INTRODUCTION:

Diabetes mellitus is a metabolic disease characterized by increased level of glucose in the blood resulting from defect in insulin secretion. According to international diabetes federation data, 67 lakhs death occur due to diabetes mellitus in 2021, and it is estimated that 53.7 crore (1 in 10) people were living with this disease in same year. There is an indication that the count rise to 64.3 crore in 2030 and 78.3 crore by 2045¹.

According to World Health Organization 2% of all deaths in India are due to diabetes. Incidentally Kerala is known as the diabetic capital of India with a prevalence of diabetes as high as 20%, more than double the national average of 8%^.There are 3 main types of diabetes mellitus, type 1, type 2, and gestational diabetes. In diabetes mellitus type 1 is the chronic condition in which the pancreas does not make insulin, because the body’s immune system attacks the islet cells in the pancreas that make insulin. In diabetes mellitus type 2 is also a chronic condition that makes less insulin than used to and of the body becomes resist to insulin²_.

Insulin therapy – Clients with type 1 diabetes Mellitus do not produce enough insulin to sustain life. Insulin is made chemically by recombinant DNA technology with different duration of action (rapid -, short -, intermediate - and long-acting). Insulin dosage varies greatly because of the effect of the various type of insulin. In some clients with type 2 diabetes mellitus combination therapy is also useful³.

STATEMENT OF THE PROBLEM:

A study to assess the effect of video-assisted teaching on practice of self administration of insulin among patients undergoing insulin therapy with diabetes mellitus in SH Medical Centre Hospital, Kottayam.

OBJECTIVES:

1. To assess the practice of self administration of insulin in diabetic patients.

2. To determine the effect of video- assisted teaching on practice of self administration of insulin among diabetic patients.

3. To find out the association between the practice of self administration of insulin and selected socio-personal variables.

OPERATIONAL DEFINITIONS:

1. Effectiveness:

It is the significant gain in practice of self administration of insulin as determined by significant difference in pre test and post test practice after video assisted teaching on insulin therapy.

2. Practice of self administration of Insulin:

It refers to the proper steps of self administration of insulin which is assessed with the help of a structured observational checklist.

3. Patients with Diabetes Mellitus:

It refers to the patients diagnosed with diabetes mellitus.

4. Video Assisted Teaching Practice:

Video-assisted teaching practice is a strategical teaching program using video to improve practice of self administration of insulin.

5. Sociopersonal Variables:

In this study it refers to age, gender, educational status, duration of diabetes mellitus, duration of insulin therapy.

Assumption:

People have some awareness about practice of self administration of insulin.

HYPOTHESIS:

H₁: There is a significant difference in the practice of self administration of insulin among diabetic patients after undergoing video assisted teaching on insulin administration.

H₂: There will be a significant association between the practice of self administration of insulin among diabetic patients undergoing insulin therapy and selected socio-personal variables.

METHADOLOGY:

Research Design:

The research design used was one group pre-test – post-test research design.

Setting of the Study:

This study was conducted in patients with diabetes mellitus undergoing insulin therapy admitted in medical ward of SH Medical Centre, Kottayam. SH Medical Centre is a 300 bedded hospital.

Population:

The patients with diabetes mellitus undergoing insulin therapy who were admitted in the medical ward of SH Medical Centre, Kottayam.

Sample:

Sample is a representative unit of the targeted population. The study sample was 50 patients with with diabetes mellitus undergoing insulin therapy admitted in the medical ward of S H Medical Centre, Kottayam.

Sampling Techinique:

Sampling is a process of selecting a portion of designated population to represent the entire population. Sampling technique used for this study is non – probability purposive sampling.

Criteria for Sample Selection:

Inclusion Criteria:

The study included patients diagnosed with diabetes mellitus undergoing insulin therapy who are willing for the study and present at the time of study.

Exclusion Criteria:

It included patients who are taking pen insulin. The two tools used in the study was prepared by the investigators after a detailed review of the literature and based on the suggestion from six experts in the field. Necessary corrections were made on the basis of expert’s opinion.

Tool 1: Consisted of interview schedule to assess the socio- personal data of the clients

Tool 2: Consisted of Checklist to assess the practice of self administration of insulin.

