THE EFFECTIVITY OF DIABETIC SELF MANAGEMENT ORIENTED TO THE FAMILY AT EFFORT TO INCREASE SELF EFFICACY, SELF MANAGEMENT, GLICAEMIC CONTROL AND OBEDIENCE TO THERAPEUTIC PROGRAM OF TYPE 2 DIABETIC

The purpose of the study is to analyze the effectivity of Diabetic self management program oriented to the family at effort to increase self efficacy, self management, glicaemic control and obedience to the Diabetic therapeutic program. The design of the study in quasy experiment with pre test and post test design with control group. Based on data release by Center of Health Distric Pasar Minggu South Jakarta, which took as the respondent of intervention and control group, using interview and questionnaire method. Analysis of data statistic has shown that there is a significant different on health condition between the intervention and control group. On the control group has score 1, 937 (4,002 – 2,065) meanwhile the score of intervention group 4,312(-15.056 to -10.744) with p-value 0,000 <0,05. The result of test different mean from diabetic self management has score of intervention group 7,62 ( 5.15-2.77) with p-value 0.000 <0,05. Meanwhile in the control group the score are 7.56 (5.18 - 12.74). Score of influence of self management upon stage of obedience in control group 1,324 (-3,062 to -1,738) meanwhile on the intervention group 1,852(-7,226 to -5374). The score of influence of self efficacy upon the obedience in control group 0,906 (-1,120 to -0,214) meanwhile in intervention group 2.889 (-8,611 to - 5,722) with p-value 0.000. on the influence of knowledge upon the obedience the score in control group is 0,928 (1.564 – 0,636) with p-value 0,000 < 0,05. Meanwhile in the intervention group the score is 2,043 (7,055 – 5,012).


INTRODUCTION
Diabetes Mellitus is a chronic metabolic disease characterized by increased blood glucose levels that cause serious damage to the heart, blood vessels, eyes, kidneys and nerves.The most common type is type 2 diabetes, which generally occurs in adults, occurs when the body experiences insulin resistance or does not produce enough insulin.In the last three decades, the prevalence of type 2 diabetes has increased dramatically in countries of all income levels (WHO, 2019).
Basic Health Research (Riskesdas) 2018 shows that the prevalence of Non-Communicable Diseases (PTM) has increased quite worryingly compared to the 2013 Riskesdas.Based on blood sugar checks, people with DM increased from 6.9 percent in the 2013 Riskesdas to 8.5 percent in 2018.Meanwhile, according to the 2015 Perkeni consensus, the prevalence of DM was 10.9 percent in 2018.Based on gender, the prevalence of DM in 2018 showed that women were higher. of 1.8% compared to men of 1.2%.The prevalence of urban residents is greater at 1.5% compared to rural residents at 1.0%.Based on age group, the highest prevalence was 6.3% at the age of 55 -64 years (Indonesian Ministry of Health, 2018).
The limited availability of health care personnel to provide support to patients living in rural communities provides recognition of the important role family members can play in caring for individuals suffering from chronic pain.As a result, in the last decades, health self-management programs have gradually included family members being involved in providing health care (Rosland et al., 2010).Numerous studies have shown that health care strategies involving family members can improve self-efficacy, knowledge about the condition, and self-care skills in individuals with chronic conditions such as Type 2 DM (Baig et al., 2015).A systematic review and meta-analysis of 52 randomized controlled trials found how such programs can improve patients' perceptions of physical and mental health (Hartmann et al., 2010); while other narrative systemic reviews discuss how these interventions can improve glycemic control in individuals with Type 2 DM (Armour et al., 2005).
However, the beneficial effects of family-oriented health care programs show inconsistent patient health outcomes (Armour et al., 2005).Some studies have shown how these programs can improve patients' self-efficacy and their overall diabetes management, while others have found that these interventions do not improve self-management in glycemia control (García-Huidobro et al., 2011).
General purpose this research is mAnalyzing the effectiveness of a familyoriented diabetes self-management program in efforts to increase self-efficacy, self-management, glycemic control and adherence to the therapy program for type 2 DM clients.The specific objectives of this research are 1).Analyze the individual characteristics of type 2 DM clients in the intervention group and control group.2).Analyzing self-efficacy, self-management, glycemic control and compliance of type 2 DM clients before implementing a familyoriented self-management program in the intervention group and control group.

