A Phenomenological Study: Self-management Experience of Type 2
Diabetes Mellitus Patients in Manggarai Regency, NTT
Oliva Suyen Ningsih
Indonesian Catholic University of St.Paul Ruteng, Indonesia
Keywords: Phenomenological Study, Diabetes Mellitus Patients’ Experience, Self-management.
Abstract: Individu with diabetes mellitus had different experience in diabetes mellitus management care. The main
goal of diabetes self- management is to normalize insulin activity and blood glucose level to reduce the
development of vascular and neuropathic complication. The objective of this study was to describe diabetes
mellitus patient’s experience on self-management in Manggarai Regency, NTT. This study used
phenomenology design and was conducted in January to February 2018. The participants of this study were
six patiens with diabetes mellitus type 2. Participants recruitment used purposive sampling technique and
data were collected through in-depth interview. Data analysis used Van Manen’s method. This study found
4 themes including, Psychological problem with a sub-theme the anxiety of illness; Self-efficacy with a sub-
theme behavior selection; Social support with sub theme family and health practitioner support; Cultural
influence with sub theme traditional medicine and diet selection. It was recommended that health
practitioners especially nurses have to provide health education on the management of diabetes mellitus
with considering local culture and emotional support as well.
1 INTRODUCTION
Diabetes mellitus (DM) is a group of metabolic
diseases characterized by increased blood glucose
levels/hyperglycemia (Hinkle & Cheever, 2014).
Diabetes mellitus is a chronic disease that requires
behavioral changes and lifestyles throughout the
entire life span and becomes a major health problem
for people throughout the world (Ignatavicius &
Workman, 2010). According to WHO (2015), in
2012 there were 1.5 billion people in the world
which died because of diabetes mellitus and as
many as 80% came from countries with low to
medium income. WHO estimates that diabetes
mellitus disease will be the seventh cause of death
worldwide in 2030. In Indonesia, based on the
results of Riskesdas in 2013, there were 12,191,564
or as many as 6.9% of Indonesia's population
suffering from DM disease. Indonesian people who
have diabetes mellitus based on doctor's diagnosis
are about 1.5% and in East Nusa Tenggara Province
as much as 0.6% (Indonesian Ministry of Health,
2018). Patients with diabetes mellitus in Manggarai
Regency increased from year to year, in 2014 and
2015 there were 612 and 1604 people, respectively.
Risk factors that cause diabetes mellitus are family
history with a diabetic, race or ethnicity, age over 45
years, hypertension, high levels of high- density
lipoprotein (HDL) cholesterol, triglycerides and lack
of physical activity (Hinkle & Cheever; DeWit &
Kumagai, 2013). Various complications can occur in
clients with diabetes mellitus. These complications
can be acute and chronic. Acute complication occurs
when blood sugar level is suddenly high
(hyperglycemia) or low (hypoglycemia) (DeWit &
Kumagai, 2013; Hinkle & Cheever, 2014). The
condition of severe hyperglycemia and hypoglycemia
can treat diabetes mellitus clients. Hyperglycemia and
hypoglycemia usually occur due to changes in the
management of insulin therapy or oral antidiabetic
drugs, diet and exercise. Chronic complications
include macrovascular, microvascular and neuropathy
diseases (Lewis, 2011; DeWit & Kumagai, 2013;
Hinkle & Cheever, 2014).
Individu with diabetes mellitus has a very
important role in comprehensive diabetes care.
Diabetes self-management education (DSME) is a
process that facilitates the knowledge, skills and
abilities needed to help prediabetes and patients
with diabetes to be able to treat diabetes (Haas,
Mellinda,Joni, Cox, & Duker, 2012). Every individu
Ningsih, O.
A Phenomenological Study: Self-management Experience of Type 2 Diabetes Mellitus Patients in Manggarai Regency, NTT.
