The Role Of Family Support And Self-Efficacy On Self-Care Behavior In The Elderly With Type 2 Diabetes

Received: October, 5, 2020 Revised: December, 4, 2020 Available online: May 2021 Diabetic self-care is an effort to control type 2 diabetes. Family support and selfefficacy are need for the elderly with type 2 diabetes mellitus to increase independence in managing their disease. This study investigates the correlation between family support and self-efficacy with self-care behavior in the elderly with type 2 diabetes. This study was a correlational analysis using a cross-sectional approach. There were 100 respondents with simple random sampling. The independent variables were family support and self-efficacy, while the dependent variable was self-care behavior. The instrument to measure family support was the Hensarling Diabetes Family Support Scale (HDFSS), and to assess self-efficacy was the Diabetes Management Self Efficacy Scale (DMSES). Meanwhile, the instrument to evaluate self-care behavior was the Summary Diabetes Self Care Activities (SDSCA). The analysis utilized the Rank's Spearman test with a significant p <0.05. The results showed a correlation between family support and self-care with p=0.006 (p≤0.05) and an association between selfefficacy and self-care with p=0.001 (p≤0.05) in the elderly with type 2 diabetes. Family support and self-efficacy play an essential role in carrying out self-care behavior in the elderly with type 2 diabetes, so there is a need for family assistance and increased selfefficacy in carrying out self-care.


INTRODUCTION
Diabetes is a suboptimal insulin use in the body. This condition occurs due to increased blood glucose that exceeds the body's normal limits ( (Rahmawati, Nursasi & Widyatuti, 2018)). Self-care is the basis for controlling diabetes and preventing complications. Increasing self-care activities will have an impact on improving the individual's health status. But in reality, most people with diabetes have not consistently carried out proper self-care activities. The low self-care carried out by them will harm their health status.
Prolonged therapy and management for people with diabetes can cause boredom and even frustration. Therefore, it requires both internal and external motivation for patients to undergo all diabetes treatment therapy (Bistara & Ainiyah, 2017).
World Health Organization (WHO) predicts the prevalence of diabetes globally increases progressively every year to reach three times in 2030, which is 21.3 million. The International Diabetes Federation estimates it will touch 16.7. million in 2045(International Diabetes Federation, 2019. According to Basic Health Research (Riskedas), the prevalence of self-care in people with diabetes was very low in Indonesia, namely 1.8% in 2018. Irregularity of taking anti-diabetes drugs in them as much as 9% in 2018 https://doi.org/10. 33086/jhs.v14i2.1801 Erika Chandra Dewi -The Role Of Family Support And Self-Efficacy On Self-Care Behavior In The Elderly With Type 2 Diabetes because they feel already healthy (50.4%), no routine treatment (30.2%), traditional medicine use (25.3%), often forgetting (18.8%), and unable to buy medicine regularly (8,5%) (Kemenkes RI, 2018).
Based on the data obtained from the Elderly Integrated Health Service Post (from now on, it is named with posyandu lansia) Wadungasri Village, Waru District, Sidoarjo Regency, There was 132 elderly living with diabetes. They had poor self-care behavior because their willingness and support to carry out self-care was very low. There was no proper self-care in diabetic elderly at posyandu lansia Wadungasri Village.
Family support has a positive effect on compliance in implementing self-care. People with diabetes have cognitive impairments and often rely on their families to help with self-care. Their self-care requires lifestyle modification plus the family's role to strengthen self-confidence, which leads to changes in selfcare behavior (Mohebi et al, 2018; (Ravi, Kumar & Gopichandran, 2018). According to Firmansyah (2018), self-efficacy is the beliefs that exist in the patient. Changing or improving it will help enhance self-care independently. Self-care in people with diabetes improves their health status, and self-care includes dietary regulation, physical activity, periodic blood glucose monitoring, regular taking of medication, and doing foot care (Yao et al., 2019). Inadequate self-care will harm their lives and increase the risk of complications (Chaidir, Wahyuni & Furkhani, 2017).
There is a correlation between inadequate self-care and self-efficacy. Self-efficacy is a person's mindset to extensively regulate a human being's motivation and actions (Bandura, 1986). Self-efficacy can help know and see the strength of setting goals and holding fast in carrying out self-care behavior, which has become the goal (Amer et al., 2018)). Based on the above background, the authors want to prove whether there is a correlation between family support and self-efficacy with Self Care Behavior in the Elderly with Type 2 Diabetes Mellitus at the Posyandu Lansia in Wadungasri Village, Sidoarjo".

