Received: 16 November 2017
Revised: 15 January 2019
Accepted: 30 March 2019
DOI: 10.1111/ijn.12737
ORIGINAL RESEARCH PAPER
Effects of message‐framed informational videos on diabetes
management knowledge and self‐efficacy
Emmanuel Dayao Paragas Jr., DNS, RN, Assistant Professor1,2
|
Teresita I. Barcelo PhD, RN, Professor1
1
The Graduate School, University of Santo
Tomas, Sampaloc, Manila, Philippines
2
Abstract
Department of Nursing, West Liberty
University, West Liberty, West Virginia, USA
Aim:
Correspondence
Emmanuel Dayao Paragas, Jr., The Graduate
School, University of Santo Tomas, España
Blvd., Sampaloc, Manila, Philippines 1008; or
Department of Nursing, West Liberty
University, 208 University Drive, West Liberty,
WV 26074.
Email: emmanparagasjr@yahoo.com
the effects of message‐framed informational videos on diabetes management
Nurses play an essential role in improving health‐related knowledge and
self‐efficacy of patients through health education. This study aimed to investigate
knowledge and self‐efficacy in patients with type 2 diabetes.
Methods:
A quasi‐experimental pretest and posttest design with two experimental and
one standard care comparison groups was carried out to examine the effects of the
message‐framed videos. The two message‐framed informational videos were developed
to provide health teachings about diabetes self‐care. The knowledge and self‐efficacy
of the two video groups and lecture comparison group were measured before and after
the intervention using valid and reliable instruments established by the authors.
Results:
After the intervention, the knowledge and self‐efficacy of the two
experimental groups were significantly higher than the comparison group. No significant
difference was found in the knowledge scores between the two experimental groups,
but a significant difference was noted in the average increase in their self‐efficacy.
Conclusion:
Message‐framed informational videos can be effective in increasing
the diabetes management knowledge and self‐efficacy, and a gain‐framed rather than
loss‐framed approach can be superior in increasing self‐efficacy.
K E Y W OR D S
diabetes mellitus, type 2, health education, message framing, nursing, self‐efficacy
S U M M A R Y ST A T E M E N T
problems like type 2 diabetes. Limited work has reported the magnitude of the effect of message‐framed videos on self‐efficacy.
What is already known about this topic?
What this paper adds?
• The use of an informational video in providing health education to
• Gain‐ and loss‐framed informational videos, created to provide
patients improves retention of information.
health teachings about diabetes self‐care management, significantly
• Message framing may be used to provide health‐related informa-
increased the diabetes management knowledge of older adults with
tion effectively regarding gains and losses of behavioural changes
among patients. The majority of the literature has focused on the
type 2 diabetes.
• Both message‐framed informational videos achieved a modest
moderating effects of self‐efficacy on message framing.
• There is a dearth in message framing research in the nursing literature particularly in a patient setting with high risk for actual health
Int J Nurs Pract. 2019;e12737.
https://doi.org/10.1111/ijn.12737
wileyonlinelibrary.com/journal/ijn
increase in diabetes management self‐efficacy of older adults with
type 2 diabetes, but the gain‐framed messages were more effective
than the loss‐framed ones.
© 2019 John Wiley & Sons Australia, Ltd
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PARAGAS JR AND BARCELO
The implications of this paper:
of their capabilities to organize and execute courses of action required
• Nurses can use message‐framed informational videos to increase
to attain designated types of performances” (Bean, Cundy, & Petrie,
the diabetes management knowledge and self‐efficacy in patients
2007). Earlier research findings have identified an association between
with type 2 diabetes during health teaching.
self‐efficacy and diabetes self‐management (Sarkar et al., 2006).
Regarded as a condition‐specific characteristic, self‐efficacy is influenced or improved by four diverse mechanisms, which Bandura
1
|
I N T RO D U CT I O N
(1986) identified as mastery experience, modelling, social persuasion,
and judgement of bodily states.
