ABSTRACT
BACKGROUND: In response to the need for safe care for people with diabetes mellitus in the current outbreak of COVID-19, it is critical to evaluate the model, service delivery, feasibility, and efficiency of diabetes mellitus telecoaching. OBJECTIVE: This study aimed to conduct a systematic review and meta-analysis of the model and efficacy of telecoaching to improve self-care and clinical outcomes. METHODS: This study uses the Preferred Reporting Item for Systematic Review and Meta-Analysis (PRISMA). We searched on 22 March 2022, using keywords that matched the MeSH browser in four databases to find relevant studies, namely, PubMed/Medline, Proquest, Scopus, and EBSCOhost. Additionally, we collected randomized controlled trials (RCTs) on Google Scholar using the snowball technique. A quality assessment was performed using the Cochrane Collaboration's Risk of Bias tool (RoB)2. The meta-analysis used the DerSimonian-Laird random-effects model to analyze the pooled mean difference (MD) and its p-value. RESULTS: Thirteen RCT studies were included for the systematic review and meta-analysis with a total number of participants of 3300. The model of telecoaching is a form of using nurses-led telephone and mobile apps, which are relatively cost-effective. The meta-analysis showed a positively improved statistically significance in clinical outcomes, including in HbA1c (a pooled MD of -0.33; 95% CI: -0.51--0.15; p = 0.0003), blood glucose (-18.99; 95% CI: -20.89--17.09; p = 0.00001), systolic blood pressure (-2.66; 95% CI: -3.66--1.66; p = 0.00001), body mass index (-0.79; 95% CI: -1.39--0.18; p = 0.01), and weight (-2.16 kg; 95% CI: -3.95--0.38; p = 0.02). It was not, however, statistically significant in diastolic blood pressure (-0.87; 95% CI: -2.02-0.28; p = 0.14), total cholesterol (-0.07; 95% CI: -0.26-0.12; p = 0.46), low-density lipoprotein (-2.19; 95% CI: -6.70-2.31; p = 0.34), triglycerides (-13.56; 95% CI: -40.46-13.35; p = 0.32) and high-density protein (0.40; 95% CI: -1.12-1.91; p = 0.61). CONCLUSIONS: The telecoaching with nurses-led telephone and mobile apps significantly affected clinical outcomes on HbA1c, systolic blood pressure, weight, and BMI. Moreover, there was no significant effect on the total cholesterol, low-density lipoprotein, triglycerides, and high-density lipoprotein. Thus, telecoaching has the potential as a care model in diabetes mellitus during COVID-19 and similar pandemics to improve self-care and clinical outcomes, but all the studies analyzed involved non-COVID-19 patients, limiting the generalizability of the results to COVID-19.
Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Humans , Glycated Hemoglobin , Self Care/methods , COVID-19/epidemiology , COVID-19/therapy , Diabetes Mellitus, Type 2/therapy , Triglycerides , Lipoproteins, LDL , CholesterolABSTRACT
Vaksinasi merupakan salah satu solusi dalam penekanan kasus dan kematian akibat COVID-19 namun penolakan vaksinasi sejumlah kelompok menyebabkan strategi eliminasi vaksin di Indonesia menjadi tantangan. Sehingga studi ini bermaksud melakukan analisis penyebab dan intervensi berdasarkan perspektif teori planned behavior. Studi kasus berdasarkan kajian pustaka dari berbagai database dan search engine dilakukan menggunakan teknik snowball. Data dari literatur dianalisis berdasarkan kerangka teori planned behavior secara deskriptif dengan pendekatan tematik. Kepercayaan yang menyebabkan perilaku penolakan vaksin disebabkan karena faktor individu atau kelompok terhadap kepercayaan perilaku normatif dan kontrol. Faktor tersebut diantaranya kecemasan terhadap efek samping vaksin riwayat penerimaan vaksin sebelumnya penolakan dari tokoh publik kampanye penolakan vaksin kehalalan vaksin ketidakyakinan terhadap program pemerintah dan kesediaan membayar. Intervensi dengan meningkatkan keterbukaan terhadap publik terkait keamanan dan efektivitas vaksin;mengantisipasi penyebaran hoaks;menjadikan percaya sebagai unsur utama dalam penerimaan kebijakan publik terkait vaksinasi;melibatkan tokoh peran individu penting dan organisasi masyarakat dalam proses meningkatkan cakupan vaksinasi;komunikasi efektif;serta menerapkan kebijakan vaksin gratis khusus untuk masyarakat miskin dan rentan merupakan intervensi strategis dalam mencegah dan mengurangi perilaku penolakan vaksin. Upaya pemerintah dalam meningkatkan cakupan vaksinasi perlu memperhatikan kepercayaan masyarakat dalam tiga aspek utama yakni kepercayaan perilaku normatif dan penerimaan kontrol perilaku. Kata Kunci: Penolakan vaksin;planned behavior;vaksin COVID-19