METHOD
The research design used qualitative analysis with a cross-sectional approach. This study population was 132 elderlies with type 2 diabetes at posyandu lansia Wadungasri Village. The number of samples in the study was 100 respondents with a simple random sampling. Inclusion criteria were elderly with type 2 diabetes, willing to be respondents, able to read and write and communicate well. The exclusion criteria were individuals with type 2 diabetes who experienced complications. The instrument utilized three standard questionnaires. To evaluate family support used the Hensarling Diabetes Family Support Scale (HDFSS) from (Hensarling, 2009), to assess self-efficacy utilized the Diabetes Management Self Efficacy

RESULT
Research obtained respondent's characteristics, family support, Self Efficacy, and Self Care. Respondents Characteristics based on demographic data include:     (2020), which stated no separation between adherence and self-care behavior in people with diabetes with family support's significant role. The more incredible and optimal family support, the more patient compliance in implementing self-care as recommended.
The family is the predisposing factor for diabetic people in their support (Rahmawati, Nursasi & Widyatuti, 2018;(Bistara, et al 2020). It is the closest person to the environment and is easy to reach, especially in Indonesia, where the diabetic people lives with his family. The family has a massive role in providing direction for life to be healthy for family members, especially those who live with diabetes. The family is the most appropriate person to be their caregiver. The environment that exists in the family can https://doi.org/10.33086/jhs.v14i2.1801 Erika Chandra Dewi -The Role Of Family Support And Self-Efficacy On Self-Care Behavior In The Elderly With Type 2 Diabetes have a positive influence. This study showed that family support correlated with self-care behavior. It is in line with a study by Prasetyani et al. (2018) which stated that family support is significantly associated with self-care abilities in diabetic people.

Self-efficacy
Most elderly with type 2 diabetes had adequate self-efficacy. Self-efficacy is very important for diabetic people. When the self-efficacy is low, doing self-care will be hampered. On the contrary, when selfefficacy is good, self-care behavior will be more obedient. This opinion is in line with the research of Handayani, Putra & Laksmi (2019) which reported that the higher the self-efficacy, the higher the compliance level in carrying out self-management of diabetic people. As a result, hopes or desires to improve health status or recover were more significant.
According to Handayani, Putra & Laksmi (2019), self-efficacy was the essential element to increase compliance in diabetic individuals in terms of self-management or self-care. The formation of a person's self-efficacy is obtained from experienced others by fostering self-confidence to affect the behavior to carry out well-planned tasks and goals, such as self-care compliance.

Self-care Behavior
This study showed that most respondents had inadequate self-care. Wrong perceptions can influence selfcare implementation. Besides, the lack of self-care is because of a lack of confidence, so that there is 4. The correlation between family support and self-care behavior in the elderly with type 2 diabetes Hanifah (2019) stated that the better family support, the better self-care. This opinion is in line with Ravi, Kumar & Gopichandran (2018) They reported that diabetic people with sufficient support from their families could influence the success rate in dealing with and overcoming their problems better than those who were not. This study also found an association between family support and self-care in the elderly with type 2 diabetes mellitus. They had good family support to elevate their self-confidence and hope in self-care behavior. 5. The correlation between self-efficacy and self-care behavior in the elderly with type 2 diabetes mellitus According to research by Setyorini (2018), good self-efficacy indicated readiness to change behavior and willingness to perform behavior self-care, thereby reducing the fear of failure. This study found a https://doi.org/10.33086/jhs.v14i2.1801 Erika Chandra Dewi -The Role Of Family Support And Self-Efficacy On Self-Care Behavior In The Elderly With Type 2 Diabetes correlation between self-efficacy and self-care behavior in the elderly with type 2 diabetes. The presence of good self-efficacy can increase adherence. It maintains the required behavior in self-care.
Self-care behavior in the elderly with diabetes controls blood sugar by eating control, physical activity or exercise, monitoring blood sugar levels within normal limits, taking the medication regularly, and foot care (Prasetyani et al. 2018). There will be good self-care behavior when there are family support and self-efficacy. In diabetic management, the family must understand the importance of dietary regulation, elderly physical activity, regulating blood sugar levels, and foot care (Ainiyah & Martining, 2021;Ravi et al., 2018). Family support can influence self-care behavior, but self-efficacy also has a significant role in building it. Self-efficacy plays a role in self-belief in carrying out self-care. Diabetic elderly must appropriately implement self-efficacy because it only can be carried out by themselves, so they need to instill confidence (self-confidence) in carrying out these self-care behaviors (Amer et al., 2018).

CONCLUSION
This study indicates that family support and self-efficacy correlates with self-care behavior in the elderly with type 2 diabetes. Family support to the elderly with type 2 diabetes will help maintain health. Besides, self-efficacy also has a significant role in older people's self-care behavior with type 2 diabetes. Good selfefficacy can increase adherence and maintain their health status.