**7. Diabetes self-care, self-care activities and its adherence**

Diabetes self-care is explained as "evolutionary process of development of knowledge or awareness by learning to survive with the complex nature of the disease within social context" [20]. Diabetes education is critical and must be practically translated into activities for the achievement of better diabetes outcomes. The self-care activities includes adherence to dietary plan, avoidance of fatty food, regular physical activity and self-glucose monitoring, and foot care, taking of medication (insulin or an oral hypoglycaemic agent), and cessation of smoking [21]. In addition, self-care activities includes good problem-solving skills, healthy coping skills and risk-reduction practices [20]. Integrating self-care activities into patients' daily routine improves diabetes outcomes, minimizes chances of developing complications and diabetes related health problems. Compliance or adherence to diabetes treatment remains a problem, in spite of the advantages of integrating the self-care activities into patients' daily routine.

Diabetes Self-Management Education and Support, and Family as provider of home care to patients.

Diabetes Self-Management Education (DSME) is regarded as "the process of facilitating knowledge, skill, and ability necessary for diabetes self-care" [18], and is provided by healthcare providers. Multi-disciplinary team provides various diabetes care services, therefore, a clear referral system should be developed and implemented. The DSME is provided with the sole purpose of capacitating both patients and family members with skills and knowledge required in self-care practices. Adequate diabetes care knowledge may pursue both patients and their family members to follow healthy lifestyle healthy lifestyle [15], so as to prevent diabetes complications and also reduce new cases, respectively. Sufficient diabetes knowledge also minimizes risk of comorbidity which impact significantly the QoL of patients [22]. However, Ajzen et al. [23] argued that adequate knowledge alone is not sufficient for the adoption of healthy lifestyle, it should be accompanied by positive attitudes. There should be collaboration between the health sector and the

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*Family-Centered Diabetes Care for Better Glycemic Outcomes of Outpatients in Rural Areas*

family, since collaboration is one of the principles of FCC. Among the families of patients, there should be dedicated person to represent the family in the interaction and consultation with patients at the healthcare facilities [24]. Spouses and parents can be in charge of both their partners and children; respectively, however, the families may as well nominate a member to represent them. In ensuring the success of the FCC, the healthcare professionals may assure the families that they will be listened, supported and that their doors will forever be opened for any challenges encountered to ease the home caregiving. The family receives home care through consulting together with patients or DSME program. The outpatients receive their diabetes treatment at PHC facility, which is inadequately resourced with other healthcare workers such as dietitians and physiotherapists, who support the PHC facilities. Therefore, there is a need for a well-organized and structured education programme for people living with diabetes for the DSME to be fully functional at

Whereas, Diabetes Self-Management Support (DSMS) refers to the "support that is required for implementing and sustaining coping skills and behaviours needed to self-manage on an ongoing basis, and it is provided by family members with recognition that most care happen at the families patients reside" [18]. Family plays especially significant role in diabetes care for better glycaemic outcomes. A study involving 5000 diabetes patients recognizes importance of family, relatives and colleagues in improving well-being and self-management of diabetes [25]. Home care refers to "health or social service provided by formal and informal caregivers to the recipient" [26]. Informal home caregivers are explained as "individuals actively and directly involved in the patient care and support at home without earning any salary for caring and supporting the patients" [27]. The FMs maybe distressed by diabetes status of their loved ones, particularly when they have poor knowledge of the condition or not knowing how best to provide support [25]. Families sometimes have misconceptions, like believing that their loved ones living diabetes know more about the management of the disease, than they actually report. The family as informal caregivers are usually not trained in the care of patients; and as such families are underutilized resource. The success stories related to home care for diabetes patients includes adherence to diabetes treatment and improved quality of life and reduction of prevalence. However, failures of home care which often occurs in the event of inadequate diabetes knowledge includes poor diabetes outcomes and quality of life. Hence the need for family centered

diabetes care to improve knowledge of both family and patients.

**8. Why adopt family-centred care in diabetes management**

Lack of adequate knowledge about illness and inadequate social support contribute to poor control of diabetes [25]. The adoption of FCC is aimed at capacitating both family members through the DSME together with patients at the healthcare facility, which capacitate and empower them with knowledge on how to best become healthcare providers at home, where most of the diabetes care takes place. Adequate social support from knowledgeable family members helps in preventing, delaying and minimizing the severity of diabetes complications, as well as reducing the chances of family members from developing diabetes. Family members are informal healthcare providers at home as they primarily provide Diabetes Self-Management Support. The QoL is regarded as "an estimation of well-being as well as the measurement of health and the effects of health care" [28]. In order to achieve better QoL, it is important to adhere to diabetes treatment and adopt

*DOI: http://dx.doi.org/10.5772/intechopen.96223*

PHC level.

#### *Family-Centered Diabetes Care for Better Glycemic Outcomes of Outpatients in Rural Areas DOI: http://dx.doi.org/10.5772/intechopen.96223*

family, since collaboration is one of the principles of FCC. Among the families of patients, there should be dedicated person to represent the family in the interaction and consultation with patients at the healthcare facilities [24]. Spouses and parents can be in charge of both their partners and children; respectively, however, the families may as well nominate a member to represent them. In ensuring the success of the FCC, the healthcare professionals may assure the families that they will be listened, supported and that their doors will forever be opened for any challenges encountered to ease the home caregiving. The family receives home care through consulting together with patients or DSME program. The outpatients receive their diabetes treatment at PHC facility, which is inadequately resourced with other healthcare workers such as dietitians and physiotherapists, who support the PHC facilities. Therefore, there is a need for a well-organized and structured education programme for people living with diabetes for the DSME to be fully functional at PHC level.

Whereas, Diabetes Self-Management Support (DSMS) refers to the "support that is required for implementing and sustaining coping skills and behaviours needed to self-manage on an ongoing basis, and it is provided by family members with recognition that most care happen at the families patients reside" [18]. Family plays especially significant role in diabetes care for better glycaemic outcomes. A study involving 5000 diabetes patients recognizes importance of family, relatives and colleagues in improving well-being and self-management of diabetes [25]. Home care refers to "health or social service provided by formal and informal caregivers to the recipient" [26]. Informal home caregivers are explained as "individuals actively and directly involved in the patient care and support at home without earning any salary for caring and supporting the patients" [27]. The FMs maybe distressed by diabetes status of their loved ones, particularly when they have poor knowledge of the condition or not knowing how best to provide support [25]. Families sometimes have misconceptions, like believing that their loved ones living diabetes know more about the management of the disease, than they actually report. The family as informal caregivers are usually not trained in the care of patients; and as such families are underutilized resource. The success stories related to home care for diabetes patients includes adherence to diabetes treatment and improved quality of life and reduction of prevalence. However, failures of home care which often occurs in the event of inadequate diabetes knowledge includes poor diabetes outcomes and quality of life. Hence the need for family centered diabetes care to improve knowledge of both family and patients.
