Diabetes brings a big burden to a person who acquired this. Though the body’s blood sugar level can be controlled, until now, there is still no cure for this condition. The current treatment is by administering oral anti-diabetic medication and insulin injection derived from human or animal insulin. If the person can purchase the medications prescribed by their physicians, complications which might cause devastation to their daily life can be prevented.

In the Philippines, the Department of Health (DOH) provides a program under the Non-Communicable Disease Prevention and Control & Healthy Lifestyle in which patients with diabetes mellitus will be able to monitor their health condition, having free follow up check-up and receive medication to help maintain and attain a quality of life [1]. According to the study, it projects that 380 million people around the world will be affected by the proliferation of diabetes which includes the Philippines [2]. That is why a psychosocial intervention is imperative to reduce or control its incidence. Likewise, research has shown the efficacy of several psychosocial interventions in improving compliance with diabetic treatment regimens and blood glucose levels and in reducing diabetes-related hospitalizations [3]. 

In the Diabetes Prevention Program, a large prevention study of people at high-risk for diabetes, people treated with the drug metformin reduced their risk of developing diabetes by thirty-one percent. As supported by Jackson [4], a Diabetes Prevention Program (DPP) based lifestyle modification curriculum is effective in promoting weight loss among adults across all socioeconomic classes, sex, gender and race/ethnicity.

According to Al-Nozha et al. [5], Diabetes Mellitus (DM) can be treated and the evidence for the effectiveness of treatment on early detection is promising. In terms of high coverage, the number of positive screening with successful referral and follow-up, was high at Primary Health Care Centers (PHCC) while mobile teams, other public venues had the disadvantage of limited coverage and the failure to confirm positive screening owing to the loss of contact, or shortage of time and manpower [6].

The roles and duties of community health workers in diabetes care were varied ranging from substantial involvement in inpatient care to providing instrumental assistance in education sessions taught by other health professionals. Community health workers’ responsibilities in diabetes care were varied ranging from substantial involvement in inpatient care to providing instrumental assistance in education sessions taught by other health professionals [7].

The abovementioned pieces of literature motivated the researchers to conduct a study regarding the program for diabetic clients. Therefore, the study is aimed to identify the factors affecting the effectiveness of the Diabetes Control Program (DCP) implementation in one of the Rural Health Units in Bataan, Philippines. The result of the study will contribute to the improvement and enhancement of its existing strategies and protocols.

Quantitative approach [8], specifically, a descriptive-correlational method was used as its design which identifies the relationship [9], of the healthy lifestyle and clinic-related factors to the level of effectiveness of the Diabetes Control Program [10]. It involved a total population sample of 211 (185 DM clients who were: a) enrolled in the diabetes control program, b) under 18-60 years of age and 26 healthcare providers who handle the diabetes control program implementation) who were willing to participate and was recruited via convenience sampling technique. A self-made non-standardized survey questionnaire derived from literature reviews [11] and Diabetes Control Program training manual and validated by the three experts:

• An experienced municipal health officer

• A professor of the graduate school

• Nursing professor expert in public health served as the research instrument

It undergone a pilot testing before it was given to the actual participants. Before the conduction of the study, permission was sought from the Dean of the Graduate School of Bataan Peninsula State University. After the approval, permission was secured from the Municipal Health Officer and Diabetes Control Program Coordinator in one of the Rural Health Units (RHUs) situated in Bataan, Philippines who caters to the DCP which serves as the context of the study. A brief explanation regarding the purpose of the conduction of research was provided to the participants. They were instructed that anytime they may withdraw from the study without receiving any punishment. However, no withdrawal was observed during the data collection. Consent was secured before they answered the survey questionnaire. They were also informed that anonymity and confidentiality will be implemented towards the completion of the study. Refreshment was given to the participants as part of the reward in participating in the study. It spent almost 1 month to collect the necessary data for the study and this was collected during the follow-up check-up of the clients in the RHU. Tallying was made after the collection of data and was computed using SPSS software version 19. Six months after the analysis of data, all questionnaire was shredded and disposed of properly. For the analysis of data, Pearson’s product-moment of correlation was employed to identify if there is a significant relationship between the healthy lifestyle and clinic-related factors to the level of effectiveness of the Diabetes Control Program.

Table 1 presents the correlation coefficients of the effectiveness of the Diabetes Control Program and the healthy lifestyle components namely, adequate diet and nutrition, rest and sleep, proper exercise, abstinence from smoking, alcohol-free and stress reduction and management. In terms of program administration, non-significant correlation of 0.188 (p = 0.05) was observed with stress reduction and management which is considered negligible. With regards to information dissemination, abstinence from smoking is the most correlated having a result of low correlation coefficient of 0.240 (p = 0.01). Overall, a healthy lifestyle component is not significantly correlated (r = 0.82, p = 0.05) with the level of effectiveness of the Diabetes Control Program.

