than five years.
Table 1.
Respondent characteristics (N = .
Respondent characteristics Sex
Male
Female Age
>65
Educational level Elementary Senior high school University Occupation Unemployed Employed Lama riwayat DM <5 tahun >5 tahun Percentage (%) Table 2.
Comparison of respondentsAo knowledge on the five pillars of diabetes self-care before and after education (N = .
Pillar Nutrition management Physical activity & exercise Blood glucose monitoring Antidiabetic treatment Category Good Average Poor Good Average Poor Good Average Poor Good Pre-Test n (%) 18 .
https://ijhp.
Post-Test (%) 24 .
International Journal of Health and Pharmaceutical Pillar Category Average Poor Good Average Poor Foot care Pre-Test n (%) 4 .
Post-Test (%) 3 .
Table 2 shows respondentsAo knowledge levels across the five pillars of diabetes self-care before and after receiving the educational intervention.
Prior to the program, the highest knowledge level was observed in nutrition management .
%) and antidiabetic medication .
8%), while the lowest was in foot care .
7%).
After the intervention, all respondents .
%) demonstrated good knowledge in nutrition management, and notable improvements were observed in blood glucose monitoring .
0% to 87.
and foot care .
7% to 79.
2%).
These findings indicate that the educational sessions effectively improved participantsAo understanding across all self-care.
Table 3.
Self-Care Behavior Based on the Five Pillars of Diabetes Education Before and After the Intervention (N = .
Category Good Poor Pre-Test n (%) 13 .
Post-Test n (%) 24 .
Table 3 shows the respondentsAo self-care behavior before and after the diabetes education program.
Before the intervention, 54.
2% of respondents had good self-care behavior, while 45.
8% were still poor.
After receiving the Five Pillars Diabetes Education, all respondents .
%) showed good self-care behavior.
This result means that the education program helped participants apply better diabetes management practices in their daily lives.
Table 4.
Effect of diabetes education on knowledge and self-care behavior (N = .
Aspect Tested Nutrition management Mean Rank p-value (Asymp.
Sig 2-taile.
Physical activity & exercise Blood glucose monitoring Antidiabetic treatment Foot care Self-care behavior .
ive pillar.
Table 4 shows the results of the Wilcoxon Signed-Rank Test on the effect of the Five Pillars Diabetes Education on respondentsAo knowledge and self-care behaviour.
The results indicate that there were significant differences between pre-test and post-test scores in several areas of diabetes self-care.
Significant improvements were found in nutrition management .
= 0.
, blood glucose monitoring .
= 0.
, and foot care .
= 0.
This means that the education sessions successfully increased participantsAo knowledge in these areas, especially in aspects that were less emphasized before.
Meanwhile, no significant changes were observed in physical activity .
= 0.
and antidiabetic treatment .
= 0.
, even though some improvement was seen.
A significant increase was also found in overall self-care behavior .
= 0.
showing that the Five Pillars Diabetes Education program helped participants apply better diabetes self-care practices in their daily lives.
Discussion This study implemented a comprehensive educational intervention based on the Five Pillars of Diabetes Self-Care, which aimed to improve both knowledge and self-care behavior among patients with Type 2 Diabetes Mellitus.
The findings showed significant improvements in participantsAo knowledge regarding nutrition management, blood glucose monitoring, and foot care, as well as an overall enhancement in self-care behavior.
These results indicate that structured and comprehensive diabetes education can effectively strengthen patientsAo understanding and daily self-management practices.
The difference between the five-pillar educational approach in this study and that of other articles lies in its more practical and https://ijhp.
International Journal of Health and Pharmaceutical structured delivery of material, which comprehensively covers all pillars.
This distinguishes the present study from previous ones that tended to focus on only two or three aspects of self-care.
For example, several studies emphasized increasing knowledge and behavior related to dietary management and physical activity, without integrating aspects of foot care or independent blood glucose monitoring .
