COMMUNITY-BASED EDUCATION PROGRAM ON KNOWLEDGE AND SELF-EFFICACY OF TYPE 2 DIABETES MELLITUS’ PATIENTS IN BANDUNG

Introduction. Type 2 Diabetes Mellitus was a chronic disease have complicated. Amount of patient Type 2 Diabetes Mellitus (DM) was increased. Knowledge and self-efficacy is mainly important for self-care behavior. The purpose of this study was aimed to examine knowledge, and self-efficacy among patients with Type 2 DM in Bandung, Indonesia. Methods . The research was a quasi-experimental with pre and posttest control group. Sixty two type 2 DM were recruited from 8 working area Primary Health Centers in Bandung who have diagnosed DM, using purposive sampling technique. Knowledge questionnaire from Michigan Diabetes Research and Training Center’s Brief Diabetes Knowledge Test, Self-efficacy were measured by the developed Stanford Patients Education Research Center. Both of questionnaires comprised five dimensions: nutrition, sport and activity, drugs and glucose monitoring. Patients of in intervention group received 2 weeks Diabetes Mellitus education program be given healthcare workers. Techniques used in this program consisted of community-based education, goal setting, follow-up and face-to-face interview. Data were analyzed by independent t-test . Results . There are significantly different of knowledge and self-efficacy after community-based education program in intervention (M = 9.26, SD = 2.8 ; M = 53.26, SD = 10.50) and control group (M = 7.39, SD = 2.4; M = 36.74, SD = 4.49).  This study revealed that community-based education program significantly improved self-efficacy ( p =0.000) but not improved for knowledge ( p =0.180). Conclusion . These findings indicated that Knowledge and Self-efficacy of type 2 Diabetes Mellitus patients in Bandung required improvement. Therefore, further study regarding the effective in improving knowledge and self-efficacy type 2 Diabetes Mellitus is extremely needed.


INTRODUCTION
Along with technological advances in the world of health, there has been a shift in the pattern of disease in the world.One of them is the number of lifestyle diseases caused increasing compared with the number of infectious disease or other disease.One of the diseases caused by lifestyle are Diabetes Melitus (DM).Based on data from the WHO in 2010, the number of diabetes patients in the world is 8.4 million and Indonesia ranks fourth in the number of DM patients in the world (WHO, 2010).Based on data from the International Diabetes Federation (IDF) in 2011, Indonesia was ranked 9th in the world.Based on data Riskesdas (2007) West Java Province was ranked 12 in Indonesia with a prevalence of 3.7% (Riskesdas, 2007).
The research about treatment of DM education program has much to do with a lot of measurement results.All the research done on the individual patient with a hospital setting (Vatankhah et al, 2009 andKurniawan et al, 2011), at home (Lincoln et al, 2008, Sari et al, 2012, and Susanti et al, 2011).From the four studies only Susanti et al (2011) and Sari et al (2012) which involves the family but only in doing foot care education, while Susanti et al (2011) in the management of DM.There are no research on how the knowledge and self-efficacy in patients with DM involving community.According to Friedman (2010), the Indonesian Contemporary Nursing Journal, 2(1), 38-44 community can be involved as targets for patient's self-efficacy because the community can be a driver of the other members of the community to perform a behavior.
DM management education by involving the community is also very important for other members of the community, considering DM is a hereditary disease that a risk for other members of the community.In addition, DM is a chronic disease that decreases the ability of the patient, so that if the community is involved in this educational program, the community can assist in the management of DM and improve knowledge and selfefficacy in patients This study aimed to identify the effect of communitybased education program on knowledge and elf-efficacy in patients with DM in Bandung.

METHODS
The method used is a quasiexperimental design using techniques Cluster randomized with two groups: the control and the intervention.of knowledge and self-efficacy in diabetes mellitus before and after the intervention in the control group.The average value of knowledge before it is 7.39 (2741) and after 8:10 intervention (2.70).The average value of the respondents' knowledge of the control group there were significant changes (p = 0.00).The value of selfefficacy before the intervention in the control group was 27.74 (5,871) while the post is 27.70 (5:06).The average value of respondents' self-efficacy in the control group there were significant changes (p = 0.007).6. Test average difference in respondents Self efficacy of diabetes mellitus before and after the intervention in the control group and intervention Table 4 illustrates the different test average variable knowledge and self-efficacy in patients with diabetes mellitus before and after the intervention in the intervention group.The average value of knowledge before it is 8.35 (2138) and after the intervention 9:26 (2898).The average value of the respondents' knowledge in the intervention group there was no significant change (p = 0.067).The value of self-efficacy before the intervention in the control group was 29.84 (6822) while the post is 36.74 (4,494).The average value of respondents' self-efficacy in the control group there were significant changes (p = 0.000).Either Table 5 or Table 6 showed there were no significant difference in the mean value of knowledge before the intervention in both groups (p = 0.220).The average value of self-efficacy after the intervention significantly different (p = 0.000).