Table 1: Healthy Lifestyle and Level of Effectiveness of Diabetes Control Program

*Significant at 0.05 level; Significant at 0.01 level; ns – not significant at 0.05 level Correlation Coefficients:              ±0.80–±1.0: High Correlation, ±0.60-0.79:                        Moderately High Correlation, ±0.40-±0.59:    Moderate Correlation, ±0.20 -±0.39:                  Low Correlation, ±0.01-±0.19:      Negligible Correlation

Table 2 presents the correlation coefficients of the effectiveness of the Diabetes Control Program and the clinic-related factors namely, accessibility of medical facilities and supplies, recording, reporting supervision, monitoring, attitude towards patients and client education. Accessibility of medical facilities and supplies is significantly correlated with the level of effectiveness of the Diabetes Control Program having a moderate correlation coefficient of 0.43 (p = <0.01). Also, supervision is moderately correlated with the level of effectiveness of the Diabetes Control Program having coefficient result of 0.42 (p = <0.01). However, a low correlation coefficient of 0.20 (p = 0.01) with information dissemination was outputted. Overall, clinic-related factors are significantly correlated with the level of effectiveness of the Diabetes Control Program with a correlation coefficient of 0.44 (p = <0.01) which indicates a moderate relationship.

Table 2: Clinic-Related Factors and Level of Effectiveness of Diabetes Control Program

** - significant at 0.01 level; * - significant at 0.05, ns – not significant at 0.05 level

The study revealed that RHU-related factors are significant in the program implementation of DCP. Involvement is very important to diabetic clients because it will monitor their current health status through communication to health care providers to achieve positive health outcomes and treatment goals [12]. 

This can be done through health promotion initiated by health care provider especially nurses since this is their general role as primary care providers in the community [13,14], thus, a healthy lifestyle should be emphasized. In the study conducted by Chan and Molassiotis [15], it was found out that clients with diabetes are having gaps in terms of what they are doing to what the health care provider taught to them. But if the clients are involved in the program, health care providers may supervise and monitor the clients leading to successful changes in their lifestyle habits [16-18]. It implies that community health care providers must be adamant in the implementation of DCP to ensure its program effectiveness. But there should be an adequate facility that facilitates the sustenance of the program especially on the provision of free medications among clients [19]. Accessibility shows a significant relationship in the effectiveness of a diabetes control program. This is because some of the clients are indigent and live in the remote areas of the community. Likewise, accessibility of health services is very important and policies should be intact to improve the health outcomes of clients [20-22]. In addition, Local Government Unit (LGU) and Non-Government Organization (NGO) also play an important role in supporting and sustaining a health program especially with regards to resources and allocation of the budget which can add support to the operations of DCP in the community [23,24]. Further, public health nurses must maintain their supervision and monitoring of their clients as well as to reinforce or strengthen their health teachings in order to attain quality health outcomes among DM clients [1], because it was found out that participants who are under diabetes control program have a significant effect when it comes to their lifestyle habits which reveal increase engagement to exercise, having regular sleep patterns and decrease alcoholic drinkers [16]. This implies that DCP is necessary to maintain and sustain in the community to monitor and supervise the DM clients and improves their quality of life (Qol).

The study revealed that the Diabetes Control Program was not effective as a result of a high correlation to its RHU-related factors to the program administration particularly in the accessibility of medical facilities and supply and supervision. Likewise, public health nurses must be aggressive in giving health teachings to prevent the proliferation of Diabetes Mellitus (DM) cases in the community as part of their health promotion which can be done through conduction of seminars, symposiums and the like activities. Collaboration in the LGU and NGO is imperative to support the implementation of DCP especially in the far-flung and remote areas in the community. Since it is done only in one context, it is recommended to conduct further studies regarding DCP implementation in the Philippines. Moreover, further study is recommended to conduct regarding other factors that affecting the total implementation of DCP including comparative studies among other municipalities in the Philippines.

Acknowledgment

This paper is a part of the thesis of the corresponding author for his Master of Arts in Nursing. He would like to express his profound gratitude to the people behind this success. His co-author and adviser, Dr. Ruby S. Matibag, for always giving her expert opinion towards the completion of this study. His family, Joseph E. Orte, Arnie E. Orte and Carl James S. Orte. The panel members, Dr. Danilo C. Galicia (former Dean of the Graduate School), Dr. Sylvia B. Pangilinan, Ms. Anita R. Pereyra, Dr. Jesselyn Mortejo (present Dean of the Graduate School) and Dr. Melvin Escartin for the incorporation of their insights towards the improvement of this manuscript. Lastly, to his wife, Catherine M. Herbon-Orte, RN, CPC for the unending love and support.

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