Interventions

The EPSOC-2DM was developed by integrating the qualitative analysis results of previous studies’ interventions that were aimed at enhancing SOC,¹⁵⁾ with those of nursing support recognized as enhancing SOC.¹⁶⁾ The EPSOC-2DM comprised four, 30-minute group sessions and was delivered by nurses who had at least three years of experience with diabetes patients. The specific types of support were as follows: The educational goal of the first session included: (1) promoting mutual understanding among participants, (2) sharing feelings during care, and (3) understanding the meaning of enhancing SOC. The educational content of the first session covered: (1) feeling burdened by the disease and treatment, (2) how patients have managed their diabetes, to date, (3) what patients learned after diabetes diagnoses, and (4) SOC. The educational method was aimed at facilitating: (1) communication, (2) discussing, and (3) listening to the explanation. The educational goal of the second session was for patients to reflect on their lives until the point when they became sick. The educational content of the second session covered such reflections, treatments, and actions. The educational method entailed: (1) patients’ communication of their reflections on life up to now and (2) sharing their feelings and opinions after listening to someone talking. The educational goal of the third session was to identify problems in life and points for improvement. The educational content of the third session was for participants to become aware of the problems that they recognized while looking back on their lives, how to manage their disease, and find the solutions. The educational method included communicating what they found while looking back at their lives to date, and conveying their feelings and opinions after listening to other participants. The educational goal of the fourth session was to discover solutions to potential problems. The educational content of this session covered potential problems and concerns. The educational method entailed getting participants to: (1) communicate their ideas and (2) discuss what might happen.

Textbooks were used for each session. In the first session, materials were used to facilitate an understanding of SOC and its subdomains, namely, comprehensibility, manageability, and meaningfulness, and the scales relating to these concepts in detail. In the second and third sessions, once the process of becoming sick had been reflected upon from a viewpoint of SOC, the participants were expected to find the meaning of current treatments and recovery activities. We created materials called “life reflection sheets” for that purpose. This was intended for patients to recall the past/present “facts” and determine prospects for the future by filling in the blanks and checking off boxes regarding transformations in their lives, from the past to the present, as well as future prospects, based on this life change. Patients could prepare for each session, since they could recall the past and present life facts by filling in the sheets.