Croatian Translation and Validation of the Patient Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ).

Patient satisfaction is a crucial measure of the quality of healthcare, especially with regard to nursing services in hospital settings. Understanding and increasing patient satisfaction with nursing care is critical to improving overall healthcare and ensuring positive patient experiences during their hospital stay. The aim of this research was to evaluate the psychometric properties of the Croatian version of the Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ), test the reliability and validity of the tool after translation, and investigate differences in patient satisfaction based on demographic variables, as well as their contribution to satisfaction with the quality of nursing care. After translation and adaptation, the Croatian version of the PSNCQQ was applied to 350 hospitalized patients (average age 51.19 years (range: 18-87)), of whom 194 (55.4%) were men and 156 (44.6%) were women. The results showed high internal consistency (Cronbach's α = 0.977) and confirmed the one-factor structure of the questionnaire, explaining 70.64% of the total variance. Confirmatory factor analysis supported the unidimensional model, showing strong fit indices (χ2 = 583.047, df = 149, p < 0.001, GFI = 0.861, AGFI = 0.818, NFI = 0.936, TLI = 0.946, CFI = 0.955, RMSEA = 0.080, PCLOSE < 0.001). In conclusion, the validation of the PSNCQQ in the Croatian language increases resources for evaluating and improving the quality of nursing care. This research lays the foundation for future studies and practical applications aimed at improving patient satisfaction and nursing care outcomes in Croatia, but there are also limitations to this study, including its one-institution scope, the possible influence of factors outside the current treatment on satisfaction, and the lack of comparison with objective clinical indicators.

Mentoring Support Quality in Group and Individual Mentoring Approaches during Nursing Clinical Training: A Quasi-Experimental Study.

Clinical training is an essential element in nursing education, the outcomes of which are directly related to the quality of mentoring support. This quasi-experimental study aimed to examine whether the group or individual form of the mentoring approach used and the order of application of the mentoring approach contribute to the quality of mentoring support provided to students. The study comprised two measurement points with 130 nursing students, divided into two groups with different orders of application of the mentoring approach. The validated Mentoring Support Quality Evaluation Questionnaire (MSEQ) was used. Students in both groups rated the quality of mentoring support as higher following an individual mentoring approach. A significant interaction was found between the mentoring approach used and the order in which the mentoring approaches were applied (p = 0.002). The individual mentoring approach contributed significantly to a higher quality of mentoring support after the second round of clinical training (p = 0.021), while after the first round, the difference between the group and individual approaches was not as clear. The results suggest that not only the form of the mentoring approach but also the sequence of changes in the mentoring approach should be planned when implementing clinical training.

Prevalence of risk factors for development of cardiovascular diseases in urban and rural areas of Eastern Croatia: a cross-sectional study.

OBJECTIVE: Cardiovascular diseases are the leading global cause of death. Due to the disparities in cardiovascular risk factors between rural and urban populations, this study aims to assess the differences in the prevalence of risk factors in urban and rural areas of eastern Croatia. METHODS: The cross-sectional study included 280 participants (140 from urban and 140 from rural areas) registered at studied general practice offices. Methods included e-health records, questionnaire, physical examination methods, and blood sampling for laboratory tests. RESULTS: The most common risk factors among participants were elevated total cholesterol (83.6%), elevated LDL cholesterol (81.8%), increased body mass index (75.0%), increased waist-hip ratio (82.9%), increased waist circumference (63.2%), and arterial hypertension (70.1%). The rural participants had a significantly higher prevalence of arterial hypertension (p = 0.023), increased body mass index (p = 0.004), increased waist circumference (p = 0.004), increased waist-hip ratio (p < 0.001), and increased LDL cholesterol (p = 0.029), while the urban participants had a significantly higher prevalence of insufficient physical activity (p < 0.001). CONCLUSIONS: In the examined sample, the prevalence of cardiovascular risk factors is generally high. Participants from rural areas are significantly more susceptible to cardiovascular risk factors than participants from urban areas.

Assessment of Empathy as a Prerequisite for Holistic Nursing: Psychometric Analysis of the Jefferson Scale of Empathy-Health Profession Students for Croatian BSc and MSc Nursing Students.

