Effectiveness of a Structured Teaching Programme on Insulin Self-Administration Among Patients with Diabetes Mellitus

India has one of the largest populations of people living with diabetes, and a growing number of them are started on insulin. In a busy medical OPD, a patient may receive a pen or vials and syringes with a two-minute explanation, and then go home to inject themselves for years. Common errors — injecting through clothes, not rotating sites, reusing needles many times, not priming the pen, not holding the needle in place for ten seconds, storing insulin in the freezer, or injecting and skipping meals — cause lipohypertrophy, erratic glucose control and hypoglycaemia. Nurses are the professionals best placed to teach correct technique.

This B.Sc Nursing NRST 405 group research project evaluates a structured teaching programme (STP) on insulin self-administration using a one-group pre-test/post-test (pre-experimental) design among 60 adults with diabetes on insulin attending the medical OPD of a teaching hospital. Knowledge (insulin types, storage, sites, rotation, dose timing, hypoglycaemia recognition and management, needle disposal) is measured with a structured questionnaire, and practice is observed with a 15-step injection-technique checklist using a demonstration pen. The STP (45 minutes: flip chart, demonstration, return demonstration and a take-home leaflet) is delivered after the pre-test; the post-test is done on day 7.

Pre- and post-test scores are compared with the paired t-test, and associations of pre-test knowledge with demographic variables with the chi-square test, in SPSS.

Abstract

A pre-experimental one-group pre-test/post-test study was conducted to assess the effectiveness of a structured teaching programme on insulin self-administration among patients with diabetes mellitus. Sixty patients on insulin were selected by purposive sampling from the medical OPD of a teaching hospital. Knowledge was assessed by a 30-item structured questionnaire and practice by a 15-step observation checklist. The STP was given after the pre-test and the post-test was done after seven days. Data were analysed with descriptive statistics, paired t-test and chi-square test.

Introduction

Insulin therapy is essential for type 1 diabetes and for many people with type 2 diabetes whose glucose is not controlled on oral agents. Its benefit depends on correct self-administration: right dose, right time in relation to meals, right site, right depth and correct storage. Errors are common and often unnoticed by clinicians because they happen at home. Structured, demonstration-based teaching with return demonstration is a core nursing intervention to correct them.

Need for the study

During medical-ward and OPD postings, students observed patients reusing a single needle for weeks, injecting at one spot repeatedly and storing pens in freezer compartments. Several patients admitted with hypoglycaemia had injected insulin and then delayed their meal. A structured teaching programme addresses these specific gaps.

Hypotheses (at 0.05 level)

• H1: the mean post-test knowledge score is significantly higher than the mean pre-test knowledge score.
• H2: the mean post-test practice score is significantly higher than the mean pre-test practice score.
• H3: there is a significant association between pre-test knowledge and selected demographic variables.

Feasibility

• Adequate OPD caseload of insulin-treated patients; permission from the medical superintendent and physician in charge.
• Low cost: printing, flip chart, demonstration pen with saline and practice pad.
• Fits the 40 hours of NRST 405 lab time plus medical-surgical posting days.
• Ethics committee approval and informed consent obtained.

Patients with diabetes mellitus who are prescribed insulin often receive brief instructions at the time of initiation and then self-administer insulin at home for long periods. Errors in storage, site selection and rotation, injection technique, needle reuse and timing of meals are common and lead to lipohypertrophy, unpredictable glucose control and hypoglycaemic episodes. There is limited evaluation of whether a short, nurse-led structured teaching programme with demonstration and return demonstration improves both knowledge and actual technique in Indian OPD settings.

Statement of the problem: "A pre-experimental study to assess the effectiveness of a structured teaching programme on knowledge and practice regarding insulin self-administration among patients with diabetes mellitus attending the medical OPD of a selected hospital."

In scope

• Adults aged 25–70 with type 1 or type 2 diabetes self-administering insulin by pen or syringe for at least one month.
• One medical OPD of a teaching hospital; 60 participants.
• A 45-minute STP with demonstration and return demonstration; post-test on day 7.
• Knowledge and observed practice as outcomes.

Out of scope

• Glycaemic outcomes such as HbA1c or hypoglycaemia frequency (need longer follow-up).
• Insulin pumps and patients who depend entirely on a caregiver for injections.
• A control group (listed as a limitation and future scope).

Research approach: evaluative (quantitative). Research design: pre-experimental one-group pre-test/post-test design (O1 X O2).

Setting: medical OPD and diabetic clinic of a selected teaching hospital.

Population and sample: adults with diabetes on insulin attending the OPD; 60 patients meeting the criteria.

Sample size: based on a paired design with an expected mean knowledge gain of 3 marks (SD of difference 7), α = 0.05, power 80%, n ≈ 45; increased to 60 to allow for loss at post-test.

Sampling technique: non-probability purposive sampling.

Inclusion criteria: age 25–70; on insulin for ≥ 1 month and self-administering; able to understand the local language or English; available for post-test on day 7.

Exclusion criteria: health professionals; visual impairment or hand tremor preventing self-injection; cognitive impairment; patients who previously attended a formal diabetes-education programme in the last six months.

Tools:

• Section A — demographic and clinical data (age, sex, education, occupation, duration of diabetes, duration on insulin, device).
• Section B — 30-item structured knowledge questionnaire: adequate (> 75%), moderate (50–75%), inadequate (< 50%).
• Section C — 15-step observation checklist of injection technique (hand hygiene, checking insulin and expiry, rolling cloudy insulin, priming, dose dialling, site selection and rotation, skin fold when needed, 90° insertion, holding 10 seconds, needle removal and disposal): scored yes = 1, no = 0.

Intervention — STP (45 min): introduction and diabetes basics; insulin types and action profiles; storage; sites and rotation; step-by-step technique; timing with meals; hypoglycaemia recognition and rule of 15; sick-day advice; sharps disposal; demonstration and return demonstration; leaflet.

Validity and reliability: content validity by seven experts (medical-surgical nursing faculty, a physician/diabetologist, a diabetes educator, a statistician); reliability by split-half for knowledge and inter-rater reliability for the checklist.

Ethics: ethics committee approval; hospital permission; written informed consent per ICMR National Ethical Guidelines (2017); demonstration done on a practice pad with saline, never on participants.

Data analysis: frequency, percentage, mean, SD; paired t-test for pre–post knowledge and practice; Pearson's correlation between post-test knowledge and practice; chi-square test for association; p < 0.05; SPSS.