DOI: 10.5220/0008205801150122
In Proceedings of the 1st International Conference of Indonesian National Nurses Association (ICINNA 2018), pages 115-122
ISBN: 978-989-758-406-0
Copyright
c
2020 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
115
with diabetes mellitus has different experience in
treating diabetes, which is influenced by various
factors including attitudes or beliefs, cultural factors,
self- efficacy, and social support (Kadirvelu,
Sadasivan, & Hui, 2012, Mayberry & Osborn, 2012,
Abolgehasemi & Sedaghat, 2015). In a previous
study conducted by researchers with the title, the
effect of health education intervention and self-
efficacy on changes in health behavior and blood
sugar levels in diabetes mellitus patients in
Manggarai Regency showed that based on paired t-
test there were significant difference in knowledge,
attitudes, eating patterns, physical activities, blood
sugar, foot care and blood sugar levels before and
after intervention with p value 0.000. However, the
results of the one-year evaluation after the diabetes
self-management education indicated that the
majority of respondents (50%) included in the
intervention group were not obedient in carrying
out self-management (Ningsih, 2016). Based on
observation of researchers, most respondents (50%)
were not obey in carrying out self- management
because cultural factors, social support, self-
confidence and maladaptive coping when finding
problems in self-management. It is needed to study
the experience of patients with diabetes mellitus in
carrying out self-management through
phenomenology study. The aim of this study was to
explore the experience of patients DM type 2 in
Manggarai Regency in conducting self-management.
2 METHOD
The phenomenology design was used to explore the
experience of patients with DM type 2 in conducting
self-management and the Hermeneutic
phenomenological method facilitates the formation
of a complete interpretive description of the
experience of diabetes mellitus patients in self-
management (Van Manen,1990, Streubert, Speziale,
& Carpenter, 2007). The phenomenological
approach of Van Manen (1990) focuses on four
activities: turning to phenomenon of interest,
explores participant's life experiences, reflects
important themes of the phenomenon and describes
his experience through writing and rewriting. Van
Manen emphasizes research question and considers
the relationship between the parts and the whole.
According to Van Manen (1990) hermeneutic
phenomenology is an attempt to build interpretative
descriptions of several aspects of life. Therefore, the
focus of this study is to explore the experience of
patients with diabetes mellitus in self-management
that includes self-care behaviors such as diet,
activity, treatment, control of blood sugar levels, and
prevention of complications after diabetes mellitus
patients get diabetes self- management education.
The experience of becoming a diabetic and doing
self-management after obtaining self-management
education for improved outcome represent the
phonomena of interest. The application of self-
management in daily life to improve glycemic
control and prevent complications from occurring is
an interesting experience.
2.1 Participants
Participants in this study were type 2 diabetes
Mellitus patients in Manggarai Regency. This study
involved six participants. Participants recruitment
used purposive sampling where researchers choose
individually to participate based on criteria. The
inclusion criteria in this study: diagnosed with type 2
diabetes mellitus, had no serious complications, had
participated in the Diabetes self-management
education (DSME). The exclusion criteria in this
study were: not willing to be involved in the study,
blood sugar levels < 70 mg/dl and hearing loss. The
researcher obtained in-depth interview with
participants in January-February 2018. Interview was
conducted at the participant's home in the area on the
City Health Center, Manggarai Regency, NTT.
2.2 Data Collection
Methods of collecting data through in-depth interview
and the time for each participant about 45-60 minutes.
Data recorded using an audio digital recorder.
Demographic data including participant's identity,
gender, age, occupation, marital status, education,
duration of diabetes, type of medication consumed,
and address of the participant were collected before
interview. The focus of the question during interview
is the experience of diabetes mellitus patients in
carrying out self-management after getting DSME.
The researcher also used field notes when interacting
with participants to support transcript of data
participants. The researcher explained the purpose of
the study and description of the procedure for
collecting data, then asked all participants for
approval involved in the study by signing informed
consent. Participants have the right to resign and
refuse to provide information. The researcher has to
exam blood sugar before the study to minimize the
risk of incidence hyperglycemia and hypoglycemia.
Participants who had blood sugar level < 70 mg/dl
were not included in the study.
ICINNA 2018 - The 1st International Conference of Indonesian National Nurses Association
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2.3 Data Analysis
Data analysis in this study used the method of Van
Manen (1990). Analysis started since interview by
researcher when actively listen and think about
things that are said by participants. The Analysis
process completely is conducted by converting
interview data and field notes into the transcript.
