Impact of a Structured Family Empowerment Program on Self-Efficacy and Quality of Life among Diabetes Caregivers: A Repeated-Measures Quasi-Experimental Study

Setyoadi Setyoadi; Dina Dewi Sartika Lestari Ismail; Annisa Wuri Kartika; Shinta Amalia

doi:10.58545/jrcnp.v4i2.786

Authors

Setyoadi Faculty of Health Sciences, University of Barawijaya, Malang, Indonesia https://orcid.org/0000-0003-1563-0032
Dina Dewi Sartika Lestari Ismail Faculty of Health Sciences, University of Barawijaya, Malang, Indonesia https://orcid.org/0000-0002-5629-7435
Annisa Wuri Kartika Faculty of Health Sciences, University of Barawijaya, Malang, Indonesia https://orcid.org/0000-0003-4520-3285
Shinta Amalia Faculty of Health Sciences, University of Barawijaya, Malang, Indonesia https://orcid.org/0000-0002-1839-2730

DOI:

https://doi.org/10.58545/jrcnp.v4i2.786

Abstract

Background: Family caregivers play a critical role in supporting patients with type 2 diabetes mellitus (T2DM); however, prolonged caregiving responsibilities may negatively affect caregivers’ self-efficacy and quality of life. Strengthening caregiver empowerment through self-efficacy-oriented interventions may improve caregivers’ confidence, coping ability, and overall well-being. Purpose: This study aimed to examine the effectiveness of a self-efficacy-based family empowerment intervention in improving caregiver self-efficacy and quality of life among family caregivers of patients with T2DM. Methods: A quasi-experimental pre-test–post-test control group design with repeated measurements was conducted in community-based primary healthcare centers in Malang City, Indonesia. A total of 64 family caregivers were recruited and allocated to either the intervention group (n = 32) or the control group (n = 32). The intervention group received the “Berdaya DM” program, a structured family empowerment intervention delivered over four weekly sessions focusing on diabetes care, caregiver support strategies, stress management, and self-efficacy enhancement, whereas the control group received standard diabetes education routinely provided by the primary healthcare centers. Outcome measurements were conducted at baseline, immediately after completion of the intervention (post-test 1), and eight weeks after baseline (post-test 2). Caregiver self-efficacy was assessed using the General Self-Efficacy Scale (GSES), and quality of life was measured using the WHOQOL-BREF. Data were analyzed using repeated-measures ANOVA to examine the effects of time, group, and time-by-group interaction. Results: Caregiver self-efficacy and quality of life improved more markedly in the intervention group than in the control group across repeated measurements. At post-test 2, mean self-efficacy scores were 32.37 ± 3.77 in the intervention group and 27.37 ± 3.77 in the control group, corresponding to a between-group mean difference of 5.00 points. Mean quality-of-life scores were 77.14 ± 7.04 and 67.14 ± 7.04, respectively, yielding a between-group mean difference of 10.00 points. Significant time-by-group interaction effects were observed for self-efficacy (F = 73.92, p < 0.001, partial η² = 0.54) and quality of life (F = 82.41, p < 0.001, partial η² = 0.57), indicating large intervention effects over time. Conclusion: The self-efficacy-based family empowerment intervention effectively improved caregiver self-efficacy and quality of life among family caregivers of patients with T2DM. Integrating caregiver-centered empowerment programs into primary healthcare services may strengthen sustainable diabetes management and caregiver well-being.

Keywords:

Family empowerment, Self-efficacy, Caregiver, Quality of life, Type 2 diabetes mellitus

Downloads

Download data is not yet available.

Author Biographies

Setyoadi, Faculty of Health Sciences, University of Barawijaya, Malang, Indonesia

Department of Nursing

Dina Dewi Sartika Lestari Ismail, Faculty of Health Sciences, University of Barawijaya, Malang, Indonesia

Department of Nursing

Annisa Wuri Kartika, Faculty of Health Sciences, University of Barawijaya, Malang, Indonesia

Department of Nursing

Shinta Amalia, Faculty of Health Sciences, University of Barawijaya, Malang, Indonesia

Department of Nursing

References

Ahmad, F., & Joshi, S. H. (2023). Self-Care Practices and Their Role in the Control of Diabetes: A Narrative Review. Cureus, 15(7). https://doi.org/10.7759/cureus.41409