RESEARCH METHODS
The research design used in this study was a quasi-experimental design using a pre-test and post-test design with a control group which aimed to see the effectiveness Based on data obtained from the Pasar Minggu District Health Center as an intervention group, after that home visits were carried out to carry out the Diabetes Self Management program.Previously, a pre-test of self-efficacy and adherence to the type 2 DM client therapy program was carried out in the intervention group and control group using the interview method using a questionnaire.Next, a diabetes selfmanagement program intervention was carried out with a family approach for 4 weeks.
In the first week, researchers carried out a diabetes self-management education intervention for patients and their families using booklets or modules.Researchers provided Diabetes selfmanagement education about choosing footwear, preventing and managing foot injuries to respondents and their families.In the second week, researchers carried out follow-up interventions to respondents by telephone to families by identifying behaviors related to diabetes self-care that had been carried out and reminding patients and families about the diabetes self-care educational material that had been provided.Week III and Week IV researchers visited face to face with patients and families to carry out monitoring and evaluation related to diabetes self-care that had been carried out.p-value< 0.05 based on paired ttest Based on the table above, the p-value for Diabetic self-management is 0.000 <0.05, so it can be concluded that there is a significant difference in the health condition of Type 2 Diabetes Mellitus clients before and after the control and intervention groups.In the control group there was a change of 3,062-1,738 (ᴧ 1,324) while in the intervention group it was 7,226 -5374 (ᴧ 1,852) 4. The influence of self-efficacy on the level of compliance The results of statistical tests on the effect of knowledge on the level of compliance show that in the control group there are differences from1,564 -0.636 (ᴧ0.928)The p-value is 0.000 < 0.05, while in the intervention group there was a change of 7.055 -5.012 (ᴧ 2.043), so it can be concluded that there is a relationship between knowledge and the level of compliance in Type 2 Diabetes Mellitus clients before and after in the control and intervention groups.

Discussion
Based on the results of univariate analysis of data from 60 respondents, it is known that 75% are female, 25% are male, with the old age category being 63.3%, young age 26.3% in the age range 30 to 76 years and the category low education 93.3%, higher education 5.7% in the range from no school to Bachelor's degree.
As for data on the health conditions of clients in the intervention group, the change was higher with a mean score of 10.74 to 15.05 (ᴧ 4.31) compared to the control group from a score of 2.06 to 4.00 (ᴧ 1.94) showing a significant difference with p -value < 0.05 with the client's health indicators being blood pressure, blood sugar levels, no diabetic ulcers.
Based on the results of the Bivariate analysis, it can be seen that the effect of Diabetic self-management intervention on the health condition of clients in the intervention group showed a change from a mean score of 5.15 to 12.77 (ᴧ 7.62) compared to a change in the control group from a mean score of 5.18 to 12.74 (ᴧ 7.62).ᴧ 7.56) by showing a significant difference with a p-value of 0.000.
The influence of self-efficacy on the level of compliance in self-management in the intervention group showed an increase in the mean score from 5.72 to 8.61 (ᴧ 2.89) with a p-value of 0.000, while in the control group the increase in the mean score was 0.21 to 1.12 with (ᴧ 0, 91) p-value 0.005, so it can be concluded that in the intervention group there was a more significant effect.The influence of knowledge on the level of compliance of type 2 DM sufferers in carrying out Diabetic self-management in the intervention group showed a change in the mean from 5.02 to 7.05 and a change in the mean score from 0.63 to 1.56 with a pvalue of 0.000, so it can be concluded that there is a relationship between knowledge with the level of compliance.

CONCLUSION
Based on the results of the analysis, it can be concluded that the level of knowledge plays a significant role in type 2 diabetes mellitus patients' compliance with their self-management.Good knowledge about the disease is positively associated with adherence to medication use, selfmanagement, and patient quality of life.Apart from that, the diabetes selfmanagement intervention also had a significant effect on the client's health condition, with the intervention group showing greater changes than the control group.This shows the importance of education and appropriate interventions in the management of type 2 diabetes mellitus to improve patient compliance and quality of life.
Engineering, Social and Health Volume 2, No. 12 December 2023 of a family-oriented self-management program in efforts to increase self-efficacy and compliance with type 2 DM client therapy programs.

Table 5 :
The influence of self-efficacy on the level of compliance of type 2 DM sufferers before and afterThe Effectivity of Diabetic Self Management Oriented to The Family at Effort to Increase Self Efficacy, Self Management, Glicaemic Control and Obedience to Therapeutic Program of Type 2 Diabetic