The Effect of Diabetes Self-Management Education Using Audiovisual Media on Self-Efficacy Among Patients with Type 2 Diabetes Mellitus: A Quasi-Experimental Study at an Indonesian Puskesmas

Abstract

Background: Self-efficacy is a critical determinant of dietary adherence and self-care among patients with type 2 diabetes mellitus (T2DM). In Indonesian primary care, the pandemic disrupted face-to-face Posbindu (Integrated Health Development Post) services, limiting opportunities for structured diabetes education and leaving many patients with suboptimal self-management capacity. Purpose: To examine the effect of Diabetes Self-Management Education (DSME) delivered through audiovisual media on self-efficacy among patients with T2DM at a community health centre (Puskesmas) in Bandung, Indonesia. Methods: A quasi-experimental pre-test-post-test with non-equivalent control group design design was used. Sixty-six patients with T2DM enrolled in the Prolanis programme at a Puskesmas in Bandung were recruited through total sampling and allocated equally to an intervention group (n=33) receiving DSME via a 20-minute audiovisual programme covering the four pillars of diabetes management, and a control group (n=33) receiving usual care. Self-efficacy was measured using the Diabetes Management Self-Efficacy Scale (DMSES). Within-group changes were analysed using the Wilcoxon signed-rank test, and change scores (post-test minus pre-test) were compared between groups using the Mann-Whitney U test, with effect sizes and 95% confidence intervals reported for all primary outcomes. Results: Mean self-efficacy in the intervention group rose from 61.79 (SD=15.68) to 76.64 (SD=7.98) post-intervention (mean change +14.85; p<0.001), with 66.7% reaching the high category. The control group showed no significant change (65.03 to 66.55; p=0.366). The proportion with low self-efficacy in the intervention group fell from 18.2% to 0%. The improvement was significantly greater in the intervention group than in the control group (Mann-Whitney U=761.5, p=0.005, r=0.34; Cohen's d=0.77, 95% CI 0.27 to 1.27). Conclusions: Audiovisual DSME was associated with a significant within-group increase in self-efficacy among patients with T2DM in an Indonesian primary-care setting, and the improvement was significantly larger than under usual care. Given the quasi-experimental, single-site, urban, and short-term design, the intervention should be considered potentially adaptable, rather than directly transferable, to rural and peri-urban community health settings, and it warrants formal evaluation in those settings before wider adoption.