Purpose: To translate the original Jefferson Scale of Empathy-Health Profession Students version in a group of nursing students and asses its psychometrical characteristics according to the COnsensus-based Standards for the selection of health Measurement INstruments guidelines. Design: A descriptive cross-sectional study. Methods: The study included 345 bachelor's and master's students in the nursing degree program. Construct validity was tested by exploratory factor analysis using principal component analysis with varimax rotation. Convergent validity was tested using the Pearson correlation coefficient to test the relationship between empathy and emotional intelligence. The reliability of internal consistency was estimated using Cronbach's alpha. Findings: The final version of the 16-item scale with its three-factor structure has a high reliability with a Cronbach's alpha value of 0.86, and the Pearson correlation coefficient revealed a positive and significant relationship between emotional intelligence and the total score of the empathy scale and the three subscales. Conclusion: The contribution of the study is significant as the instrument is qualitatively validated and its content is clinically and educationally important for understanding the concept of empathy, especially in the education of nursing students. The correct assessment of empathy contributes to a better understanding and implementation of the components of holistic care.

The (Mis)use of Psychotropic Drugs and Addiction to Anxiolytics among Older Adults Living at Home or in Retirement Homes: Implications for Quality of Life.

Nowadays, the growing number of people aged 65+ has become a global phenomenon. At that age, the most common medical problems are multimorbidity and inappropriate polypharmacy, which have a negative impact on the quality of life in older adults. The aim of this cross-sectional study was to examine comorbidity, the use of psychopharmaceuticals, and symptoms of addiction to anxiolytics among older adults living at home or in retirement homes, and to examine the differences in quality of life in relation to the use and misuse of psychotropic drugs. The research included 383 people aged 65+ living in the Republic of Croatia (EU). A standardized questionnaire CAGE was used to collect data about the use of psychotropic drugs. Quality of life was examined using the WHOQOL-BREF scale. The average age of respondents was 83 years. There is a significantly higher prevalence of anxiety disorders (p = 0.001) in respondents who live at home. Psychopharmaceuticals were used by 218 (56.9%) respondents, equally in both groups of respondents. A total of 77 (20.1%) respondents had been using anxiolytics for more than five years, while 26 (6.8%) of them had significant clinical symptoms of addiction to anxiolytics. All domains and the overall quality of life scale were significantly lower (p < 0.001) in respondents who have clinical symptoms of anxiolytic addiction. The results indicate that the use of psychotropic drugs by respondents is inappropriate. Respondents who inappropriately and excessively use psychotropic drugs have a significantly worse quality of life.

Factors Related to the Knowledge and Practice of Breast Self-Examination: A Cross-Sectional Study.

Objective: Identification of the factors associated with knowledge and practice of breast self-examination (BSE). Materials and Methods: The online survey method was used to collect data. Questions were based on an analysis of the literature and instruments used to study BSE awareness, knowledge, and practices. The study included 3536 participants, aged 18 to 71 years. Results: Most participants (62.9%) believed they were not at risk of developing a breast cancer (BC). In the sample 459 (19%) reported they perform a BSE once a month after cessation of menstruation. The reason given for not performing the BSE by 521 (46.8%) was that they forgot, while 363 (32.6%) indicated they did not know how to perform a BSE. The mean ± standard deviation value of responses to the knowledge questions (response range 0-5) was 1.04±0.63. Almost all participants (98.6%) believed that BSE is important for the early detection of BC and that BSE awareness can be increased (96.9%). Conclusion: Lack of comprehensive knowledge of BSE and low prevalence of regular BSE practice were observed. Education, profession, experience with BC, "not" performing BSE, and attitudes toward the importance of BSE in the early detection of BC were associated with knowledge of BSE.

(Dis)Agreement with Dysthanasia, Religiosity and Spiritual Experience as Factors Related to Nurses' Workload during End-of-Life Care.

This study intended to investigate whether the workload of nurses in the course of providing end-of-life care correlated with their religiousness, spiritual experience and level of agreement with dysthanasia procedures. The respondents included 279 nurses from four Croatian hospitals. A structured and validated instrument was applied. Almost 90% of respondents are religious, and almost 45% of them have daily spiritual experiences. Respondents, especially those with high levels of religiousness and spiritual experience, express a low level of agreement with dysthanasia (mean = 58.21; score = 25−125). Moreover, nurses self-rated (on a scale of 1−5) their workload as quite high, especially when performing contradictory tasks imposed on them by their superiors (mean = 3.05) and during direct contact with dying patients and their family members (mean = 2.56). This significantly highest level of workload was experienced by the youngest nurses (p = 0.01) and nurses with little work experience (p < 0.01). This study also indicated that nurses who agree with dysthanasia experienced a higher level of workload when providing end-of-life care (r = 0.178; p < 0.01), while more frequent spiritual experiences reduced the level of workload (r = −0.205; p < 0.01). A deeper understanding of nurses' attitudes toward dysthanasia, as well as of their religiousness and spiritual experiences, may ensure the collection of data beneficial to the timely identification of potential risks caused by workload.

