page                                                                                                     i

Certification                                                                                                                ii

Dedication                                                                                                      iii

Acknowledgements                                                                                        iv

Abstract                                                                                                          v

Table of Contents                                                                                           vi

List of Tables                                                                                                  viii

List of Figures                                                                                                 ix

List of Appendices                                                                                         x

CHAPTER ONE: INTRODUCTION

1.1Background to the Study                                                                          1

1.2Statement of the Problem                                                                          3

1.3 Objective of the Study                                                                             3

1.4 Research Questions                                                                                     4

1.5 Hypotheses                                                                                               4

1.6 Scope of the Study                                                                                   4

1.7 Significance of the Study                                                                         4

1.8 Operational Definition of Terms                                                               5

CHAPTER TWO: REVIEW OF LITERATURE

2.0 Introduction                                                                                              6

2.1 Definition, cause, symptoms, complication and types of diabetes mellitus         6

2.2Epidemiology of Diabetes mellitus                        8

2.3 Impact of Diabetes in Nigeria                                                                     9

2.4Organizations of diabetes care in Nigeria  9

2.5 Profile of patients with diabetes in Nigeria                                            11

2.6 The way forward                                                                                        12

2.7 Previous research in diabetes self-management intervention       14

2.8 Diabetes self-management Education      15

2.9 Diabetes self-management                                                                                17

2.10 Barriers to diabetes care                                                                             20

2.11 Conceptual model                                                                               22

CHAPTER THREE: METHODOLOGY

3.0 Introduction                                                                                              25

3.1 Research Design                                                                                              25

3.2 Population                                                                                            25

3.3 Sample size and sampling Technique                                                        25

3.4 Instrumentation                                                                         26

3.5 Validity of Instrument                                                                             27

3.6 Reliability of Instruments                                                           27

3.7 Data Collection Procedure                                                                        27

3.8 Method of Data Analysis                                                                         28

3.9 Ethical Consideration                                                                               28

CHAPTER FOUR: DATA ANALYSIS, RESULTS AND

DISCUSSION OF FINDINGS

4.0 Introduction                                                                                              30

4.1 Data analysis and results                                                                           31

4.2 Discussion of Findings                                                                             39

CHAPTER FIVE: SUMMARY, CONCLUSION

 AND RECOMMENDATIONS

5.1 Summary                                                                                                 44

5.1.1 Nursing Implication                                                                               45

5.2 Conclusion                                                                                         45

5.3 Recommendations                                                                                    46

5.4 Suggestion for Further Studies                                                                 47

REFERENCES                                                                                                   48

APPENDICES                                                                                          57

LIST OF TABLES

Table                                                                                                              Page

1 Frequency and percentage on demographic data of respondents                                        31

2 Descriptive statistics of diabetic patient’s knowledge regarding self-management            33

3 Comparative frequency distribution of Knowledge Responses from questionnaires          34

4Descriptive statistics of diabetic patient’s practice of self-care activities                            36

5 Comparative frequency distribution of Self-care Activities Responses from         37

6Descriptive and inferential statistic of diabetic patient’s pre/post-intervention       38

Knowledgeregarding self-management                                                         

7Descriptive and inferential statistic difference of diabetic patient’spre/      38

Post-interventionpractice of self-care activities                                             

LIST OF FIGURES

Figure                                                                                            Page

1 Dorothea Orem self-care conceptual model                        22

2 Self-care conceptual model                                                                                  24

APPENDICES

Appendix                                                                                                                       Page

 A: Informed Consent form                                                               57

 B: Questionnaire                                                                               58

 C: Training program hand-out                                                           61

 D: Pictures from the field work                                                                66

 E: Study Setting Clearance                                                                                 68

 F: BUHREC                                                                                             69

 G: Turnitin Report                                                                               70

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Diabetes mellitus (DM) is a metabolic disease in which glucose level in the blood is high over extended periods (World Health Organization, 2014). DM results when the pancreas is unable to produce insulin or cell of the body is not responding to insulin produced  (Shoback, 2011). In 2013 alone 4.6 million people died of DM (Aschner, Beck-Nielsen, Bennett, Boulton, & Colagiuri, 2013). Low and middle-income countries of the world is being affected by DM, there are more than 77 % morbidity and 88 % mortality (International Diabetes Federation, 2013). Type 2 diabetes mellitus (T2DM) is the commonest form of DM and it account for 90 % of disease (Aschner et al., 2013).

13.2% is the prevalence rate of DM with registered 4,600 people (International Diabetes Federation, 2014). Estimate of the World Health Organization (WHO) states that DM prevalence among adults in 2014 was 9%, a prediction of at least 350 million people with T2DM by 2030 (WHO, 2015). In accordance with a national survey carried out, the prevalence of diabetes mellitus in Nigeria increased from 2.2% to 5.0% by 2013 estimates of the International Diabetes Federation (IDF). Complications of diabetes are common at the time of presentation in Nigeria: neuropathy 56%, erectile dysfunction 36%, nephropathy 9%, and retinopathy 7% (Chinenye & Ofoegbu, 2013). This is partly because diabetes is a progressive illness with an initial asymptomatic phase associated with on-going tissue damage and decline in pancreatic beta cell mass and function.

