Published date: Mar 08 2023

Journal Title: KnE Medicine

Issue title: 2nd International Conference on Medical Health Science (2nd ICMEDH)

Pages: 410–419

DOI: 10.18502/kme.v3i2.13075

Henik Tri Rahayutrirahayu@umm.ac.idLecturer, Department of Nursing, Health Sciences Faculty, University of Muhammadiyah Malang, Jl. Raya Bendungan Sutami No.188A Malang, Jawa Timur, Indonesia

Mei-Chih HuangProfessor, Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan

Self-management is a crucial part of diabetes treatment to prevent short-term and longterm complications. Self-management education sometimes raises some ethical issues. This paper aims to discuss the ethical issues arising from diabetes self-management education practice. We discuss the ethical issues based on case study of patient self-management education in a public health centre (PHC) outpatient department in Malang City, Indonesia. We observed the patients’ education practices and conducted interviews randomly with diabetes patients who visited PHC for their treatment. Findings showed that the central theme of ethical issues arising from the movement toward patient self-management must be raised: preparation, empowerment, predominant assumption of self-management, and lack of standards for patient selection. Putting patient education in its rightful place and respecting patient preferences’ was one way to reduce the risk of ethical dilemmas arising from self-management.

Keywords: diabetes self-management, patient education, ethical issues reviews

[1] International Diabetes Federation. IDF Diabetes Atlas Ninth Edition 2019. 2019, [Online]. Available from: https://www.diabetesatlas.org/en/resources/

[2] World Health Organization. World Health Statistic 2020: Monitoring Health the SDGs. 2020, [Online]. Available from: https://www.who.int/gho/publications/world_health_statistics/2020/en/

[3] Kementerian Kesehatan Indonesia. Morbiditas dan Multi Morbiditas Pada Kelompok Lanjut Usia di Indonesia. J. Biotek Medisiana Indones. 2015;4(2):77–88,

[4] World Health Organization. Health statistics and information systems: Metrics: Disability-Adjusted Life Year (DALY). 2020.

[5] Chamberlain JJ, Rhinehart AS, Shaefer CF Jr, Neuman A. Diagnosis and management of diabetes: synopsis of the 2016 american diabetes association standards of medical care in diabetes. Ann Intern Med. 2016 Apr;164(8):542–52.

[6] International Diabetes Federation. IDF Global Guideline on Managing Older People with Type 2 Diabetes. 2013, [Online]. Available from: http://www.idf.org

[7] Barlow J, Wright C, Sheasby J, Turner A. Self-management approaches for people with chronic conditions: a review. Patient Education and Counseling. 2002;48(2):177– 187.

[8] Warsi A, Wang PS, LaValley MP, Avorn J, Solomon DH. Self-management education programs in chronic disease: a systematic review and methodological critique of the literature. Arch Intern Med. 2004 Aug;164(15):1641–9.

[9] Redman BK. Responsibility for control; Ethics of Patient Preparation For Self-Management of Chronic Disease. Bioethics. 2007;21(5):243– 250.https://doi.org/10.1111/j.1467-8519.2007.00550.x.

[10] Stevension F, Scambler G. The relationship between medicine and public: the challenges of concordance. Health Educ Behav. 2005;9:5–21.

[11] Funnell MM. Implementing an empowerment-based diabetes selfmanagement education program. Diabetes Educ. 2005;31(53):53, 55-56. https://doi.org/10.1177/0145721704273166.

[12] Broom D, Whittaker A. Controlling diabetes, controlling diabetics: moral language in the management of diabetes type 2. Soc Sci Med. 2004 Jun;58(11):2371–82.

[13] Williams GC, McGregor HA, King D, Nelson CC, Glasgow RE. Variation in perceived competence, glycemic control, and patient satisfaction: relationship to autonomy support from physicians. Patient Educ Couns. 2005 Apr;57(1):39–45.

[14] Strine TW, Okoro CA, Chapman DP, Beckles GL, Balluz L, Mokdad AH. The impact of formal diabetes education on the preventive health practices and behaviors of persons with type 2 diabetes. Prev Med. 2005 Jul;41(1):79–84.

[15] Gremigni P, Bacchi F, Turrini C, Cappelli G, Albertazzi A, Bitti PE. Psychological factors associated with medication adherence following renal transplantation. Clin Transplant. 2007;21(6):710–5.

[16] Redman BK. Ethics of patient education and how do we make it everyone’s ethics. Nurs Clin North Am. 2011 Sep;46(3):283–9.

[17] Lorig K, Ritter PL, Turner RM, English K, Laurent DD, Greenberg J. Benefits of Diabetes Self-Management for Health Plan Members: A 6-Month Translation Study. J Med Internet Res. 2016 Jun;18(6):e164.

[18] Lorig K, Holman HR, Sobel D, et al. Living a healthy life with chronic, conditions., 3rd edition. Boulder (CO): Bull Publishing, 2006.

[19] Kosmala-Anderson JP, Wallace LM, Turner A. Confidence matters: a Self- Determination Theory study of factors determining engagement in self-management support practices of UK clinicians. Psychol Health Med. 2010 Aug;15(4):478–91.

[20] Bernardini J. Ethical issues of compliance/adherence in the treatment of hypertension. Adv Chronic Kidney Dis. 2004 Apr;11(2):222–7.

[21] Falvo DR. Effective patient education: A guide to increased adherence. Jones & Bartlett Publishers; 2010.