After making the complete transcript, the researcher
met with the participant to validate the findings. The
researcher then included some changes based on
participant feedback. The process of data analysis
for this study was continued by rereading the
interview transcript after getting input from the
participants. The next step in the analysis is data
transformation or data reduction, where the
researcher makes decision about what are relevant
and rearrange the interview related to the topic,
eliminates irregularities and simplifies the language
without changing the nature of the interview. The
researcher then makes thematic analysis followed by
coding ine-by-line where the researcher underlines
each sentence that indicated the same theme. The
same themes are then grouped and divided into
selected sub-themes. The final step is to write and
rewrite documents based on research analysis by
paying attention to diaries and field notes to support
the interpretative process and the transformation of
field texts into narrative texts.
3 RESULTS
3.1 Demographic Data
Table 1: Characteristics of Respondents with Type 2 Diabetes Mellitus in Manggarai Regency 2018 (n=6).
Participant
Age
Gender
Durasi of DM
Blood sugar
Medication
1
70
Male
3 years
250 mg/dL
Not taking drugs
2
38
Male
7 years
430 mg/dL
Metformin 3x1
3
40
Male
3 years
299 mg/dL
Metformin 1x1
4
67
Female
18 years
144 mg/dL
Metformin 1x1
5 43 Female 8 years 300 mg/dL
Gilmepirid 1x1
Metformin 2x1
6
48
Female
14 years
419 mg/dL
Metformin 1x1
Table 2: Identification of Themes Based on Experience of Type 2 DM Patients in Self-management (n=6).
The main thema
Psychological problems
Self-efficacy
Social support
Social support
Cultural influence
Cultural influence
3.2 Thema Identification
In phenomenological research, interviewing is a
means to gather information and develop a rich and
deep understanding of the personal phenomenon
(Van Manen, 1990). During the interview, the
sharing experience of diabetes mellitus patients
permits the researcher to get meaning the actual
lived experience in self-management. The themes
are understood as structures of the experience so that
as one analyzes the phenomenon and determines the
themes, the experiential structure are uncovered or
revealed (Van Manen, 1990).The data analysis for
this study will be reported as themes and sub theme.
It was obtained 4 themes including, Psychological
problem with a sub- theme the anxiety of illness;
Self-efficacy with a sub-theme behavior selection;
Social support with sub theme family and health
practitioner support; Cultural influence with sub
theme traditional medicine and diet selection.
3.3 Psychological Problems: The
Anxiety of Illness
This theme illustrates how participants feel anxious
about diabetes mellitus disease experienced.
Participant 2 said, "after being diagnosed with
diabetes mellitus, I felt shock and stress with the
disease I was experiencing.” Participant 4 said, "at
first I felt anxious, but because every month I
controlled the doctor and the doctor always provided
support and family support, now I have accepted my
situation.". Participant 5 said, "at first I felt scared
and anxious about the disease I was experiencing."
A Phenomenological Study: Self-management Experience of Type 2 Diabetes Mellitus Patients in Manggarai Regency, NTT
117
Participant 6 said, "I was traumatized and stressed
with the pain that I experienced.
3.4 Self-efficacy: Behavior Selection
Based on the result of the study, some participants
had low self-efficacy which affected the selection of
bad behavior. Participant 3 said," I have consumed 1-
2 glasses of alcohol almost every day since the end of
September 2017. I also consume meat almost every
day for the past one week. If at home I always follow
the rules of eating, but if I am outside the house, I
cannot follow the rules of eating.”If I gather with
friends, I often consume roasted pork and consume
alcohol and sweet cakes. I am very happy to consume
sweet cakes. During holidays like Christmas, I also
do not follow the dietary rules for diabetic patients.
" Participant 2 said,"In my daily diet, I try to obey
the recommended diet such as eating small portions
of rice, eating more vegetables but sometimes when
I'm hungry, I eat more than the recommended
portion. In addition, when I visit a neighbor's house,
I usually do not follow diet rules because I feel
embarrassed and afraid to refuse the food served,
especially offered by the "anak rona", even though
the food is not good for my health such as beer and
soft drinks. I feel embarrassed if I refuse the food
given."
