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Ethics code: IR.IAU.K.REC.1399.039

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1- Department of psychology, Karaj Branch, Islamic Azad university, Karaj, Iran‏.‏
2- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
3- Department of Biostatistics and Epidemiology, School of Health, Alborz University of Medical Sciences, ‎Karaj, Iran.‎
Abstract:   (180 Views)
Comparison of the effectiveness of Hope Therapy and Spiritual Therapy on Self-Care, depression and HbA1c in middle-aged women diagnosed with Type 2 Diabetes
Background & Objective: Diabetes mellitus (DM), commonly known as diabetes, is a group of metabolic disorders characterized by a high blood sugar level over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased appetite.
In  2019, an estimated 463 million people were diagnosed with diabetes worldwide (8.8% of the adult population), with type 2 diabetes making up to 90% of these cases. Rates are similar in women and men. Trends suggest that rates will continue to rise. Diabetes at least doubles a personchr('39')s risk of early death. In 2019, diabetes resulted in approximately 4.2 million deaths. It is the 7th leading cause of death globally.
One of the most common problems in patients with type 2 diabetes is depression, which directly affects the patient’s physical and mental health. Its prevalence in patients with type 2 diabetes is two to three times higher than people without diabetes and can directly affect patients’ biologically derived materials such as fasting blood sugar and HbA1c. Depression has a great effect on life quality and mental health. Ignoring or late diagnosis of psychological problems can endanger patient’s health while the combination of behavioral, psychological and physiological problems hampers the disease control and lead to other physical problems such as cardiovascular disease, Retinopathy, blindness, neuropathy and etc. The more severe the depression, the more challenging the disease management becomes.
 Depressive symptoms have a significant impact on self-care and well-being. seven essential self-care behaviors  predict good treatment outcomes:  healthy eating, enough physical activity, blood sugar monitoring, compliant with medications, good problem-solving skills, healthy coping skills and risk-reduction behaviors. All these seven behaviors have been found to be positively correlated with good glycemic control, reduction of complications and improvement in depression.  Though multiple demographic, socio-economic and social support factors can be considered as positive contributors in facilitating self-care activities in diabetic patients, the Health Psychologist’s role in promoting self-care is vital and has to be emphasized. The aim of this study was to compare the effectiveness of hope therapy and spiritual therapy on depression, self-care and HbA1c in patients with type 2 diabetes.
Methods: The research method was quasi-experimental in pre-test-post-test design with follow-up study and a control group. The statistical population included all middle-aged women patients with type 2 diabetes in Tehran Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute. 45 people were selected by random sampling method who were randomly assigned into two experimental and one control groups (15 people in each group). The experimental groups received hope therapy (Snyder treatment protocol , 2002) and spiritual therapy (Richards et al treatment protocol., 2007) in  8 weekly sessions, While the control group did not receive any intervention, Data were collected using the Depression Inventory (Beck, 1972), the Self-Care Questionnaire ‎(Tobert & Glasgow, 2000) ‎and the HbA1c blood test. Pre-test and post-test were performed for all groups. Finally, one month after the post-test, in the follow-up phase, the all measures were repeated. The data Were analyzed using descriptive statistics and repeated measures ANOVA, followed by Tukey ‎and Bonferroni post hoc tests. All statistical analysis were performed in SPSS20 software with a significance level of less than 0.05.‎
Results : In the present study, hope therapy and spiritual therapy had a reducing effect on depression (P<0.001) and HbA1c (P=0.024) and an increasing effect on self-care (P=0.012). The mean of depression (P<0.001), HbA1c (P<0.001) and self-care (P<0.001) showed significant reduction over time. The significant time*groups interaction was observed for depression (P<0.001), HbA1c (P<0.001) and self-care (P<0.001) in the experimental group. The results of Bonferroni post hoc test confirmed the significant difference between both experimental groups and the control group for all three variables of depression (P<0.001), HbA1c factor (P<0.001) and self-care (P<0.001), but there was no significant difference between hope therapy and spiritual therapy for all three variables of depression (P=1.000), HbA1c factor (P=0.974) and self-care (P=0.143).
Conclusion: Based on our findings, hope therapy and spiritual therapy were effective in reducing depression, HbA1c and increasing self-care in patients with type 2 diabetes. Hope and spiritual therapy has a significant role in coping with chronic diseases, such as diabetes mellitus. It seems that the improvement of psychological capital in patients with diabetes is an effective strategy for health promotion. Hope therapy led to the improvement of psychological capital and its components (i.e., hope, self-care, optimism, and depression).Therefore, The results indicate the effect of spiritual care on diabetics’ self-care , emphasizing the fact that patient, as a part of health care system, must continuously pay attention to spiritual care . So, it is essential to consider hope and spiritual therapy interventions when planning for the improvement of psychological capital in diabetics.
Keywords: Hope Therapy, Spiritual Therapy, Self-Care, depression, HbA1c, Type II Diabetes
Type of Study: Original Research Article | Subject: Psychology
Received: 2020/11/9 | Accepted: 2020/03/20

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