The world's population is experiencing a rapid rise in chronic health
Message framing is an effective message tailoring approach that
problems, which is imposing an enormous burden on the health‐care
can provide equivalent outcome information regarding either gains or
services and economics of many nations (Tunstall‐Pedoe, 2006). In
losses (Rothman, Bartels, Wlaschin, & Salovey, 2006). Gain‐framed
2008, the rates of diabetes mellitus surged with an estimate of 347
messages typically emphasize the benefits achieved by adopting a
million worldwide (Danaei et al., 2011). In the Philippines, a 9‐year
targeted behaviour, whereas loss‐framed messages emphasize the
incidence rate of 16.3% and a prevalence rate of 28% were reported
consequences of not adapting to such strategies (Salovey, 2005). Most
for type 2 diabetes mellitus between 1998 and 2007 (Soria et al.,
health‐related information can be framed effectively regarding gains
2009). The burdens brought about by chronic diseases, especially
and losses to educate patients about their health. For instance, one
diabetes mellitus, have led the World Health Organization to demand
study designated diabetes patients to view either a gain‐ or a loss‐
the evolution of health‐care teams from using a provider‐centred
framed video about proper foot care. The study revealed that
approach to a patient‐centred approach (Pruitt, Canny, & Epping‐
gain‐framed messages provided sustainable, long‐term, positive behav-
Jordan, 2005).
ioural changes (Grady et al., 2011). A review of literature over the past
Nurses play a pivotal role in improving health‐related behaviors of
20 years has demonstrated a large amount of health‐related message‐
patients through health education. This was shown in a study where
framing research (Myers, 2010). However, few were found in the
nurses were very effective as health‐information providers and were
nursing literature, particularly in relation to patients at high risk for
more highly preferred by patients because they were more approach-
actual health problems, such as diabetes and cardiovascular diseases.
able than doctors (Koutsopoulou, Papathanassoglou, Katapodi, &
Nurses are well positioned in a range of clinical settings and have
Patiraki, 2010). Despite this, nurses often report difficulty in providing
significant opportunities to initiate the use of message‐framed videos
health information to their patients, with time being considered a
in providing health information. This study therefore primarily aimed
critical obstacle in providing patient education (Cook et al., 2006).
to examine the effects of message framing through the use of an
The vast need for patient education, along with the scarcity of
informational video when delivering self‐care education to older
health educators, has led to innovations in delivering health‐related
adults with type 2 diabetes for the purpose of increasing their
information to patients (Grady, Entin, Entin, & Brunyé, 2011). A sys-
diabetes‐management knowledge and self‐efficacy. This research can
tematic review found that information technology can be a powerful
help introduce an innovative technique for nurses in delivering
tool to improve the process of care for patients with type 2 diabetes,
health‐related information to their patients.
showing significant improvements in health‐care utilization; specifically, the inclusion of an informational video in providing education
can improve retention of information (Jackson, Bolen, Brancati,
2
METHODS
|
Batts‐Turner, & Gary, 2006; Kinnane, Stuart, Thompson, Evans, &
Schneider‐Kolsky, 2008). The effects of informational videos in
2.1
|
Study design
increasing knowledge can be explained by the cognitive theory of multimedia learning, which posits that people learn more effectively from
This was a quasi‐experimental pretest and posttest study with two
narration and animation than from text and animation. It emphasizes
intervention treatments and a standard care comparison group. Spe-
three factors: there are dual channels, ie, two separate channels for
cifically, the study used two experimental interventions, gain‐ and
processing visual and auditory information; humans have limited
the loss‐framed videos that contained the same health teaching about
capacities to process material in each channel at one time; and humans
diabetes self‐care but differed on the framed outcomes of adherence
possess active processing, which includes attending to relevant mate-
or nonadherence to diabetes self‐care. Further, this design was
rials and then organizing this relevant material into clear mental repre-
strengthened by adding lecture as the standard care comparison group
sentations to integrate them with other knowledge (Mayer, 2002).
to establish which approach was the most effective.
However, the promotion of self‐efficacy among patients through
education remains a research imperative. Diabetes self‐management
2.2
|
Setting and participants
incorporates behavioral, personal, and environmental factors into the
daily performance of recommended activities; therefore, the concept
The study was carried out in two diabetes centres in the city of
of self‐efficacy is vital for improving self‐management (Sarkar, Fisher,
Manila, Philippines, among 165 patients with type 2 diabetes. The
& Schillinger, 2006). Self‐efficacy is defined as “people's judgments
sample size was based on an a priori power analysis (medium effect
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PARAGAS JR AND BARCELO
size = 0.5; significance level = .05; and statistical power = 0.80) calculated using G Power Software.