3.5 Social Support: Family Support
This theme describes family support for participants.
The finding of study showed, several participants
received family support which had a positive impact
on patients with diabetes mellitus. Participant 1 said,
"I always exercise every day which is walking for 30
minutes and exercising every month.” My child and
my wife always support and remind me to exercise
every day."Participant 4 said,"I always get support
from my family.” My child said, "I am proud of my
mom because my mother is not affected by the
environment and always follows the diet
recommended by the doctor.” However, there was
one participant who did not get support from the
family. Participant 6 said, "there is no family that
reminds me of a regular diet and taking medication."
3.6 Social Support: Health Practitioner
Support
The finding this study showed some participants did
not get support from health care providers for self-
management of diabetes mellitus. Participant 1 said,
"Every month I always follow prolanis but health
workers do not recommend me to take medicine
regularly. “When our blood sugar levels are high,
health care providers do not provide us with
information about what we should do to reduce blood
sugar levels. Health care provider does not provide
information needed by participants cause wrong
perception about treatment in diabetes mellitus.
Participant 1 said, "I think if I go to the doctor every
month and take medicine, I am afraid I feel
dependent on drugs. “The medicine in my opinion is
poisons and chemicals. “I once got sugar medicine
but after I finished I didn't control anymore because
my blood sugar was normal 130 mg/dl, so I didn't
take medicine. "Participant 5 said, "I never took
medicine. ”I routinely take medicine for the last 2
years because according to the health worker, blood
sugar is present and can go down again so I don't take
the medicine.”
3.7 Cultural Influence: Traditional
Medicine Selection
This study found that participants who consumed
traditional medicine did not take oral antidiabetic
drugs regularly which resulted in instability of blood
sugar levels.
Participant 1 said, "I once felt weak, had sweating
and diarrhea. “This happened because I consumed
dew drops of water which, according to people, can
cure all diseases including the sugar that I
experienced.” Participant 2 said, "I consume
traditional medicine because I feel after consuming
traditional medicine I feel fresher and I feel that the
drug can also reduce my blood sugar. "Participant 3
said, since one Sunday ago I consumed traditional
medicines to reduce blood sugar levels.
3.8 Cultural Influence: Diet Selection
Based on the results of the study, 66.7% of
respondents disobeyed the diet due to cultural factors.
Participant 2 said, "When I outside the house, I
usually don't follow the diet rules because I feel
embarrassed and afraid to refuse the food that is
served especially offered by" anak rona ", even
though the food is not good for my health such as beer
and soft drinks. Participant 3 said, “that during this
time I have consumed 1-2 glasses of alcohol almost
every day since the end of September. “I also
consume meat almost every day for the past week.” If
at home I always follow the rules of eating, but if
outside the house when with friends, I cannot
follow the meal order and my habit when gathering
ICINNA 2018 - The 1st International Conference of Indonesian National Nurses Association
118
with friends is to eat pork that is baked and consume
alcohol and sweet cakes.” Participant 5 said, "When I
visit neighbors, I always break the rules of eating
like eating sweet cakes and feel guilty if I don't eat
food that has been served.”
4 DISCUSSION
4.1 Psychological Problem: The
Anxiety of Illness
Patients with diabetes mellitus generally had an
experience psychological problem since being
diagnosed. Nearly 20% of adult diabetic patients had
an experience anxiety problem compared to
individuals who do not have diabetes (Groot, Golden,
& Wagner, 2016). Psychological problems such as
anxiety in patients with diabetes mellitus affect the
level of blood sugar, complications of diabetes
mellitus and adherence to behavioral self care (Groot,
Golden, & Wagner, 2016). Psychological problems in
patients with DM must be addressed immediately
because it can have an impact on poor glycemic
control, increased complications of diabetes mellitus
such as cardiovascular disease, increased health costs,
and death (Groot, Golden, & Wagner, 2016). The
results showed that there was a relationship between
diabetes and various issues of mental health
problems. These mental health problems relate to the
experience of patients living with diabetes mellitus,
difficulties in carrying out self -management,
difficulties in social relations, anxiety due to
increased blood pressure and hyperglycemia. Patients
with diabetes mellitus who have mental health tend
to have a high mortality rate, a high risk of
cardiovascular disease and have a low quality of life.