Stressful Experiences of Parents in the Paediatric Intensive Care Unit: Searching for the Most Intensive PICU Stressors.

Hospitalization of a child in the paediatric intensive care unit (PICU) is extremely stressful, both for the child and for his or her family. The purpose of this study was to gain deeper insight into the stressful experiences of parents of children hospitalized in the PICU. This study included 96 parents. The data were collected using a translated and standardized scale "The Parental Stressor Scale: Paediatric Intensive Care Unit (PSS: PICU)". This study confirms high exposure of parents to numerous PICU stressors. The most intense PICU stressor for parents was child's breathing depending on the ventilator (4.22 ± 1.17), and the least intense was child's demanding behaviour (1.17 ± 0.33). A significant positive correlation between the level of parents' perceived stress and the number of their children was recorded (r = 0.240, p = 0.02), while there was no significant correlation between the level of stress and other sociodemographic variables. A significantly higher level of stress was experienced by parents with primary school education (p = 0.032) and parents who are not healthcare professionals (p < 0.01). It is necessary to establish a system that will enable continuous assessment of parents' stress levels and timely prevention of stressful experiences for parents in the PICU.

Impact of Immediate and Delayed Breast Reconstruction on Quality of Life of Breast Cancer Patients.

A mastectomy affects the psychological, social, and sexual well-being of patients. Research has confirmed that breast reconstruction is important for improving the quality of life in patients with breast cancer. The aim of this study was to assess the quality of life of patients who underwent a mastectomy followed by immediate or delayed breast reconstruction. This prospective study was conducted from January 2018 to March 2020 at the Clinical Hospital Center Osijek, using the health questionnaire SF-36. The study included 79 patients. The results of the study showed that patients who underwent a mastectomy had the lowest scores in the domain of restriction due to physical difficulties, 18.8 (6.3−31.3), in physical functioning and limitation due to emotional difficulties, 16.7 (8.3−33.3), in mental health. In immediate breast reconstruction, patients rated better physical health (p < 0.001), while patients who underwent delayed breast reconstruction rated their mental health worse (p < 0.001) as measured by the SF-36 questionnaire. Conclusion: The results of this study show that patients without breast reconstruction rated their quality of life worse than patients who underwent immediate and delayed breast reconstruction after mastectomy. There is no difference in the quality of life between patients who underwent immediate and delayed breast reconstruction after mastectomy.

Profiling nursing students' dishonest behaviour: Classroom versus clinical settings.

BACKGROUND: While academic dishonesty among nursing students is becoming a global problem, the instruments used in studies on this topic are heterogeneous and, in many cases, not even validated. This makes it difficult or impossible to compare the findings on a global scale. OBJECTIVES: To investigate the profile of Croatian nursing students' dishonest behaviour in classroom and clinical settings and to examine the relationship between the incidence of dishonest behaviour in both settings. RESEARCH DESIGN: A quantitative cross-sectional study using a Croatian online version of the Nursing Student Perceptions of Dishonesty Scale (overall Cronbach's alpha 0.933). PARTICIPANTS AND RESEARCH CONTEXT: 446 nursing students from a higher education institution in Croatia, EU, in the academic year 2020/21. ETHICAL CONSIDERATIONS: The study was approved by the relevant committee of the higher education institution. FINDINGS/RESULTS: Almost all participants (91.3%) performed dishonest behaviour on two or more occasions in the classroom and 32.5% did so in the clinical setting. The incidence of dishonest behaviour increased with the students' year of BSc study (p = .008). All subscales of dishonest behaviour in the classroom were significantly and positively associated with dishonest behaviour in the clinical setting, except for the Not My Problem and Non-Compliance subscales. DISCUSSION: Based on these results, the following should be taken into consideration: 1) dishonest behaviour in the classroom is associated with dishonest behaviour in the clinical setting; 2) even the slightest occurrence of dishonest behaviour in the clinical setting can lead to fatal events. CONCLUSIONS: The gradual increase in BSc nursing students' dishonest behaviour with their year of study raises several questions regarding the development of ethical and moral values in this population. This raises the need for early and continuous exposure of students to ethical content from the beginning of their studies and support from competent educators.

