Disertasi

The Empowerment Model towards Type 2 Diabetes Mellitus Adults to Enhance Vegetable Intake in Achieving Glycemic Control. = Model Pemberdayaan terhadap Penyandang Diabetes Tipe 2 Dewasa untuk Meningkatkan Asupan Sayur dalam rangka Mencapai Kontrol Glikemik.

Dietary pattern high in fibre and green leafy vegetable in particular have shown inverse association with lower risks of Type 2 Diabetes Mellitus and improved glycemic control. However dietary change is also considered as lifestyle change that requires behaviour modifications. The Empowerment Model for health provider consisting of coaching skill based on Porter and Lawler motivational method, Kotter’s leadership model and creative kitchen has been developed, established and pre-tested using a mix method study design. Qualitative study was an embedded design within the quantitative study which was a randomised controlled trial. Subjects of the study were employees of PT Telkom Indonesia or their family members. 84 subjects who met the inclusion criteria working in 8 office groups following clustered random sampling were divided into intervention and control groups with 42 subjects each. Subjects of the intervention group received the Empowerment Model in weekly meeting with trained health providers for 12 weeks. Conventional counselling was applied on the control group weekly for 12 weeks. At the end of the study, there were 3 drop-out subjects, 2 subjects from the intervention group and 1 subject from the control group. There was significant difference in change of vegetable intake of the intervention group compared to the control group (p < 0.001). HbA1c decreased significantly in the intervention group compared to the control group (p=0.009). At the end of the study, the significant differences shown in the intervention group compared to the control group were: decreased fasting blood glucose (p=0.034), postprandial blood glucose (p=0.006), and decreased waist circumference (p=0.044). Qualitative study demonstrated that health provider’s positive attitudes defined subject’s attitudes in creating adherence during coaching sessions with the presence of encouragement and acknowledgment, learned lessons, process honouring, buddy’s involvement, confidence and self regulation, also outreaching ability being role model to enrol others in consuming more vegetables.
Key words : Type 2 Diabetes Mellitus, The Empowerment Model, vegetable intake, HbA1c.



Pola makan tinggi serat, khususnya asupan sayur hijau diketahui erat hubungannya dengan rendahnya risiko diabetes tipe 2 dan perbaikan kontrol glikemik, namun perubahan pola makan yang merupakan perubahan gaya hidup menuntut modifikasi perilaku. Model Pemberdayaan bagi petugas kesehatan yang terdiri dari keterampilan coaching berdasarkan metode motivasional Porter and Lawler, Kotter’s leadership model dan creative kitchen telah dikembangkan, disusun dan telah diujicobakan dengan disain mix method. Efektivitas model ini dibuktikan dengan melakukan penelitian kualitatif sebagai embedded design dalam studi kuantitatif yang merupakan randomised controlled trial. Subyek penelitian adalah karyawan atau keluarga karyawan PT Telkom Indonesia. Sampel diambil secara randomisasi kluster, 84 subyek yang memenuhi kriteria inklusi penelitian dibagi menjadi 42 orang di kelompok intervensi dan 42 orang di kelompok kontrol. Selama 12 minggu subyek kelompok intervensi mendapat Model Pemberdayaan dalam pertemuan seminggu sekali dengan petugas kesehatan. Subyek kelompok kontrol mendapat konseling konvensional seminggu sekali. Di akhir penelitian, terdapat 3 subyek drop out, 2 orang dari kelompok intervensi dan 1 orang dari kelompok kontrol. Terdapat perbedaan bermakna peningkatan asupan sayur pada kelompok intervensi dibanding kelompok kontrol (p < 0.001). Demikian pula penurunan HbA1c pada kelompok intervensi berbeda bermakna dibanding kelompok kontrol (p=0.009). Di akhir penelitian terjadi perbedaan bermakna antara kelompok intervensi dan kontrol untuk penurunan kadar gula puasa (p=0.034), kadar gula darah 2 jam postprandial (p=0.006), dan penurunan lingkar pinggang (p=0.044). Studi kualitatif menunjukkan bahwa sikap petugas kesehatan yang positif menentukan sikap subjek sehingga menghasilkan sesi coaching dengan ciri-ciri: adanya dorongan dan penghargaan, halhal yang dipelajari oleh subjek, penghargaan atas proses, keterlibatan pasangan, rasa percaya diri, regulasi diri serta kemampuan untuk menjangkau keluar sebagai tokoh panutan agar orang lain terdorong ikut mengonsumsi sayur lebih banyak.
Kata kunci : Diabetes melitus tipe 2, Model Pemberdayaan, asupan sayur, HbA1c.