METHOD OF DATA COLLECTION:

Development of the Tools:

The two tools used in the study was prepared by the investigators after a detailed review of the literature and based on the suggestion from six experts in the field. Necessary corrections were made on the basis of expert’s opinion.

Tool 1: Consisted of structured interview schedule to assess the socio – personal data of the clients.

Tool 2: Consisted of checklist to assess the practice of self administration of insulin.

Description of the Tool:

Tool 1: Socio - personal data

The questionnaire was prepared to assess the socio – personal data of the patients with diabetes mellitus in SH Medical Centre, Kottayam. The socio – personal data comprised of age, gender, education, duration of diabetes mellitus, duration of insulin therapy.

Tool 2: Checklist to assess the practice of self administration of insulin. The checklist consisted of 14 steps of self administration of insulin. The maximum score was 14 with a range of 0 –14.

The practice was categorized as given below:

Good Practice: 10 - 14

Average Practice: 5 - 9

Poor Practice: 0 - 4

Video-Assisted Teaching Programme:

Video – assisted teaching programme is a strategic teaching approach using video to improve the knowledge. In the study a video demonstrating self administration of insulin with appropriate explanation is shown to the patient.

Data Collection Process:

The research study was started after getting formal permission from the Director of SH Medical Centre, Kottayam. The data were collected from 26^th july 2023 to 30^th July 2023 from patients with diabetes mellitus undergoing insulin therapy admitted in the medical department of SH medical centre, Kottayam the data were collected after taking informed consent from the patients. Pre-test was done on the first day along with video-assisted teaching. Post-test of self administration of insulin was done on the next day.

Plan for Data Analysis:

The data collected from 50 subjects were organized, tabulated and analyzed by using descriptive and inferential statistics.

· Socio: personal data were analyzed using frequency distribution and percentage.

· Effect of video: assisted teaching programme regarding practice of self administration of insulin was analyzed using paired t - test.

· Association between the practice of self administration of insulin with selected socio: personal variables were analyzed using chi-square test.

Analysis of Socio-Personal Variables:

Section 1:

This section deals with socio- personal data of samples such as age, gender, education, duration of diabetes mellitus, duration of insulin therapy.

Table no. 1- Distribution of samples based on socio-personal variables

Socio-personal variable	Frequency	Percentage
1 Age
A) 30 – 40	1	2%
B) 40 – 60	10	20%
C) Above 60	39	78%
2.Gender
Male	22	44%
Female	28	56%
3. Education
School level	33	66%
Degree	12	24%
Post graduate	5	10%
4. Duration of diabetes mellitus
Below 10 years	10	20%
Above 10 years	20	40%
More than 20 years	20	40%
5. Duration of insulin therapy
Below 1 year	2	4%
Above 1 year	19	38%
Above 5 year	29	58%

The data in table 1 indicates that 78% of samples were above 60 years of age. Majority of the samples were females (56%) and 44% of samples were males. The data in table indicates that the majority of samples (66%) were having school level education, 24% of samples were having degree and 10% of them were post graduates. It also shows 20% was having diabetes below 10 years, 40% having diabetes above 10 years and 40% having diabetes more than 20 years. The data represented in the table that 4% of samples were taking insulin below 1 year, 38% of samples were taking insulin above 1 year and 58% of them were taking insulin above 5 year.

Section 2: Effect of video- assisted teaching on practice of self administration of insulin among diabetic patients.

This section deals with the significant difference between pre-test and post-test practice of self administration of insulin after the video -assisted teaching. The null hypothesis was stated as follows:

H₀₁: There is no significant effect of video- assisted teaching on practice of self administration of insulin among diabetic patients.

In order to find out the significant difference in pre-test and post-test practice of self administration of insulin after video-assisted teaching, paired 't' test was performed.

Table 2: Frequency distribution and percentage of patients having diabetes mellitus undergoing insulin therapy with respect to pre-test practice score. (n=50)

Practice score	Frequency	Percentage
Pre- Test
Poor (0-4)	9	18%
Average (5-9)	36	72%
Good (10-14)	5	10%
Post- Test
Good	33	66%
Average	17	34%

The table 2 indicates that in pre- test 10% of samples showed good practice, 18% of them showed poor practice and 72% of them showed average in practice of self administration of insulin and also shows that in post- test, 34% of samples showed average performance and 66% of them showed good practice.