Aljuaid, M., Ilyas, N., Altuwaijri, E., Albedawi, H., Alanazi, O., Shahid, D., & Alonazi, W. (2022). Quality of Life among Caregivers of Patients Diagnosed with Major Chronic Disease during COVID-19 in Saudi Arabia. Healthcare, 10(3), 1–15. https://doi.org/10.3390/healthcare10030523

Alzawahreh, S., & Ozturk, C. (2024). Improving Self-Efficacy , Quality of Life , and Glycemic Control in Adolescents With Type 1 Diabetes : Randomized Controlled Trial for the Evaluation of the Family-Centered Empowerment Model Corresponding Author : JMIR Form Res, 8(e64463), 1–12. https://doi.org/10.2196/64463

American Diabetes Association. (2025). Diagnosis and Classification of Diabetes : Standards of Care in Diabetes-2025. Diabetes Care, 48 (January), 27–49. https://doi.org/10.23 37/dc25-S002

Araújo, F., Cardoso, C., Sá, M., & Lopes, M. (2025). Efficacy of digital technology- based interventions for reducing caregiver burden and stress : a systematic review and meta-analysis. Front. Digit. Health, 7(2), 1–12. https://doi.org/10.3389/fdgth.2025.1636084

Baig, A. A., Benitez, A., Quinn, M. T., & Burnet, D. L. (2015). Family interventions to improve diabetes outcomes for adults. Annals of the New York Academy of Sciences, 1353(1), 89–112. https://doi.org/10.1111/nyas.12844

Bandura, A. (1993). Percieved Self-Efficacy in Cognitive Development and Functioning. Educational Psychologist, 28(2), 117–148. https://www.itma.vt.edu/courses/tel/resources/bandura(1993)_self-efficacy.pdf

Bel, M., Jim, S., & Bel, A. (2026). Acta Psychologica Psychoeducational intervention against support groups for caregivers : A randomised controlled trial of its effectiveness. Acta Psychologica, 265(1), 1–12. https://doi.org/10.1016/j.actpsy.2026.106676

Dailah, H. G. (2024). The Influence of Nurse-Led Interventions on Diseases Management in Patients with Diabetes Mellitus: A Narrative Review. Healthcare (Switzerland), 12(3). https://doi.org/10.3390/healthcare12030352

Edmunds, S. R., Renaud, M., Goodrum, N. M., Bradshaw, J., Cooper, D. K., & Ingersoll, B. (2025). Caregiver Self-Regulation as a Key Factor in the Implementation Potential of Caregiver-Mediated Interventions. Behavioral sciences (Basel, Switzerland), 15(10), 1336. https://doi.org/10.3390/bs15101336

Eshtaya, R., Ayed, A., Malak, M. Z., & Shehadeh, A. (2025). The association between diabetes management self-efficacy and quality of life among Palestinian patients with type 2 diabetes. BMC Primary Care, 26(1), 1–9. https://doi.org/10.1186/s12875-025-029 80-1

Guo, F., Li, L., Jiang, H., Yu, J., & Wang, Y. (2024). Effectiveness of a family empowerment program on caregiving capacity and adverse mood in caregivers of children with acute leukemia : a quasi-experimental study. BMC Nurs, 23(1), 1–9. https://doi.org/10.1186/s12912-024-01973-2

Haeruddin, H., Amiruddin, R., Yusuf, S., Naiem, M. F., Sidin, A. I., Wahiduddin, W., Wahyu, A., Kurnyata, M., Kada, R., Ma, A., & Harbaeni, H. (2026). Exploring Self-Care Interventions to Improve Glycemic Control in Type 2 Diabetes Mellitus : A Scoping Review. F1000Research, 15(371), 1–18. https://doi.org/10.12688/f1000research.177355.1

Huang, H., Liao, Y., Kung, P., Shyu, Y. L., Hsu, W., & Hsu, J. (2024). Caregiving management needs and predictors for family caregivers of persons with dementia : a cross-sectional study. BMC Geriatr, 24(724), 1–12. https://doi.org/10.1186/s12877-024-05316-3

IDF. (2021). International Diabetes Federation (Vol. 102, Issue 2). https://diabetesatlas.org/atlas/tenth-edition/