The participants watched their assigned videos from a screen projector, facilitated by the nurses and the researcher for about
Purposive sampling was utilized in the selection of participants
30 minutes before their scheduled check‐ups. One group watched
with the following inclusion criteria: (a) Filipino; (b) at least 18 years
the gain‐framed version, and the other group viewed the loss‐framed
of age; (c) currently residing in the city of Manila; (d) clinically
version on separate days for a single time. The effects of the videos
diagnosed with type 2 diabetes mellitus; (e) able to speak, write, read,
were assessed immediately after the participants watched them, using
and understand Filipino and/or English; (f) oriented to time, place, and
valid and reliable instruments.
person at the time of data gathering; and (g) no psychological disorders, cognitive disorders, or physical limitations in diabetes self‐care.
2.4
Instruments
|
The participants were not randomized to reduce contamination
since one diabetes centre has two departments that conduct specialty
The participants were required to provide their socio‐demographic
clinics for diabetes independently. The participants on two consecu-
and clinical background such as age, gender, educational attainment,
tive Tuesdays were assigned to the comparison group (N = 55),
duration of being diagnosed with type 2 diabetes mellitus, and
while the patients on two successive Thursdays were assigned to the
involvement in any intensive formal education about diabetes self‐
loss‐framed video group (N = 55). In the other diabetes center, the
care. Two questionnaires were established for this study:
participants were assigned to the gain‐framed video group (N = 55).
2.4.1 | A Test of Knowledge About Diabetes
Self‐Care Questionnaire
2.3
|
Interventions
This researcher‐created tool to measure diabetes knowledge is a 24‐
The message‐framed diabetes management informational videos
item, multiple‐choice questionnaire written in English, based on the
were delivered as (a) gain‐framed for one experimental group and (b)
information delivered in the interventions. Although there are numer-
loss‐framed for the other experimental group. These groups were
ous validated knowledge scales about type 2 diabetes, the authors
compared with the lecture‐type group who received the standard
produced this questionnaire to ensure that the questions were
approach of providing health teachings about diabetes self‐care, which
specific to the intervention content. Six categories were identified,
did not contain message framing.
including the definition of diabetes; blood‐glucose monitoring; proper
The interventions were designed and content validated by an
diet; proper exercise; oral hypoglycemic agents; and treatment,
endocrinologist, a diabetes nurse educator, and a clinical professor of
detection, and prevention of acute complications (hypoglycemia and
nursing. The content was prepared from the website of the American
hyperglycemia). Each question offered four response options, and
Diabetes Association (ADA), which includes the definition of diabetes
participants were asked to select their best answer. Each correct
and health teachings about blood glucose monitoring; proper diet and
answer was given one point. An item with no response or with mul-
exercise; oral hypoglycemic agents; and recognition, treatment, and
tiple answers was considered as incorrect, with no points awarded.
prevention of hypoglycemia and hyperglycemia. The Filipino language
The maximum score was 24 points. A Filipino version was also
was used as the medium of instruction, and the scripts were validated
developed, validated by a language expert, and pilot tested among
by a language expert for its linguistic, conceptual matter, and cultural
38 patients with type 2 diabetes, who were excluded from the actual
acceptance. The videos were pilot tested among 38 patients with type
study sample.
2 diabetes, and no changes were necessary, based on the participants'
comments and review.
The two message‐framed videos included the same information
that was delivered by a nurse while the patient was performing the
Face validity was supported by an endocrinologist, a medical‐
surgical nursing professor, and a diabetes nurse educator. The instrument obtained an item reliability of 0.87 and an item separation of
2.56 from Rasch analysis, which established its reliability.
actual self‐care. The information was given using animation, narration,
and text. The only main difference was the framing of the outcomes of
maintaining or not maintaining normal blood glucose, which was pre-
2.4.2
Scale
|
Filipino Diabetes Management Self‐Efficacy
sented in the last scenes of the videos. Specifically, the gain‐framed
video contained the 10 positive outcomes of adherence to diabetes
The researcher adapted the Diabetes Management Self‐Efficacy Scale
self‐care, while the loss‐framed video comprised the 10 negative out-
(Sturt, Hearnshaw, & Wakelin, 2010) to determine the participants'
comes of nonadherence. For instance, one statement in the gain‐
diabetes management self‐efficacy after permission was secured from
framed version was “If you maintain good control of your blood
the original authors. A forward and backward translation from English
glucose, the acid in your blood will be normal, and being comatose will
and Filipino was conducted by two independent language experts
be prevented,” with a scene showing a healthy person. Its counterpart
based on the methods used by Wu et al. (2008). The developed
in the loss‐framed version was “If you do not maintain good control of
Filipino version was validated by an endocrinologist, a diabetes nurse
your blood glucose, the acid in your blood will be elevated that could
educator, and a psychiatric nursing professor. The accuracy, clarity,
lead to being comatose,” with a scene showing a comatose patient.