Despite its importance in preventing ulceration and lower-extremity complications, the foot care component of diabetes self-management is frequently overlooked in both research and patient education programs.
This study also employed a simulation-based approach, including diabetes exercise demonstrations, food label reading practice, and self-monitoring of blood glucose, which have not been widely implemented in other studies.
Weise et al .
, in a national study, found that many participants in diabetes education programs felt that the education they received was passive and lacked practical skills training that could be applied in daily life.
This finding suggests that experiential educational approaches, such as those used in this study, can have a greater impact on knowledge internalization and the development of long-term healthy Additionally, this approach incorporates local cultural elements and is specifically designed to meet the needs of the local community, as suggested by Rahman et al .
, who emphasized the importance of community-based contextual education.
Therefore, the five-pillar approach in this study can be considered a development of previous educational models that is more comprehensive and holistic.
Despite the overall improvement, the findings indicate that there was no significant improvement in physical activity and antidiabetic treatment.
This phenomenon can be explained by several inhibiting factors.
Internal barriers such as physical limitations, advanced age, and negative perceptions of physical activity may reduce motivation to engage in regular exercise.
In addition, limited facilities present obstacles to maintaining consistent physical activity.
The absence of a significant improvement in the antidiabetic treatment aspect may be attributed to the already high level of compliance prior to the intervention, leaving little room for further behavioural change.
Furthermore, various external constraints, including limited access to healthcare facilities, inflexible visit schedules, and the financial burden of treatment, may also have contributed to the lack of improvement in this pillar.
These findings are consistent with the studies conducted by Hailu et al.
Rahman et al .
, and Wichit et al .
, which state that the effectiveness of diabetes self-care education largely depends on social context, individual abilities, delivery methods, and environmental support.
Therefore, a more individualized, participatory, and sustainable educational approach is needed to optimize the impact across all aspects of the five pillars of self-care.
IV.
CONCLUSION
This study found that implementing the Five Pillars Diabetes Education significantly improved participantsAo knowledge in three areasAinutrition management, blood glucose monitoring, and foot careAi and led to overall improvement in self-care behaviour among patients with Type 2 Diabetes Mellitus.
These findings demonstrate that structured and comprehensive education effectively enhances understanding and supports behavioral change in diabetes management.
However, no significant improvement was observed in physical activity and antidiabetic medication knowledge, indicating the need for more adaptive and contextual strategies to address barriers such as physical limitations, motivation, and prior adherence patterns.
Overall, this study demonstrates that the Five Pillars Diabetes Education Model and the implementation of supportive interventions for each pillar is an effective model for empowering patients in the selfmanagement of diabetes.
Nurses play a key role in maintaining this approach, while future programs should integrate community-based and culturally tailored interventions to encourage long-term behavioral change and improve quality of life for people with diabetes.
RECOMMENDATIONS
Based on the findings of this study, the Five Pillars Diabetes Health Education Program has been proven to improve the knowledge and self-care behavior of patients with diabetes mellitus, although not evenly across all aspects.
The results of this insignificant physical activity need to be observed and further motivated, as one of the interventions for normal blood sugar control is physical activity.
The Jalan Emas Community Health Center itself already has a Prolanis program for service activities and exercises for adults https://ijhp.
International Journal of Health and Pharmaceutical and seniors, especially those with diabetes.
Therefore, it is recommended that future educational interventions adopt more interactive and adaptive methods that are appropriate to the socio-cultural context of the participants.
A combination of lectures, demonstrations, audio-visual media, group discussions, and experience-based learning based on patient stories or real experiences is expected to increase participant engagement, understanding, and ability to apply self-care practices in their daily lives.
VI.
ACKNOWLEDGEMENTS
The author would like to express sincere gratitude and appreciation to the Faculty of Nursing.
Pelita Harapan University.
Karawaci Tangerang, the Community Health Center on Jalan Emas in Tangerang, the health cadres, and all parties who have provided support and assistance throughout the research process.
REFERENCES