Jiang, Y., & Wang, L. (2025). Caregiver Empowerment Interventions for Post-Stroke Incontinence : A Narrative Review of Chinese and International Practices. Journal of Multidisciplinary Healthcare, 19(1), 6965–6974. https://doi.org/10.2147/JMDH.S552868

Ka, M., Cowman, S., Sm, D., Sm, S., Mcgilloway, S., & Dl, W. (2018). Family-based interventions for adults with type 2 diabetes mellitus ( Protocol ). Cochrane Database Syst Rev, 1(7), 1–19. https://doi.org/10.1002/14651858.CD013064

Kristaningrum, N. D., Ramadhani, D. A., Hayati, Y. S., & Setyoadi. (2021). Correlation between the burden of family caregivers and health statuof people with diabetes mellitus. Journal of Public Health Research, 10(2), 326–331. https://doi.org/10.4081/jphr.2021.2227

Martínez-Melero, I., Ruiz-García, M. J., Ruiz-Merino, G., & García-Rubio, A. (2025). Impact of a community-based educational intervention on the burden and health-related quality of life of informal caregivers. Geriatric Nursing, 65, 103513. https://doi.org/10.1016/j.gerinurse.2025.103513

Matrook, K. A., Whitford, D. L., Smith, S. M., McGilloway, S., Piyasena, M. P., & Cowman, S. (2025). Family-based interventions for adults with type 2 diabetes mellitus: A systematic review and meta-analysis. Primary care diabetes, 19(2), 111–119. https://doi.org/10.1016/j.pcd.2025.01.006

Meyer, K., Glassner, A., Norman, R., James, D., Sculley, R., Lealvasquez, L., Hepburn, K., Lui, J., & White, C. (2023). Caregiver Self-Efficacy Improves Following Complex Care Training: Results from the Learning Skills Together Pilot Study. Geriatr Nurs, 45(1), 147–152. https://doi.org/10.1016/j.gerinurse.2022.03.013

Mphasha, M. H., Skaal, L., Mothiba, T. M., Ngoatle, C., Hlahla, L. S., & Group, F. (2023). Primary health care – family partnership for better diabetes outcomes of patients : a systematic review Primary health care – family partnership for better diabetes outcomes of patients : a systematic review. Global Health Action, 16(1), 1–12. https://doi.org/10.1080/16089677.2022.2140517

Natawirarindry, Catherine, and Guino-o, Theresa A. (2022). Quality of Caregiver Services and Quality of Life among Chronic Illness Undergoing Home Care in Katingan Districts, Central Kalimantan, Indonesia. International Journal of Nursing and Health Services (IJNHS), Volume 5, Issue 3. pg. 234-241. https://doi.org/10.35654/ijnhs.v5i3.575

National Institute of Health. (2023). The Caregiver’s Handbook. NIH Publica-tion. https://order.nia.nih.gov/sites/default/files/2023-03/caregivers-handbook-nia_0.pdf

Niño-de-Guzman Quispe, E., Bracchiglione, J., Ballester, M., Groene, O., Heijmans, M., Martínez García, L., Noordman, J., Orrego, C., Rocha, C., Suñol, R., & Alonso-Coello, P. (2023). Patients’ and informal caregivers’ perspectives on self-management interventions for type 2 diabetes mellitus outcomes: a mixed-methods overview of 14 years of reviews. Archives of Public Health, 81(1), 1–21. https://doi.org/10.1186/s13690-023-01153-9

Pahn, J., Yang, Y., & Kim, S. H. (2025). Factors influencing self-management and health-related quality of life in low-income patients with diabetes: a predictive model. International journal of nursing studies advances, 8, 100349. https://doi.org/10.1016/j.ijnsa.2025.100349

Pamungkas, R. A., Chamroonsawasdi, K., & Vatanasomboon, P. (2017). A systematic review: Family support integrated with diabetes self-management among uncontrolled type II diabetes mellitus patients. Behavioral Sciences, 7(3), 1–17. https://doi.org/10.3390/bs7030062

Rojas-oca, M. J., & Bego, E. (2021). Educational interventions by nurses in caregivers with their elderly patients at home. Primary Health Care Research & Development, 22(e26), 1–11. https://doi.org/10.1017/S1463423621000086