Risk factors for developing depression in patients
with diabetes mellitus are adolescence, lack of social
support, poverty, poor glycemic control, long
suffering from diabetes mellitus, complications of
diabetes mellitus (Robinson, Coons, & Heidi, 2108).
Psychological problems such as anxiety
experienced by participants mostly occur due to
difficulties in carrying out self-management due to
poverty, low self-efficacy, lack of social support,
poor glycemic control, long suffering from diabetes
mellitus and having maladaptive coping
mechanisms. Most of the people in Manggarai
Regency is farmers with an average yield of <
1,000,000.00 per month that may affect the ability of
patients with diabetes mellitus to carry out self-
management. One participant said,"I don't control
regularly to the doctor. I go to the doctor if I feel
unwell like dizziness or weakness. During this year, I
have never had control. I have no health insurance,
and I pay personally when I control the doctor or
hospital. Low self-efficacy is also very influential on
the mental health of patients with diabetes mellitus.
Participants who have low self-efficacy will have an
impact on poor glycemic control which can increase
anxiety in diabetes mellitus patients. One participant
said, "I can't help myself eat sweet foods like cakes.”
When there is an event like a party I cannot follow
the recommended dietary rules and for 3
consecutive days, I consume pork at morning,
afternoon and evening because there is a family
event.
The anxiety experienced by participants, mostly
also due to poor glycemic control (83% with blooding
sugar > 200 mg/dl), duration of suffering from
diabetes mellitus (67% > 5 years). One participant
said, "I just feel stressed if my blood sugar rises to
500 mg/dL and if my blood sugar rises, I only drink
water because I'm afraid that if I eat then my blood
sugar increases. I was scared and felt stressed when
my blood sugar increased because if it wasn't
overcome I could coma and finally die. Patients with
diabetes mellitus who experience anxiety mostly have
maladaptive coping mechanisms that can have a
negative impact on health. One partisipant said,"To
relieve stress both stress due to illness, work and
other problems I usually smoke. I smoke 2 ½ packs
per day. I know smoking can be detrimental to my
health but by smoking I feel the burden of illness,
work and problems that I experience can be reduced.
4.2 Self-efficacy: Behavior Selection
Self-efficacy is an individual's belief in his ability
which is shown by the level of productive appearance
that influences his life. The level of individual self-
efficacy greatly influences the choice of individual
behavior and motivation (Bandura, 1994). Self-
efficacy is very important in self-management in
patients with diabetes mellitus. Self-efficacy in
diabetes mellitus patients is a special behavior that
need to be built because has an important role in
behavior change. Low self-efficacy affects individual
efforts to carry out expected behavior and influences
an individual's ability to survive in carrying out tasks
when experiencing obstacles and failures. Increasing
self-efficacy can improve individual adherence to
treatment regimens for chronic diseases (Mishali,
Omer, & Heyma, 2011; Beckerle & Lavin, 2013).
Self-efficacy is indispensable in self-care behavior in
patients with diabetes mellitus and plays an important
role in shaping diabetes self-management that has an
A Phenomenological Study: Self-management Experience of Type 2 Diabetes Mellitus Patients in Manggarai Regency, NTT
119
impact on glycemic control. Bad behavioral self-care
can affect mortality in patients with diabetes mellitus
(Seo, Keumok, Kim, & Youngshin, 2017).