Table 3: Mean, standard deviation and t-value of pre-test and post-test practice score of pursed-lip breathing exercise (n=50)

Variable	Mean score	Mean difference	Standard deviation	df	t value
Pre-test practice	6.76
		3.08		49	20.10***
Post test	9.84		1.30

*** Significant at 0.001 level

The above table 3 shows that the obtained ‘t’ value is 20.10 significant at 0.001 level. Hence the null hypotheses was rejected. It can be concluded that there is a significant difference between pre-test and post test practice of self administration of insulin among diabetic patients undergoing insulin therapy.

Section 3: Association of practice of self administration of insulin with selected socio-personal variables:

Chi- square was used to obtain the association between pre-test practice of self administration of insulin with selected socio- personal variables like age, gender, education, duration of diabetes mellitus and duration of insulin therapy.

Table 4: Chi-square value showing the association of pretest practice of self administration of insulin with different variables. (n=50)

Level of practice
Variables	Poor	Average	Good	df	ᵡ²
	f	f	f
Age in year
30 - 40	1	0	0
40 - 60	1	8	2	4	11.59^*
Above 60	8	27	3
Gender
Male	3	18	1	2	1.3
Female	6	19	3
Education
School level	7	24	2
Degree	1	9	2	4	4.10
Post Graduate	2	2	1
Duration of Diabetes mellitus
Below 10years	2	7	1
Above 10years	2	14	3	4	21.51*
More than 20years	5	15	11
Duration of Insulin therapy
Below 1 year	0	2	0
Above 1 year	3	12	4	4	4.15
Above 5 year	6	22	1

*Significant at 0.05 level

The results from Table 4 indicate that there is a significant association between the pre-test practice of self-administration of insulin and age (χ² = 11.59, p and lt; 0.05), leading to the rejection of the null hypothesis. However, no significant association was found with gender (χ² = 1.3, p and gt; 0.05) and education (χ² = 4.10, p > 0.05), so the null hypothesis was accepted in both cases. A significant association was observed with the duration of diabetes mellitus (χ² = 21.51, p and lt; 0.05), resulting in the rejection of the null hypothesis. According to Table 4, there was no significant association between the pre-test practice of self-administration of insulin and the duration of insulin therapy (χ² = 4.15, p and gt; 0.05), and hence, the null hypothesis was accepted.

DISCUSSION:

In the present study, the socio-personal variables of patients with diabetes mellitus 44% were males and 56% were females. Majority (76%) were above 60 years of age and 22% were between the age group of 40-60 years. The socio-personal variables of the present study is comparable to the study conducted in Bedele Hospital South West Ethiopia among diabetic patients undergoing insulin therapy. The study revealed that the majority (28.5%) belongs to the age of 40-60 years, 13.8% of people were above the age of 60 years and 38.8% belongs to age group 30 – 40 years⁴.

In the present study, the pre-test practice score revealed that (10%) had good practice, 18% showed poor practice and only 72% of them showed average practice in self administration of insulin. It is congruent with the study conducted at Dhiraj General hospital, Waghodia, Vadodara (2020). The study revealed that, in pre-test 40.2% of them had shown poor practice and 55.8% shows good practice⁵.

Present study also depicts that there is a significant difference (t=20.10, p<0.001) between the pre-test and post-test score of practice of self administration of insulin. The findings of the present study is congruent to another similar study conducted at Universitas Airlanga Teaching Hospital (2020) among diabetic patients undergoing insulin therapy. The study revealed that there is a significant difference (p<0.05) self administration of insulin⁶.

CONCLUSION:

The following conclusions were drawn on the basis of findings of the study out of 50 patients with diabetes mellitus undergoing insulin therapy. 1/2th patients (100 %) practiced self administration of insulin. Video- assisted teaching programme on practice of self administration of insulin was found to be effective (t = 20.10, p<0.001) on the practice of self administration of patients undergoing insulin therapy. Age, duration of diabetes mellitus were found to have a positive association with self administration of insulin.