DISCUSSION
This study is a model application health education in community-based education program has been conducted by researchers in accordance with the theory, which involves a cadres in the process of education given to the patient and accompanied by Indonesian Contemporary Nursing Journal, 2(1), [38][39][40][41][42][43][44] researchers.This study confirmed the results of the research of Jack al ( 2004) found that Diabetes Self-Management Education methods, guidance, counseling and behavioral interventions can improve knowledge of diabetes mellitus and improving the skills of individuals and families in managing disease Diabetes mellitus.The involvement of cadres in controlling also have an important role in alerting and improve the knowledge and self-efficacy.The involvement of cadres in controlling the self-care respondents also have an important role in reminding and improving the knowledge, self-efficacy.In addition, the module given to the respondent so that the respondent can be read again with family.This makes the process of discussion among families, cadres and respondents.This discussion could add and update their knowledge and information about DM and improve their self-efficacy.
The information is a power to change attitudes of individuals that could open one's mind through reasoning, thinking and deeper understanding (Sarafino, 1998).The results showed different test level of self-efficacy before and after the intervention program, communitybased self-care education in the i n t e r v e n t i o n g r o u p c o n c l u d e s significant difference.This is consistent with previous research done by Corbett (2003) and Perrin et al (2009) and Sari et al (2012) on the behavior of foot care DM.Confidence (self-efficacy) also has an important contribution in improving self-care behavior of the respondents and the confidence of cadres carry out the assistance process in patients with DM.This is consistent with the theory of self-efficacy from Bandura, the belief in the ability of the respondent may regulate or exhibit behaviors that are considered as a destination (Passer & Smith, 2004).In addition, the strategy of self-care education program uses a community-based modules.After education is completed, the respondent is directed by cadres for planning activities to perform self-care behaviors DM, with the cadre as a controller.The main purpose of planning the activities specified respondent is the increased confidence (self-efficacy) of the respondents so that the respondent can achieve healthy behaviors (Bodenheimer et al, 2007).
According to Schultz and Schultz (2005) that there is a difference between people who have low self efficacy with high self-efficacy.Someone who has low self-efficacy would tend to feel there is no hope, unable to make arrangements on the circumstances that occurred in his life.By the time they face obstacles, they will quickly give up if the first attempt has failed.Someone who has very low self-efficacy will not make any effort to overcome the existing barriers, because they believe that their actions will not bring any influence.On the other hand someone who has a high self-efficacy believe that they can cope with the incident and the situation effectively.They have high confidence with regard to their ability compared with those having low selfefficacy.Someone who has a high selfefficacy see the difficulties that exist as a challenge rather than threatening.

CONCLUSION
Mean value of the respondents' knowledge of the control group and the intervention after intervention was not significantly different.Mean value of respondents' self-efficacy in the control group and the intervention after intervention is different significantly.The existence of educational programs, community-based knowledge and self-efficacy in patients with diabetes mellitus by involving cadre of which further research to take the setting of a broader research so as to provide the characteristics of different samples and sample sizes bigger so visible increase in knowledge and self-efficacy better again.In addition further research can apply the method of this communitybased education program with a longer Indonesian Contemporary Nursing Journal, 2(1), 38-44 intervention period and integrate the program with existing programs the health center.

Table 1 .
Frequency Distribution Analysis and Homogeneity Test Characteristics of Respondents on Intervention Group and Control Group in Bandung the study period from November to December 2013 (n = 62)

Table 2 .
Frequency Distribution Analysis and Homogeneity Test Characteristics of Respondents on Intervention Group and Control Group in Bandung the study period from November to December 2013 (n = 62)

Table 3 .
Test average difference of Knowledge, Self-efficacy among respondents about diabetes mellitus before and after the intervention in the control group

Table 3
illustrates the different test

Table 4 .
Average Difference Test Knowledge, Self-Efficacy on respondents about diabetes mellitus before and after the intervention in the intervention group

Table 5 .
Test average difference in respondents Knowledge about diabetes mellitus before and after the intervention in the control group and intervention