Volume 28, Issue 3 (7-2020)                   Avicenna J Nurs Midwifery Care 2020, 28(3): 216-226 | Back to browse issues page

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Dafei M, Hatefi S, Dehghani A. The Effect of Group Counseling Based on Cognitive-behavioral Approach on Self-Care Behaviors and Illness Perception of Middle-aged Women with Diabetes Type 2: A Quasi-experimental Study. Avicenna J Nurs Midwifery Care 2020; 28 (3) :216-226
URL: http://nmj.umsha.ac.ir/article-1-2115-en.html
1- Assistant Professor, Research Center for Nursing and Midwifery Care, Faculty of Nursing & Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran , maryam-dafei@yahoo.com
2- Msc counseling in Midwifery, Department of Midwifery, International Campus University, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
3- Associated Professor, Department of Statistics, School of Shahid Sadoughi University of Medical Sciences, Yazd, Iran Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Illness Perception and self-care behaviors are essential elements in treatment and management of patients with diabetes. Considering the increasing number of diabetic patients and the importance of self-care as a lifelong principle in controlling diabetes and the need to understand the disease in the importance of self-care activities, and the importance of using cognitive-behavioral techniques in chronic diseases, and the prevalence of cardiovascular and visual complications in women with diabetes. So that women with diabetes have a lower chance of survival and quality of life after cardiovascular events, and in addition, the risk of diabetes-related blindness is higher in women (18) and due to the lack or scarcity of Iranian and even foreign studies, The main purpose of this study was to investigate the effect of group counseling with a cognitive-behavioral approach on self-care behaviors and disease perception in middle-aged women with type 2 diabetes.


Materials and Methods

The present study is a quasi - experimental study with two groups of intervention and control in parallel with pre-test, post-test and one month control in Isfahan, Iran, comprehensive health centers. For each group, 32 middle-aged women with T2D were selected by convenience sampling. Both groups received routine care of diabetic patients, but the experimental group received a cognitive behavioral group-counseling program. Data was collected through demographic questionnaire, the illness perception questionnaire (IPQ), and summary of diabetes self-care activity (SDCS) and a checklist. Data was analyzed by SPSS 16 (SPSS Inc., Chicago, IL., USA) using descriptive statistics, Chi-square test and independent t-test with significance level of 0.05.



The groups were not significantly different demographically. The mean age was 38.65±4.23 and 39.19±4.87, and the duration of diagnosis was 2 years and less. Of patients, 77% had a history of hypertension or hyperlipidemia or both in both groups. There were no significant differences in self-care behaviors (t=-0.0222, P=0.859) and illness perception (t=-0.178, P=0.859) in the pre-test. However, in the post-test, the intervention group showed a significant improvement in self-care behaviors (t=4.25, P=0.01) and disease perception (t=3.93, standard deviation=0.87). There was also an improvement in self-care behaviors (t=4.41 and P=0.014) and illness perception (t=414 and P=0.01) in the follow-up period, indicating the persistence of changes in counseling (Tables 1-3).



Psychological counseling is an important factor in understanding the disease and performing self-care behaviors in diabetic patients. Based on the results of this study, the disease perception score in the two experimental and control groups before, immediately after and one month after cognitive-behavioral counseling showed that in the pre-test stage, the mean disease perception score between the two groups was not statistically significant. ; But after the intervention and also at the time of follow-up, the mean score of disease perception was significantly different between the two groups (P <0.001). The mean score of disease perception in the intervention group at two times compared to the control group had an increasing trend.
The findings of this study were in line with the findings of Jahandar study with the aim of "determining the effectiveness of short-term group cognitive-behavioral intervention (CBGI-CHD) on quality of life and perception of the disease in type 2 diabetic patients" whose results indicate the effectiveness of cognitive approach Behavior has been based on the perception of the disease. The factor that distinguishes the present study from the Jahandar study is the number of sessions. The present study examined self-care behaviors rather than quality of life. Also in the present study, the follow-up stage was performed one month after the intervention, but in the Jahandar study, this stage was not performed (24).
Struss (2015) in examining the perception of the disease in people at risk of diabetes, stated that there are differences in the perception of the disease in individuals that can be related to differences in risk factors in each person, so it is better to consider the risk factors underlying the disease. Provide counseling and training to health care providers, individuals.
In comparing the mean score of the effect of group counseling with cognitive-behavioral approach on self-care behaviors in the previous times, immediately after and one month after the intervention in the two groups, in the pre-test stage, the mean score of self-care between the two groups was not statistically significant. However, after the intervention and also at the time of follow-up, there was a significant difference in the mean score of self-care between the two groups (the mean score of self-care in the intervention group at two times compared to the control group had an increasing trend). In 2013, Ghotbi et al. examined the effect of family-centered self-care education on type 2 diabetic patients. The results of their study showed that the presence of family in self-care training sessions in four areas of food, medicine, physical activity, foot care and complications of diabetes is effective. , Promotes caring temperament in patients with type 2 diabetes (26).
It is suggested that in future studies in other clinical populations as well as in the families of diabetic patients, long-term follow-up tests be performed to determine the persistence of the effects of the intervention. It is also suggested that health care providers be trained in the cognitive-behavioral approach and that self-help groups be formed to help reduce and improve the complications of chronic diseases, especially diabetes, by continuing activities.



Group counseling based on cognitive-behavioral approach can enhance the perception of disease and self-care behaviors in T2D. Therefore, it can be used as a therapeutic approach to medication for patients with T2DM.



The present study is a report of the master's thesis entitled "The effect of group counseling based on cognitive-behavioral approach on self-care behaviors and perception of middle-aged women with type 2 diabetes" in the School of Medicine - Shahid Sadoughi University of Medical Sciences, Yazd. SSU.MEDICINE.REC.1397.146 has been approved. The researchers thank all the people who participated in the research and the esteemed officials who helped them in this field, as well as the researchers whose articles were used.


Conflicts of Interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.


Type of Study: Original Research | Subject: Midwifery
Received: 2019/12/16 | Accepted: 2020/03/19 | Published: 2020/05/30

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