Summary: In this single-centre, two-week semi-experimental trial of 102 elderly patients with diabetes in Iran, a Peplau-theory self-care education programme significantly improved questionnaire-measured self-care versus routine clinic education (p<0.001). Total treatment adherence did not differ between groups (p=0.307); only two adherence subdimensions improved.
PICO Summary
| Element | Detail |
|---|---|
| Population | 102 elderly patients with diabetes attending a single diabetes clinic in Hormoz, Iran (2023); semi-experimental randomised design with pre- and post-assessment at two weeks. |
| Intervention | Self-care education based on Peplau’s therapeutic-communication theory (orientation, working, termination phases) covering diet, medication, physical activity, blood-glucose monitoring and foot care; delivered individually or in small groups (n=51). |
| Comparison | Routine educational content provided by the diabetes clinic, i.e. usual care rather than no intervention (n=51). |
| Outcome | Pre-post change in total self-care score significantly greater in the intervention group (p<0.001), with the same direction for diet, blood-sugar regulation and foot-care subscales (p<0.001). Total treatment-adherence score did not differ between groups (p=0.307); only the subdimensions willingness to participate in treatment (p=0.035) and ability to adapt (p<0.001) favoured the intervention. No effect sizes, 95% CIs, ARR/NNT, or glycaemic/clinical outcomes (e.g. HbA1c) were reported. |
Expert Commentary
This small semi-experimental trial offers modest, behaviourally framed evidence that a structured Peplau-based nursing education programme can raise self-reported self-care in older adults with diabetes, with the largest signals in diet, blood-glucose monitoring and foot care. The verdict, however, must be read narrowly. The pre-specified treatment-adherence outcome was negative, with no between-group difference in the total adherence score (p=0.307); the two subdimension findings should be treated as exploratory and hypothesis-generating rather than confirmatory, given the multiple comparisons involved. The single most important limitation is that all outcomes were questionnaire-based and assessed only two weeks after the intervention, so durability and any translation into glycaemic control or hard clinical endpoints remain entirely unknown. The design is also unavoidably unblinded, the setting is a single Iranian clinic, and no effect sizes or confidence intervals were reported, which limits both precision and generalisability. No industry or manufacturer sponsorship is apparent, and the effect magnitudes are plausible rather than implausibly large. Can I use this with my patients? Cautiously yes as a framework for nurse-led self-care counselling in older outpatients, but not as a substitute for adherence-focused interventions or as evidence of improved glycaemic outcomes. Future work should use longer follow-up, blinded outcome assessment, and objective measures such as HbA1c before this approach is presented as more than a promising educational adjunct.
References
Roostaye Abkenar M, Imani E, Hosseini Teshnizi S, Sadat Ahmadi N, Moradi Y. Determining the impact of a self-care educational program designed based on the Peplau theory on adherence to treatment and self-care in elderly patients with diabetes. Invest Educ Enferm. 2025;43(1):e05. doi:10.17533/udea.iee.v43n1e05