Patients' and Nurses' Perceptions of Importance of Caring Nurse-Patient Interactions: Do They Differ?

Nurse−patient interaction is a professional and therapeutic relationship created to enable nurses to assess, plan, and deliver health care aimed at meeting patients' basic human needs. The main aim of this study was to identify distinctive characteristics and differences in perceptions between patients and nurses related to the importance of caring interactions and to examine the contribution of independent variables in explaining their perceptions. A total of 446 respondents were included in the research (291 patients and 155 registered nurses). Data were collected using the translated and standardized 70-item version of the Caring Nurse−Patient Interactions Scale (CNPI-70) version for patients and version for nurses. According to the overall CNPI-70 scale, there was a significant difference in patients' and nurses' perception (p < 0.001). Patients assessed caring nurse−patient interactions significantly higher (4.39) than nurses (4.16). Additionally, nurses assessed all subscales significantly lower than patients who assessed them high (p < 0.05), except for the subscales for "environment" (p = 0.123) and "spirituality" (p = 0.132). Independent variables did not contribute to an explanation of respondents' perceptions. Providing quality physical assistance in meeting human needs through effective communication and teaching is crucial for promoting a holistic patient approach, improving psychosocial support and nurse−patient interaction, and attaining greater satisfaction with health care provided without additional financial investments.

Croatian Version of the Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50): Cross-Cultural Adaptation and Psychometric Evaluation.

(1) Background: Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50) was originally designed for Spanish-speaking regions, and translations validated for several languages. The aim of the study was to adapt and verify the psychometric characteristics of SAHLSA-50 in the Croatian context; (2) Methods: The cross-sectional study included 590 respondents from the general population older than 18 years of age. Health literacy was measured by two scales: SAHLCA-50 and the Croatian version of the Newest Vital Sign screening test (NVS-HR), which was used as a measure of concurrent validity. Subjective Health Complaints (SHC) and Satisfaction with Life Scale (SWLS) questionnaires were also used to assess convergent validity; (3) Results: Internal consistency reliability of SAHLCA-50 was high and corresponds to the findings of the authors of the original research. The Cronbach alpha coefficient for SAHLCA-50 version was 0.91. The correlation of SAHLCA-50 with the NVS-HR test speaks in favor of concurrent validity. Correlation between health literacy and SHC speaks for convergent validity, just as was expected, while correlation with life satisfaction was not observed; (4) Conclusions: The SAHLCA-50 test can be a good and quick tool to assess health literacy of the adult population in the Croatian language. HL can affect the health and quality of life of the individual and the wider community.

Ability of Emotional Regulation and Control as a Stress Predictor in Healthcare Professionals.

Emotional Regulation and Control implies a person's ability to respond to stressful demands and emotional experiences in a socially acceptable and adaptive way. The aim of this cross-sectional study was to examine the contribution of the ability of emotional regulation and control in the prediction of workplace stress in healthcare professionals. The study included 203 healthcare professionals employed at a hospital in the Republic of Croatia. Data were collected using two validated questionnaires: Questionnaire on Workplace Stressors for Hospital Professionals and Emotional Regulation and Control Questionnaire (ERC). Most respondents (64%) experienced stress in Workplace Organization and Financial Issues factor, while 52.7% experienced stress in Public Criticism factor. The respondents assessed their ability of emotional regulation and control to be low (mean = 55; range = 20−100). The level of experienced stress was significantly higher if the ability of emotional regulation and control was low (Spearman's Rho = 0.308; p < 0.001). The multivariate regression model (11.2% explained variances; p = 0.001) indicated a greater possibility of severe stress in respondents who have stronger Memory of Emotionally Saturated Content (odds ratio = 1.18; 95% CI = 1.07−1.30). The results of this study signify the need to establish effective institutional support aimed at objectifying stress and strengthening emotional intelligence and empathy in healthcare professionals.

Psychometric Analysis of the Professional Identity Questionnaires in Croatian Nursing Student Context.

