Educational interventions to improve self-care and reduce self-neglect in Iranian elderly people with diabetes

INTERVENTION: This study was conducted over 24 weeks at three Urban Health Centers in Shiraz, Iran. Among the urban health centers with the most people with diabetes, three centers were randomly selected and then the centers were randomly assigned to the intervention and control groups. The elderly who were eligible were identified and 45 people in each center were selected using a list of random numbers. Due to the prevalence of COVID‐19, the training was done through WhatsApp software. Three WhatsApp groups were formed to provide training to the participants. In all three groups, training content was sent daily to participants for the first 2 months, and for the next 4 months training continued only on Mondays. Messages were sent in the form of text, images, media, audio, images, emoticons, and links. Data were collected between December 2020 and May 2021. In the first arm, a self‐care training program focused on behavior change based on self‐regulatory theory was sent. In the second arm, a combined intervention was presented that included mindful self‐care training and a self‐care training program based on self‐regulatory theory. In the control arm (CO), COVID‐19 prevention training was sent to the participants. Five questionnaires including demographic information, summary of diabetes self‐care activities (SDSCA), the mindful self‐care questionnaire (MSCS), Elder Self‐Neglect Scale (ESNS), and Short form Self‐Regulation Questionnaire (SSRQ) were used. Information from telephone interviews was collected at baseline, week 4, and week 16 after the intervention programs. CONDITION: Community‐dwelling elderly people with diabetes ; Nutritional, Metabolic, Endocrine ; Diabetes mellitus PRIMARY OUTCOME: ; Measured at baseline, week 4, and week 16 after intervention programs:; 1. Demographic information collected using a researcher‐made questionnaire that included gender, age, marital status, education level, occupational status, living arrangement, duration of diabetes, other diseases; 2. The different activities of diabetic patients during the previous 7 days measured by a 12‐item self‐report scale: Summary of Diabetes Self‐Care Activities (SDSCA); 3. Mindful self‐care assessed using the mindful self‐care scale (MSCS). This instrument measures the frequency of behavior within the past week in six subscales: mindful relaxation, physical care, self‐compassion, and purpose, supportive relationships, supportive structure, mindful awareness, and three general items; 4. Elder self‐neglect measured by the Elder Self‐Neglect Scale (ESNS) developed by the researchers. It consists of 26 items that specified the frequency of the self‐neglect behaviors.; 5. Self‐regulation behavior in elder diabetics measured by the Short form Self‐Regulation Questionnaire (SSRQ). It included 31 items that the higher the scores indicate a better level of self‐regulation; SECONDARY OUTCOME: There are no secondary outcome measures INCLUSION CRITERIA: 1. Age 60‐80 years old 2. Type 2 diabetes (duration =6 months) 3. Sufficient ability to read and write 4. Sufficient activity daily living 5. Sufficient WhatsApp and Internet literacy 6. Smartphone and Internet access