and cultural relevance of the translation were also assessed. The
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PARAGAS JR AND BARCELO
panel‐modified 15‐item version was pilot tested among 38 patients
their assigned intervention, and completed the posttest assessments
with type 2 diabetes. Subsequently, the internal consistency acquired
for knowledge and self‐efficacy immediately after the intervention.
a Cronbach's alpha coefficient of 0.94.
This study used a nine‐point 0 to 8 scale with reference to
Bandura's recommendation on the self‐efficacy scale construction
with respect to the view of the users (Bandura, 1997). The point terms
2.6
|
Ethical considerations
were as follows: 0 to 2, Cannot do at all; 3 to 5, Maybe yes, maybe no;
and 6 to 8 Certain can do. The maximum score was 120 points, and
The study protocol was approved by the Institutional Review Boards
higher scores indicate greater levels of self‐efficacy (Sturt et al.,
of Ospital ng Maynila Medical Center and Manila Health Department
2010). A centre anchor point (ie, maybe yes, maybe no) was used to
in the Philippines and was conducted in accordance with the Helsinki
evaluate the sureness of the respondents based on their perceived
Declaration of 1995. Written informed consent was secured from the
confidence for a particular behaviour (Bandura, 1997).
participants with an assurance of confidentiality.
2.5
2.7
|
Data collection
|
Data analyses
A health centre was chosen in the city of Manila, Philippines to serve
Descriptive statistics were used to group participants regarding age,
as the clinical site for pilot testing among 38 patients with type 2 dia-
sex, highest educational attainment, and previous intensive education
betes. The study data collection was conducted in two separate
on diabetes self‐care. Analysis of variance (ANOVA) and X2 test were
selected diabetes centres from October to December 2012 with data
utilized to compare socio‐demographic and clinical characteristics
analysis and writing undertaken in 2013. Nevertheless, the findings in
between groups. ANOVA was used to identify any significant
this study remain relevant to nursing practice most especially for dia-
differences in the knowledge and self‐efficacy scores in the two
betes nurse educators.
message‐framed video groups and the lecture‐type comparison group.
The data collection process (Figure 1) was conducted in rooms
Tukey's test was used for post hoc analysis. The standardized mean
with similar setups, facilities, and environments. The two videos for
differences with 95% confidence intervals were calculated to analyse
the experimental groups were watched by the patients from the pro-
knowledge and self‐efficacy scores between preassessment and
jector, whereas the PowerPoint lecture in the comparison group was
postassessment measures in each group. The level of significance
projected onto a white screen. The participants were unaware
was set at P < .05. All data were analysed using IBM SPSS Statistics
whether they belonged to an experimental or control group to lessen
(IBM Corp., Armonk, NY) version 21.0 and Review Manager (RevMan;
the possibility of bias. Overall, the three groups received pretest
Copenhagen: The Nordic Cochrane Centre, The Cochrane Collabora-
assessments of their knowledge and self‐efficacy, were exposed to
tion) for Mac OS X, Version 5.3.
FIGURE 1
Flow of participants through each stage of the study
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PARAGAS JR AND BARCELO
3
|
RESULTS
message‐framed video groups and lecture‐type group ( F ratio = 1.738;
df = 2164; P > .05). However, a significant difference was observed
Of the 176 outpatients screened for eligibility, 165 were analysed
following interventions ( F ratio = 17.540; df = 2164; P < .01). The
(Figure 1). These were non‐randomly assigned to three groups with
post hoc analysis (Table 4) revealed that both gain‐ and loss‐framed
55 eligible subjects each. For the socio‐demographic and clinical char-
video‐viewing groups attained significantly higher ATKADS posttest
acteristics, groups did not differ in age, sex, educational attainment,
scores compared with the lecture‐viewing groups (P < .01). However,
duration of the chronic condition (type 2 diabetes), and intensive for-
between the two video groups, no significant difference in their
mal education about diabetes self‐care (P > .05) (Table 1).