Introduction: The identification of nursing students with their profession, as well as gained professional competencies, are the crucial factors of the quality of their future work activities and the level of safety of the patient they are taking care of. Therefore, it is of utter importance to estimate the nursing students' professional identity during their education. Objectives: The purpose of this study was to translate Professional Identity Five-Factor Scale and Identity questionnaire, to test their psychometric properties in Croatian practice and to identify more suitable instrument of measuring the level of nursing students' professional identity in Croatian context. Methods: Quantitative, cross-sectional two-phase study was performed. In the first phase translated questionnaires were administered to a sample of 432 nursing students. Based on the confirmatory factor analysis (CFA), which revealed poor model fit, the principal component analysis was conducted. In the second phase, CFA was used to test the Croatian version of the instruments' factor structure on a sample of 222 students with different study orientations. Results: The CFA results, conducted in first phase, do not support the original version of the factor structures of the Professional Identity Five-Factor Scale and Identity models. The exploratory approach showed that the translated Professional Identity Five-Factor Scale had three factors with good psychometric properties explaining 49.35% of the variance. Translated Identity questionnaire had a two-factor structure (63.46% explained variance) with good reliability properties. In the second phase, on another heterogeneous sample of students, the described factor structure was found to have a good model fit obtained by CFA. Conclusions: According to the findings, Professional Identity Five-Factor is more appropriate for evaluating professional identity of nursing students, and Identity is probably better suited to measure professional identity among working professionals.

Psychometric evaluation and cross-cultural adaptation of the Croatian version of Nursing student perceptions of dishonesty scale.

BACKGROUND: Nursing students' perceptions about academic dishonesty directly affects their conduct in the clinical environment. Hence, it is crucial to systematically observe this phenomenon and develop appropriate instruments for assessing their perception of dishonest behaviors. PURPOSE: To translate and cross-culturally adapt the "Nursing Student Perceptions of Dishonesty Scale" into the Croatian language and assess its validity and reliability. METHODS: The study was performed in April 2018 in one Croatian university, 733 BSc and MSc nursing students from all Croatian counties participated in the study. RESULTS: Nursing experts confirmed the high degree of content validity of the instrument and suggested the exclusion of 13 items. The final version of the translated instrument, loaded on 11 instead of 9 factors, where subscale Cheating and Cutting corners loaded on two distinct factors. Results of internal consistency by subscale and overall (Cronbach α > 0.7 and test-retest reliability (p < 0.001)) indicate a high level of instrument reliability. CONCLUSION: The translated instrument indicates a high level of reliability and validity in assessing the students' perception of academic dishonest behavior in the Croatian socio-cultural context. The identified linguistic, cultural and organizational differences provide more insight regarding understanding what this population perceives in terms of academic dishonesty.

Nurses' Self-Assessment of Caring Behaviors in Nurse-Patient Interactions: A Cross-Sectional Study.

Nurse-patient interactions based on caring behaviors ensure better working conditions and better-quality healthcare. The aim of this quantitative study is to examine how nurses self-assess the frequency of applying caring behaviors in nurse-patient interactions and to identify the differences in the application frequency of caring behaviors in relation to work experience and education level. The respondents were Bachelor of Science (BSc) nurses and nurses with basic training (VET) employed in different clinical departments of the Clinical Hospital Center in Croatia. The survey used the "Caring Nurse-Patient Interactions Scale (Nurse Version)". The respondents assessed the caring behaviors from the subscale "needs" as the most frequently applied (median (Me): 4.7; interquartile range (IQR): 4.4-4.9), while the least frequently applied were the procedures from the subscale "sensitivity" (Me: 3.8; IQR: 3.2-4.3). The VET nurses reported applying caring behaviors to the subscales "hope" (p < 0.001), "problem-solving" (p = 0.003), and "environment" (p = 0.021) more frequently than BSc nurses did. Compared with less experienced respondents, the respondents with more than 30 years of work experience applied the caring behaviors on the subscales "sensitivity" (p = 0.009), "expression of emotions" (p = 0.001), "problem-solving" (p = 0.008), and especially "humanism" and "spirituality" (p < 0.001) more frequently. The results indicate that respondents are more focused on applying skills or carrying out a task than on caring behaviors which is about demonstrating compassion, loving kindness, and relationships.

The Influence of Self-Concept on Clinical Decision-Making in Nurses and Nursing Students: A Cross-Sectional Study.