Rondhianto, R., Kushariyadi, K., & Rahmatullah, M. N. (2024). The Effect of Family Caregiver Empowerment Model Intervention on Fear of Hypoglycemia in People with Type 2 Diabetes Mellitus. Nurse Media Journal of Nursing, 14(2), 267–278. https://doi.org/10.14710/nmjn.v14i2.56893

Rondhianto, R., Nursalam, N., Kusnanto, K., & Melaniani, S. (2022). The effect of family caregiver empowerment interventions on family caregiver capabilities in self-management of type 2 diabetes mellitus in Indonesia. Enfermeria clinica (English Edition), 32(6), 385–395. https://doi.org/10.1016/j.enfcle.2022.01.005

Schwarzer, R. &. J. (1995). Generalized Self-Efficacy Scale In Measures in health psychology: A users portfolio. Causal control beliefs, edited by Weinman, J., Wright, S., Johnston, M., pp. 35-37, Nfer-Nelson, 1995. https://psycnet.apa.org/doi/10.1037/t00393-000

Seng, J. J. B., Gwee, M. F. R., Yong, M. H. A., Kwan, Y. H., Thumboo, J., & Low, L. L. (2023). Role of Caregivers in Remote Management of Patients With Type 2 Diabetes Mellitus: Systematic Review of Literature. Journal of Medical Internet Research, 25(1), 1–11. https://doi.org/10.2196/46988

Setyoadi, Fransiskus, L., Seda, S., Lestari, P., & Irwando, E. (2023). Family Empowerment as Nursing Intervention for Families with Type 2 Diabetes Mellitus: A Literature Review. Jurnal Kesehatan Komunitas Indonesia, 3(3), 267–280. https://doi.org/10.58545/jkki.v3i3.203

Setyoadi, S., Dewi, D., Lestari, S., Hayati, Y. S., Efendi, F., & Haryanto, J. (2026). Path Analysis of Family Communication , Decision-Making , and Caregiver Burden on Family Caregivers ’ Quality of Life : The Mediating Role of Self-Efficacy. Nurse Media Journal of Nursing, 16(April), 17–29. https://doi.org/10.14710/nmjn.v16i1.73159

Setyoadi, Yusuf, A., Kristianingrum, N. D., Hayati, Y. S., Noviyanti, L. W., & Syafiky, N. F. (2023). The correlation between family support and health status in patients om m er ci al us e on m er al. Jurnal Kesehatan Komunitas Indonesia, 11, 1–6. https://doi.org/10.58545/jkki.v3i3.203

Siregar, R., Kritpracha, C., Chinnawong, T., & Latour, J. M. (2025). Quality of life among Indonesian family caregivers caring for dependent older persons with type 2 diabetes mellitus in the community: A cross-sectional, correlational study. Belitung Nursing Journal, 11(1), 48–58. https://doi.org/10.33546/bnj.3683

Stepanian, N., Larsen, M. H., Mendelsohn, J. B., Mariussen, K. L., & Heggdal, K. (2023). Empowerment interventions designed for persons living with chronic disease ‑ a systematic review and meta ‑ analysis of the components and efficacy of format on patient ‑ reported outcomes. In BMC Health Services Research (Vol. 6). BioMed Central. https://doi.org/10.1186/s12913-023-09895-6

Teli, M., Thato, R., Hasan, F., & Rias, Y. A. (2024). Effectiveness of Family-Based Diabetes Management Intervention on Glycated Haemoglobin Among Adults With Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Biological Research for Nursing, 26(2), 315–333. https://doi.org/10.1177/10998004231218887

White, C. L., Barrera, A., Turner, S., Glassner, A., Brackett, J., Rivette, S., & Meyer, K. (2022). Family caregivers’ perceptions and experiences of participating in the learning skills together intervention to build self-efficacy for providing complex care. Geriatric Nursing, 45, 198–204. https://doi.org/10.1016/j.gerinurse.2022.04.012

World Health Organization. (2026). World Diabetes Day 2026: Early action on diabetes. Geneva: World Health Organization; [cited 2026 Sep 21]. https://www.who.int/campaigns/world-diabetes-day/2026

Zhang, J., Zhang, Z., Zhang, K., Ge, X., Sun, R., & Zhai, X. (2023). Early detection of type 2 diabetes risk: limitations of current diagnostic criteria. Frontiers in endocrinology, 14, 1260623. https://doi.org/10.3389/fendo.2023.1260623