Effect of Roy’s adaptation model based interventions on quality of life in patients with type II diabetes

Diabetes is a chronic illness and considered as one of significant health problem affecting quality of life. Roy’ adaptation model based care plan is a non-invasive, non-medicated and cost efficient way to limit physical and psychological issues of patients with chronic diseases. Objective of present study was to see the effects of Roy’s adaptation model based interventions on the quality of life in patients with type II diabetes. Quasi experimental approach with 40 type II diabetics was used. DiabetesSpecific Quality of Life Scale (D-39) was used to collect data before and after intervention. Intervention involving education regarding adaptive strategies was given for 12 weeks to type II diabetics. Close monitoring of patients was done for 12 weeks. Mean score of quality of life depicts an enhancement as difference in two means. Difference in means present a way to prove the positive effect of Roy model. So, these differences in various aspects of quality of life show that Roy’s adaptation model has positive implications for type II diabetics. Results show Roy’s adaptation model based interventions significantly affected QOL as p-value was 0.000. Roy’ adaptation model served a vital role in practice to enhance QOL of type II diabetics. Roy’ adaptation model can be used effectively to manage chronic diseases where no cure is present and the only way is to maximize quality of life of patients. It could be concluded that there is a need to apply Roy’ adaptation model in routine clinical practice to manage chronic disease. Clinical area with model based education could be a positive force towards better life.


Introduction
American Diabetic Association defines diabetes as collection of metabolic diseases having characteristically high blood glucose levels due to some abnormality either in release of insulin or less body response to insulin [1]. World Health Organization defines diabetes, as a chronic illness that occurs when pancreas doesn't prepare enough insulin or when the body can't adequately utilize the insulin [2]. In 2014, approximately 422 million adults were identified as diabetic in contrast to 108 million in 1980. Diabetes was thought to be as a cause of at least 1.6 million deaths in 2016 [3].
High mortality rate related to diabetes is attributable to maladaptive behaviors linked with modern life style changes, sedentary life style, lack of physical activity, unhealthy food and eating habits. Diabetes substantially effect QOL causing impairment in all functioning aspects of patient [4]. In Pakistan, 15% of diabetics suffer from foot complications and peripheral arterial disease [5]. For diabetics, physical activity has a major role. Problems arise in diabetics due to inactive life style habits. In fact, exercise helps to regulate blood glucose level along with prevention from diabetics' complications [6]. Anxiety has adverse effects on outcomes of diabetes as it prolongs the treatment modalities, decreases the quality of life and increase the risk of mortality. On the other hand, maladaptive coping behavior in diabetics lead to significant depression [7]. Diabetes has strong implications on psychology of individuals. Psychological factors are important determinants of patient's wellbeing. Self-concept strongly affects thinking and quality of life resulting in poor response to therapy, disease progression and even mortality [8]. Adaptive behaviors like lifestyle changes are utmost important in managing diabetes. A balanced diet and an increase level of physical activity can help to reduce the risk of complications and maladaptation in diabetics [9]. Diabetes has an effect on psychological functioning and quality of life of patients. Malfunctioning and poor quality of life is associated with further complications and co morbidities. These challenges emphasize the importance of adaptive capabilities in diabetics to control dysfunction [10]. Adaptive behaviors are the only way to manage diabetes, to prevent its complications and to improve quality of life [11]. Roy' adaptation model helps to adapt healthy behaviors in diseases which are impossible to cure. [12]. Roy 'adaptation model is important to promote individuals' adaptation in changing health care demands [13]. Diabetes has an effect on patients' quality of life [14]. Roy' adaptation model based care plan is a non-invasive non-medicated and cost efficient way to limit physical and psychological issues of patients with chronic diseases [15].  [22]. Inclusion criteria of the study involve patients (age 25-40 years) having definitive diagnosis of type II diabetes mellitus from more than 6 months whereas patients with chronic disability related to type II diabetes were excluded. Informed consent was signed by the participants before giving data. Confidentiality of the participants was assured. First of all data regarding demographic and quality of life dimension was collected from participants through demographic and quality of life scale. Diabetic specific quality scale consists of 39 items [23]. This data served as baseline. Intervention based on Roy Adaptation model were applied to study group for 12 weeks and data was collected again by using same questionnaire on quality of life dimensions. Intervention involved adaptive strategies useful for diabetics like education related to diabetes, its complications, dietary approaches and coping strategies. Each session last for 60 minutes. After each education session close monitoring of blood pressure, blood sugar, BMI was done on weekly basis to assess any change. The data was analyzed using the SPSS software (version 24). Paired T test was used to analyze the pre and post data regarding quality of life.

Results
Demographics of study participants in   Table 3. Paired samples statistics Table 4. Paired samples test

Discussion
The study was aimed to depict the effectiveness of Roy' adaptation model based intervention on QOL of type II diabetics. Findings of present study showed positive effect of Roy' model based interventions. As, means scores before and after interventions show an enhancement in mean QOL of type II diabetics. These results are consistent with the study having mean increase in scores based on Roy' model [25]. In comparison, a study with the mothers of mentally retarded children showed difference in mean scores before and after application of RAM based interventions.

RAM based interventions increased the means adaption scores in a group of mothers of mentally retarded children [24].
The study findings depict an increase in QOL in type II diabetics as mean scores were increased after intervention. Mean score of QOL of type II diabetics was 2.58 before intervention and 3.92 after intervention. So, QOL was increased in type II diabetics. A similar study conducted on patients with heart failure also depict an increase in QOL in patients on the basis of Roy' s adaptation model [26]. We would like to suggest the following recommendations:  With the ever-increasing rate of urbanization around the world. It is essential to raise awareness about diabetes and its escalating complications around the world  Lifestyle interventions including modified diet, increased physical activity, and weight loss are critical for all diabetes patients. For highly motivated patients, whose diabetes is at a relatively early stage, it is even possible to pursue lifestyle interventions for improved QoL.  To develop training programs for diabetes management that focus on the preventive aspect and screening of complications rather than glycemic control and symptomatic treatment only. This study was designed to be undertaken in one community. Therefore the transferability of the findings to other settings will be challenging. Secondly, purposive sampling technique was used in this study, which did not allow random selection of participant.