The research conducted by Masoompour, Trigari,
& Ghanzanfari (2017) showed that there was a
relationship between self-efficacy and self-behavior
care in diabetic patients with p value 0.03. The
research conducted by Seo, Keumok, Kim, &
Youngshin (2017) indicated a significant relationship
between health care provider communication, support
from health care provider and self-efficacy in diabetes
mellitus patients (p value < 0.001). Other factors
predicted to be related to self-efficacy include age (p
value 0.003), religious beliefs (p value 0,040) and
experience of having had diabetes mellitus education
(p value 0.006). Patients who were older had greater
diabetes self-efficacy (Seo, Keumok, Kim, &
Youngshin, 2017). The mean age of the participants
was about 51 years. In consideration of this, low
self- efficacy on the participant may be occur
because “aging” should have an adverse effect on
the self- management capabilities of adult diabetic
patients. Some participants have low self-efficacy,
one of them may be influenced by lack of
communication and support from health care
providers. Participant 1 said, "I don't take medicine
regularly.” Every month I always follow Prolanis
(Chronic Disease Management Program) but health
workers do not recommend me to take medication
regularly.” The health care provider also did not
explain to us what we should do to reduce blood
sugar levels.” Participants have received diabetes
self-management education, but health education
regarding the management of diabetes mellitus is not
given continuously by health care providers. Based
on the observations of researchers, on prolanis
activities followed by patients with diabetes
mellitus, health care providers only check the blood
sugar levels of patients with diabetes mellitus
without providing diabetes-self management
education on an ongoing basis.
4.3 Social Support: Family Support
Some theories argue that patients with diabetes
mellitus really need social support in implementing
self-care especially family support. Support from
family members can have a negative or positive
impact on the health of patients with diabetes
mellitus. Family members can provide support to
patients with diabetes mellitus (emotional,
information and appraisal support) has been most
strongly associated with adherence to self-care
behaviors across chronic disease such as diabetes
mellitus) (Mayberry & Osborn, 2012). Research
conducted by Mayberry & Osborn (2012) showed
that some participants experienced frustrations due to
not getting family support. Many factors can be
barriers family support for patients with diabetes
mellitus. There is lack of understanding diabetes
mellitus, socially isolated or have conflicted family
relationship, and multiple activity family roles
themselves (parents, children and partners)
(Kadirvelu, Sadasivan, & Hui, 2012). In
consideration of this, lack of family support
influenced by the family's low understanding of
diabetes mellitus due to lack of information about the
disease. Based on the observation of researcher,
health care providers in both health centers and
hospitals do not involve families in diabetes self-
management education. The lack of knowledge from
family members regarding the management of
diabetes mellitus causes family members lack of
participate in providing support to patients with
diabetes mellitus in carrying out self-management of
diabetes mellitus.
4.4 Social Support: Health Practitioner
Support
Diabetes mellitus is a lifelong disease that requires
support from health care providers in self-
management. It would be logic to conclude that
support from health practitioner is critical for
effective patients with diabetes mellitus in carrying
out self- management. The social support can be
offered by health care providers includes positive
support, emotional support, and information
(Kadirvelu, Sadasivan, & Hui, 2012). Positive
support includes choosing foods that are in
accordance with diet, food portion, and blood sugar
levels. Emotional support can be in the form of
encouraging self-management, problem solving and
making patients feel not alone in carrying out
diabetes mellitus management. Support from health
care providers can increase self- confidence and self-
efficacy.
The research conducted by Seo, Keumok, Kim, &
Youngshin (2017) showed that there is a significant
relationship between health care provider
communications, health care providers supports and
self-efficacy in diabetes mellitus patients (p value <
0.001). Support from health care provider is a very
important factor in improving self-efficacy in patients
with diabetes mellitus. Patients with diabetes mellitus
who have good self-efficacy can improve adherence
to self-management of diabetes mellitus. Based on
observation of researcher, health care provider does
ICINNA 2018 - The 1st International Conference of Indonesian National Nurses Association
120
not support optimally both emotionally and
information that is needed by patients with diabetes
mellitus. Factors related to lack of emotional support
and information are health workers do not have a
specific time to discuss with patients about
psychological problems or information needed in
carrying out self- management.
4.5 Cultural Influence: Traditional
Medicine Selection
Self-management is a very important factor in health
care, especially for patients with chronic disease or
non-communicable diseases such as diabetes
mellitus. Every individu with diabetes mellitus has a
culture that plays an important role in the treatment
of diabetes mellitus. Cultural factors greatly
influence individuals in carrying out self-
management behavior (Kadirvelu, Sadasivan, & Hui,
2012). Cultural factors influence self-management
behavior in the people of Manggarai Regency who
have diabetes mellitus, especially in selection of
traditional medicines for the treatment of diabetes
mellitus.