The aim of this study is to examine the influence of nurses' self-concept (NSC) on clinical decision-making (CDM) among nursing students and hospital nurses. A further aim is to examine whether there is a difference in CDM and NSC between hospital nurses with various levels of experience and nursing students. A cross-sectional study was conducted during 2018 in the Faculty of Dental Medicine and Health and the University Hospital Center, in Osijek, Croatia, EU. The respondents consisted of 568 hospital nurses, and 129 BSc nursing students. Data were collected with the clinical decision-making in nursing scale (CDMNS) and the nurses' self-concept questionnaire (NSCQ). There was no correlation between CDM and NSC in either students or hospital nurses. Hospital nurses generally had significantly higher scores in CDM than nursing students. On the other hand, students had a significantly higher total NSC level. The results of this study suggest that experience has a positive impact on nurses' CDM skills. The high NSC estimated by students enables them to easily take up their clinical roles and approach the patient in a holistic manner, which is an attitude that gradually develops during studies and with clinical experience.

Personality traits of core self-evaluation as predictors on clinical decision-making in nursing profession.

Core self-evaluation (CSE) is a theory that includes four personality dimensions: self-esteem, self-efficacy, locus of control and emotional stability. CSE proved to be a significant predictor of the research on cognitive, emotional and behavioral responses across various situations in the workplace. The aim of this study was to examine the relationship between personality traits of the core self-evaluation and clinical decision-making in nurses' profession. A cross-sectional design was applied. Data was collected with standardized instruments: Core Self-Evaluation Scale and Clinical Decision-Making Nurses Scale, 584 nurses have participated in the study. Correlation and hierarchical regression analysis were used to test the relations and prediction of variables. The findings of the study revealed that there is a significant positive relationship between overall core self-evaluation and nurses' clinical decision-making, and there is a significant contribution of self-esteem, self-efficacy and locus of control on all dimensions of clinical decision, especially in the area of canvassing of objectives and values. Nurses with high CSE have positive self-views and tend to be confident in their ability and they also feel in control while performing nursing interventions, whereas those with low CSE tend to have fewer accessible positive resources and are more prone to risk aversion.

Parental Perception of Changes in Basic Life Needs of Children with Disabilities after Six Months of Therapeutic Horseback Riding: A Qualitative Study.

Therapeutic horseback riding (THR) has a positive effect on the physical, cognitive, and psychosocial functioning of children with disabilities. Parents' reports of the effects of THR on their children support professionals in individualizing the THR program. With this qualitative study, we aimed to explore parents' perceptions of changes in the basic life needs of their children with disabilities after six months of THR lessons and to survey parents' explanations for the causes of these changes. The study involved parents of 13 children with disabilities who were enrolled in a six-month THR program. Parents continuously monitored their children and wrote a report on possible changes in their child's needs according to Virginia Henderson's need theory. Qualitative content analysis of parents' reports indicated only positive changes in 11 children. Most codes were identified in categories "relationships and communication with other people" and "movement and posturing". Other categories identified codes such as easier breathing, a better quality of sleep, better appetite, better elimination of stool and urine, more independence in clothing and maintaining personal hygiene, and greater interest in play and learning. Parents' reports are further supported by the assessments of professionals. Most parents think THR is responsible for the noticeable improvements in their children's quality of life.

Diet Education as a Success Factor of Glycemia Regulation in Diabetes Patients: A Prospective Study.

BACKGROUND: The aim of this study was to examine the effect of dietary education on glycemic control in patients with any type of diabetes at four-week and two-year follow-ups. METHODS: A two-year prospective study was conducted in three phases: before, four weeks after, and two years after an educational program. The participants were patients diagnosed with diabetes who were receiving insulin or oral hypoglycemics and who attended the Diabetes Clinic of the General County Hospital Nasice, Croatia to receive their treatment. The questionnaire and educational program were created for the purpose of this study. Measurements were made (fasting blood glucose, glycated hemoglobin, body mass index, blood pressure, knowledge test) at baseline, four weeks and two years after education. RESULTS: A total of 109 participants took part in the study, of which 56 (51.4%) were on insulin therapy and 53 (48.6%) were on oral therapy, after two years, 78 (72%) subjects were followed up with. There was no control group. At the two-year follow-up, participants with insulin therapy had significantly higher glycated hemoglobin (Mann-Whitney U test, p = 0.035). Significant differences were observed in fasted blood glucose (Friedman's test, p = 0.001), diastolic pressure (Friedman's test, P = 0.018), and glycated hemoglobin (Wilcoxon test, p < 0.001) between Phase 1 and Phase 3. CONCLUSIONS: Education has a positive effect on adherence to recommended diet and glycemia regulation in diabetes patients after four-week follow-ups. However, after two years, participants showed a decrease in adherence to recommended diet and increased glycemia.