Volume 29, Issue 2 (Spring 2021)                   Avicenna J Nurs Midwifery Care 2021, 29(2): 81-90 | Back to browse issues page

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Shamsizadeh M, Shaadi S, Mohammadi Y, Borzou S R. The Effects of Education and Telephone Nurse Follow-Up (Tele-Nursing) on Diabestes Management Self –Efficacy in Patients with Type 2 Diabetic Referred to Hamadans Diabetes Center in 2018. Avicenna J Nurs Midwifery Care 2021; 29 (2) :81-90
URL: http://nmj.umsha.ac.ir/article-1-2137-en.html
1- Instructor, Department of Internal Surgery Nursing, School of Nursing, Hamadan University of Medical Sciences, Hamadan, Iran
2- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
3- Associate Professor, Non-Communicable Disease Modeling Research Center, Department of Biostatistics, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran
4- Associate Professor, Department of Internal Surgery Nursing, School of Nursing, Hamadan University of Medical Sciences, Hamadan, Iran , borzou@umsha.ac.ir
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✅ According to the findings of this study, it can be concluded that nurse telephone follow-up was effective in promoting self-efficacy in patients with diabetes.

Extended Abstract:   (1097 Views)

Diabetes is a common and costly disease. Nursing care services, not only are effective in reducing costs but also improve the quality of life and the relationship between the patient and the nurse. The aim of this research was evalution of telephone nursing Follow-up effects on self-efficacy in women with type 2 diabetes mellitus in Hamadan.


Materials and Methods

In this Clinical Trial study, 58 type 2 diabetic patients who met the inclusion criteria were recruited in Hamadan diabetes center by simple sampling. Patients were divided into two groups using block randomization. Data were collected using demographic and disease information questionnaire and Diabetes Management Self-Efficacy Scale (DMSES). Intervention in the experimental group was done by telephone nursing for 12 weeks in which phone calls were made during the first month (twice a week) and the second month (once a week). Phone nursing content included emphasis on diabetic diet, timely medication use, insulin injection, recreation and exercise, self care, stress management techniques, communication skills training, and more. The average duration of the call was 10-15 minutes on each call, and the time of phone call was agreed between 8 a.m. and 6 p.m. Patients were told that telephone nursing is free so patients could contact the researcher by phone or text if they had any questions. It should be noted that the patients in the control group received only the follow-up and routine care of the Hamadan diabetes center. Finally, the data were analyzed using IBM SPSS Statistics version 19 software. 



Findings of the study showed that the mean of self-efficacy in both groups before intervention was not statistically significant (P=0.15). After training the intervention group, the mean self-efficacy at one and two months after treatment was significantly improved compared to the control group (P<0.001).


Table 1. Distribution of demographic variables in women with type 2 diabetes by experimental and control groups

Number (%)
Number (%)
Statistical test
Marital status
Single 0 (0) 1 (1.8)  
Married 43 (79.6) 42 (76.4)
Divorced and deceased spouse 11 (20.4) 12 (21.8)
Education Primary 38 (70.4) 31 (56.3)  
Diploma 11 (20.5) 17 (31)
Above the diploma 5 (9.3) 7 (12.7)
Employment status
Housekeeper 51 (94.4) 48 (78.3)  
Employed 3 (5.6) 7 (12.7)
Income Less than 1 million tomans 33 (61.1) 30 (54.50)  
More than 1 million tomans 5 (9.3) 10 (18.2)

Table 2. Distribution of absolute and relative frequency of self-efficacy status of women with type 2 diabetes in the experimental and control groups before and after the intervention.

Low self-efficacy
Moderate self-efficacy
High self-efficacy
Control Before intervention N (%) 5 (9.3) 22 (44.7) 27 (50)
After intervention N (%) 4 (7.4) 23 (42.6) 27 (50)
Test Before intervention N (%) 5 (9.1) 21 (38.3) 29 (52.7)
After intervention N (%) 0 (0) 4 (7.3) 51 (92.7)

Table 3. Mean and standard deviation of self-efficacy scores in patients with type 2 diabetes in the experimental and control groups before and after the intervention

N M±SD Independent t-test
Before intervention Control 54 117.35±37.52 P=0.50
Test 55 122.05±36.41
After intervention Control 54 117.53±37.33 P>0.001
Test 5 163.03±19.93



Due to the chronic nature of diabetes, the patients suffering from this desiease need a lot of educational interventions. Nurses are among the providers of health services who know both up-to-date and scientific information about diabetes and their mission is to care.
Today, technology and topics called e-learning are considered as an effective method in many parts of the world and its use is highly recommended in chronic patients. In fact, nursing is the use of technologies such as mass media and information technology to improve nursing services despite the physical distance between the nurse and the patient (33).
In terms of self-efficacy in the management of diabetes, the results of this study showed that the level of self-efficacy in the management of diabetes in people in various cases including assessing blood sugar levels, examining lower limbs such as legs, doing personal work and diet control increased in individuals after intervention compared with before. To assess the relative extent of this increase, the group of patients received a questionnaire related to self-efficacy in the management of diabetes in relation to the goal of studying once after one month of training and again after two months of training. Findings showed that following continuous follow-up and training, patients can significantly manage their condition. Comparison of the results of self-efficacy in diabetes management after one month of training with the rate after two months of training showed that the average self-efficacy in diabetes management after two months increased significantly compared to the first month of training.
 In their study, Trief et al. (2009) investigated the effect of telenursing on patients' glycemic index and self-efficacy in diabetes management. In this study, remote intervention was able to significantly improve self-efficacy in the management of diabetes and glycemic index of patients. Also in this study, patients with higher self-efficacy in diabetes management had better glycemic indexes and better blood pressure control and eating habits. In fact, self-efficacy in diabetes management as a predictor could have a positive effect on other variables (36).
Zakerimoghadam et al. (2008) in their study examined the effect of telenursing on ​​the rate of adherence to a diabetic diet in patients with type 2 diabetes. The results of their study showed that after the intervention between the experimental and control groups, there was a statistical difference in diet adherence and the independent t-test after the intervention showed a statistically significant difference between the two groups in terms of glycosylated hemoglobin. Based on the findings, it can be concluded that nurse telephone follow-up leads to improved adherence to diabetic diet and reduction of glycosylated hemoglobin in patients with type 2 diabetes (38).
According to the results of this study and previous studies, it can be concluded that in addition to timely diagnosis and appropriate treatment, improving the treatment process and prevention of diabetes largely depends on the will of the individual in self-management and related behaviors. 



The results of this study showed that nurse telephone follow-up (telenursing) training and follow-up of the nurse in the intervention group compared with the control group improved self-efficacy in the management of patients' diabetes. Also, the self-efficacy in managing diabetes in patients two months after the intervention was clearly higher than one month after the intervention.



The researchers thank the Research Council of Hamadan University of Medical Sciences. The present article, resulting from the dissertation of the Master of Nursing and the Ethics Committee of Hamadan University of Medical Sciences with the ethics certificate IR.UMSHA.REC.1397.439, has confirmed it. Also, this study has been registered in IRCT system with clinical trial number IRCT20120215009014N249.


Conflicts of Interest

The authors declared no connflict of interest.


Type of Study: Original Research | Subject: Nursing
Received: 2020/01/28 | Accepted: 2020/07/29 | Published: 2020/10/11

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