The concept of health, wellbeing and illness
people of Manggarai Regency are related to customs
and culture. The people of Manggarai Regency still
have the belief that the illness experienced including
diabetes mellitus is a result of mistakes made in the
past or due to curses from ancestors. The customs and
culture have an effect on the selection of behavior
some participants in the treatment of diabetes
mellitus. Some participants consumed more
traditional medicines that were recommended by
"Shamans" who were believed to cure the disease.
4.6 Cultural Influence: Diet Selection
Adherence to the diet is one factor that can affect the
stability of blood sugar levels and prevent
complications in patients with diabetes mellitus.
Cultural factors greatly affect individu with diabetes
mellitus in carrying out adherence to the diet in
certain situations such as at work lunches or family
dinners, coworkers or activities related to customs
that apply to certain cultures (Kollannoor-
Samuel, 2011).
The pattern of life of the people of Manggarai
Regency is related to the culture and customs that
apply in the community. The Manggarai Regency
community has a habit when a guest visits home.
They always served coffee and food as a form of
appreciation for the guests who come. Guests who
come cannot refuse if offered to drink and eat food
that has been served including patients suffering from
diabetes mellitus. In addition, most people in
Manggarai Regency have the habit of drinking
alcoholic beverages, smoking, and consuming pork in
every custom event. Appreciation for custom makes
the people in Manggarai Regency including those
who suffer from diabetes mellitus involved in
drinking alcoholic beverages and smoking in each
customary event, even though this has an impact on
their health. Patients with diabetes mellitus should be
aware the potential specific effect of alcohol
consumption. Alcohol can be absorbed before other
nutrients. Large amounts of alcohol can be converted
into fat and increase the risk of diabetic ketoacidosis.
The main danger of alcohol consumption is
hypoglycemia in patients with insulin therapy or
drugs that increase insulin secretion by the pancreas.
Alcohol can reduce the normal physiological reaction
of the body to produce glucose. Therefore, diabetic
patients who consumes alcohol on an empty stomach
can cause hypoglycemia. Excessive alcohol
consumption also reduces the client's ability to follow
food planning and treat hypoglycemia. Other effects
of alcohol consumption are overweight,
hyperlipidemia, and increased blood sugar levels,
especially when mixed with sweet liquor (Hinkle &
Cheever, 2014). Patients with diabetes mellitus who
have smoking habits are also at high risk of
experiencing complications of macrovascular such as
cardiovascular disease and strokes and microvascular
complications such as diabetic neuropathy and foot
problems (Hinkle & Cheever, 2014; Lewis, 2011).
5 CONCLUSIONS
Participants provide information about the daily
activities after getting diabetes self-management
education including diet, medication, exercise, and
sugar testing. This study showed that some
participants experience anxiety about the condition of
the disease. This greatly affects the behavior of
participants in carrying out management of diabetes
mellitus. Participants who experience psychological
problems such as anxiety tend to have maladaptive
coping mechanisms that have an impact on poor
blood sugar control. Some participants do not take the
recommended diet, medication regularly, and check
blood sugar regularly. These are caused by several
factors such as low self-efficacy, cultural influence,
lack of family support, and health care providers. In
carrying out the management of diabetes mellitus,
individu with diabetes mellitus need support from
both family and health care providers, so that individu
A Phenomenological Study: Self-management Experience of Type 2 Diabetes Mellitus Patients in Manggarai Regency, NTT
121
with diabetes mellitus do not feel alone in carrying
out diabetes mellitus management. The result of this
study obtained 4 themes including, Psychological
problem with a sub-theme the anxiety of illness;
Self-efficacy with a sub-theme behavior selection;
Social support with sub theme family and health
practitioner support; Cultural influence with sub
theme traditional medicine and diet selection.
Nurses need to provide sustainable health education
for both patients and family with diabetes mellitus
by paying attention to local customs and culture.
Further researcher are advised to conduct
quantitative research related to the role of culture,
self-efficacy, and social support that influencing self-
management of diabetes mellitus.
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