NURSING IMPLICATIONS:

Nurses were in a large variety of specialties. They worked independently as a part of a team to asses, plan, implement and evaluate care. Nursing science is a field of knowledge based on contribution of nurse scientist through peer reviewed scholarly journals and evidence – based practice. The findings of the present study generate some implications in nursing practice, nursing education, nursing administration and nursing research.

Nursing Practice:

· Proper self administration of insulin is important to prevent complications like lipodystrophy, hypoglycemia, hyperglycemia, diabetic ketoacidosis.

· As a key personnel nurses should asses the practice of self administration of insulin among diabetic patients undergoing insulin therapy.

· Nurses should incorporate video assisted teaching in their practice to improve practice of self administration of insulin among diabetic patients undergoing insulin therapy with highly trained health care team in place, we can ensure that diabetes mellitus can be better treated at the hospitals and in the community.

Nursing Education:

Nursing education programme should be implemented on the topic ‘Effect of video assisted teaching on practice of self administration of insulin among diabetic patients.’ to impart knowledge to the public. The findings obtained from the study can be utilized by the students to educate the public. The findings of the study can also be used by the nurse educator to help nursing students to organize health teaching programmes regarding self administration of insulin.

Nursing Administration:

The nurse administrator should have an insight into the emerging problems of improper self administration of insulin and should update their knowledge about it. The administration can organize and conduct in service education in order to improve practice of self administration of insulin. Teaching programmes can be conducted through various medias like television, social media and health magazines.

Nursing Research:

The findings of the present study can be used as a reference for future studies related to effect of video assisted teaching on practice of self administration of insulin among diabetic patients. This research can also be used as a guide in researches of insulin therapy.

RECOMMENDATIONS FOR FUTURE RESEARCH:

a) A similar study can be replicated on a larger representative sample, so that the findings can be generalized.

b) Studies can be conducted for longer duration to assess the effect of self administration of insulin among diabetic patients undergoing insulin therapy, so that the findings can be more accurate.

c) Studies can be conducted to compare the practice of self administration of insulin and the reduction of complications associated with improper insulin administration.

d) An experimental study can be conducted on effect of video assisted teaching on practice of self administration of insulin among diabetic patients.

REFERENCE:

1. Available from https://idf.org/about-diabetes/what-is-diabetes/

2. Hinkle, Janice L and Cheever, Kerry H (2015) Brunner and Suddarth’s Textbook of medical surgical nursing.,13^th edition. Vol II. Published by Wolters Kluwer, Page No. 1417 -1420

3. Joyce M Black, Jane Hokanson Hawks (2015) Textbook of medical surgical nursing: Clinical management for positive outcomes, 8^th edition, Vol I. Published by Elsevier, Page No. 1072-1076.

4. Fego, Melese Workneh, Yasin, Jihad Tahir and Aga, Gezahegan Mamo (2021). Knowledge, Attitude and Practice Towards Insulin-Self Administration Among Diabetic Patients Attending Bedele Hospital, Southwest Ethiopia, 2019/2020. Available from https://pubmed.ncbi.nlm.nih.gov/33953589/

5. Sheena. V S et.al. A stud to assess the effectiveness of video assisted teaching programme on knowledge regarding self – insulin administration among patients with diabetes mellitus at selected hospital in Kelambakkam. 2022

6. Available from https://www.ijrar.org/papers/IJRAR22C2938.pdf.

7. Devi, Sarungbam Sarju and Kanika, Vinay Kumari, Effectiveness of Structured Teaching Programme on Self-administration of Insulin in terms of Knowledge and Skill of patients with Diabetes Mellitus. International Journal of Applied Research. 2015; 1(9): 919-921. Available from https://dx.doi.org/10.13140/RG.2.2.27242.36802

Received on 16.04.2025 Revised on 02.06.2025

Accepted on 14.07.2025 Published on 18.08.2025

Available online from August 30, 2025

A and V Pub Int. J. of Nursing and Med. Res. 2025;4(3):126-130.

DOI: 10.52711/ijnmr.2025.24

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