Ali, Barke, Bullard, Gregg, and Imperatore, (2012) reported that glycemic control at the suboptimal level likely cost diabetic patients increased care requirement, complications and related health care costs. Improper glycemic control has a link with an increased risk of visual impairment, kidney failure and cardiovascular disease (Balkau, Borch-Johnsen, Colagiuri, Lee, Shaw &Wong, 2011). The possible reasons for poor glycemic control includes poor adherence and awareness, manpower insufficiency, time constraint, lack of appropriate guidelines on diabetic education for health practitioners and diabetic patients (Amade, Gudina, Ram, & Tesfamichael, 2011).

Because of lack of awareness, patients with DM suffer from its complications (Gul, 2010). The way to self-management includes testing the blood glucose, adequate diet, regular examination of the foot and eye, all this have shown to reduce complications from DM (Aschner et al., 2013; Biswas, Ferrari, Islam, Islam, Lechner &Niessen, et al., 2015).Therefore, proper blood glucose control among Diabetes Mellitus patients prevents short and long-term complications and reduce cost and long hospital stay.

The aim of self-management of DM is to ensure that the blood glucose level is at a normal range and to reduce the risk of complications. There are seven self-care behavior people having DM must ensure to keep their glucose level normal: they include eating healthy, physically active, self-monitoring of glucose content, compliance with medication, risk-reduction behaviors, good problem-solving and healthy coping skill (American Association of Diabetes Educators, 2010). This measures are useful for physicians managing diabetic patients and it has impacted positively on glycemic control, complication reductions and improvement in quality of life (American Diabetes Association, 2009). Self-management goals and its implementation are written in collaboration with the diabetic patient and health care professionals, it promotes patient self-management, decrease the prevalence of DM and its complications (Ahola & Groop, 2013).

Haidet, Naik, Rodriguez and Teal (2011), also emphasized the importance of patient education for better outcomes of self-management of diabetes, stated that patient education is necessary because it promote high quality diabetic care. Diabetic education programmes stress the importance of patients comprehending the practical approach to self-manage their disease condition. Knowledge and understanding are important in helping patients towards better self-management of diabetes mellitus.

 Education help people having DM initiate good self-management and coping skill. Continuous DM education help people having the disease care for themselves.(American Diabetes Association, 2014).There is good report when intervention is long term, it includes follow-up and patients care is individualized. Intervention which promotes behavioral changes improves clinical outcome (Haidet, Naik, Rodriguez &Teal, 2011).Anderson and Funnell (2013), said that self-management education is a process of facilitating knowledge, skill and ability, is an important component of an effective diabetic management. Self-Management place patients at center of care, empowering patients to make decision that will improve clinical outcome.

1.2 Statement of the Problem

Diabetes Mellitus has significantly contributed to the reduction of life expectancy by 15 years and have increased heart disease incidence by four time (IDF, 2014; WHO, 2014). In Nigeria, diabetes mellitus contributes to medical morbidity and mortality (Chinenye, Ogbera, & Onyekwere, 2013). Patients having diabetes stay long on medical wards and pay high bills with various complications such as stroke, adult-onset blindness, lower extremity amputation from foot gangrene, heart/kidney failure and premature death (Fasanmade, Nwaiwu & Olayemi, 2015; Isezuo, Ohwovoriole,  & Sabir, 2013). An estimated 3.4 million persons died of high glucose level in 2004 & 2010 according to WHO (Fact sheets, 2013).

According to International Diabetes Federation, (2010), the prevalence of DM in Nigeria varies from 0.65% in rural Mangu to 11% in urban Lagos state. World Health Organization, (2014), suggest that Nigeria have the highest number of people having diabetes. In Nigeria, up to 73% of diabetic patients do not practice self-monitoring of blood glucose (Chinenye, Uchenna, & Unachukwu, 2010; Chinenye, et al., 2013). A study done in Malaysia, (Azmi, Barakatun-Nisak, & Firouzi, 2015) show 72 % of patients with poor glycemic control and in Ethiopia  (Abebe, Alemu, Berhane, Mesfin, & Worku, 2015) show two third of patients with poor control.

American Association of clinical Endocrinologist, (2010) report that 1 in 3 patients having T2DM is controlled while one and half of patients comply with medication.  It was obvious from this and other surveys that the status of glycemic control and other targets such as lipid, glycated hemoglobin (HbA1c), blood pressure levels and adequate education were below expectations (Chinenye, et al., 2013; IDF, 2012).Therefore, the need for a study on effect of nurse-led training on self-management of diabetes amongst diabetic patients attending medical outpatient clinic in General Hospital Odan, Lagos.

1.3 Objective of the Study