ATKADS posttest scores was found (P > .05). On the other hand,
Outcomes of diabetes management knowledge and self‐efficacy
the ANOVA (Table not shown) of the diabetes management self‐
were analysed using validated and reliable tools (A Test of Knowledge
efficacy pretest scores ( F ratio = 5.437; df = 2164; P < .01) and post-
About Diabetes Self‐Care [ATKADS] and Filipino Diabetes Manage-
test scores ( F ratio = 9.177; df = 2164; P < .01) in the three groups
ment Self‐Efficacy Scale [F‐DMSES]). For knowledge, there were
revealed significant differences. The post hoc analysis (Table 4)
significant differences in the ATKADS mean scores in the two
shows that the two video groups obtained higher scores of F‐DMSES
message‐framed video groups and the lecture‐type group before and
compared with lecture‐type group (P < .01); however, because of the
after their respective interventions (P < .05) (Table 2). For self‐efficacy,
significant differences found in the F‐DMSES pretest scores between
significant differences in F‐DMSES mean scores were noted in the
the two video groups (P < .01), the linear growth model was utilized to
two experimental groups (P < .05). No significant change of self‐
assess the average increase after the interventions. Analysis showed
efficacy was found in lecture‐type group (P > .05) (Table 3).
that the F‐DMSES average increase following the intervention in the
The results of the ANOVA (Table not shown) revealed no significant difference among the ATKADS pretest scores in the two
TABLE 1
gain‐framed group was higher than the loss‐framed group (P < .01)
(Table not shown).
Socio‐demographic and clinical characteristics of older adults with type 2 diabetes across three groups
Variables
Gain‐Framed Group
Loss‐Framed Group
Lecture‐Type Group
P Value
Age (y), mean (SD)
58.95 (10.25)
58.60 (10.23)
58.96 (9.74)
.98a
.98b
Sex
Male, n (%)
25 (15.2)
25 (15.2)
24 (14.5)
Female, n (%)
30 (18.2)
30 (18.2)
31 (18.8)
19 (11.5)
18 (10.9)
19 (11.5)
Highest educational attainment
Elementary, n (%)
.98b
High School n (%)
19 (11.5)
17 (10.3)
18 (10.9)
College, n (%)
18 (10.9)
17 (10.3)
20 (12.1)
7.69 (7.53)
7.53 (6.27)
7.69 (7.90)
.99a
Yes, n (%)
30 (18.2)
28 (17.0)
28 (17.0)
.91b
No, n (%)
27 (15.2)
27 (15.2)
25 (16.4)
Duration of diabetes (y), mean (SD)
Intensive formal education on diabetes self‐care
a
ANOVA.
b 2
X test.
TABLE 2
Mean scores of knowledge regarding diabetes self‐care in the three groups
ATKADS Mean Score (SD)
Group
Pretest
Posttest
SMD (95% CI)
Gain framed (n = 55)
9.98 (2.33)
13.07 (3.05)
1.13 (0.73 to1.53)*
Loss framed (n = 55)
10.67 (3.29)
14.22 (2.98)
1.12 (0.72 to1.53)*
Lecture type (n = 55)
9.64 (3.19)
11.09 (2.31)
0.52 (0.14 to 0.90)*
Abbreviations: ATKADS, A Test of Knowledge About Diabetes Self‐Care; CI, confidence interval; SMD, standardized mean difference.
*Statistically significant at P < .05.
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PARAGAS JR AND BARCELO
TABLE 3
Mean scores of self‐efficacy regarding diabetes self‐care in the three groups
Group
Pretest
Posttest
SMD (95% CI)
Gain framed (n = 55)
61.16 (18.59)
90.85 (19.26)
1.56 (1.13 to 1.99)*
Loss framed (n = 55)
72.85 (20.98)
89.58 (18.18)
0.85 (0.46 to 1.24)*
Lecture type (n = 55)
69.85 (18.25)
76.62 (20.35)
0.35 (−0.03 to 0.72)
F‐DMSES mean scores (SD)
Abbreviations: F‐DMSES, Filipino‐Diabetes Management Self‐Efficacy Scale; CI, confidence interval; SMD, standardized mean difference.
*Statistically significant at P < .05.
TABLE 4
Comparisons of the diabetes management knowledge and self‐efficacy scores between groups in pre‐ and post‐interventions
ATKADS Pretest
ATKADS Posttest
F‐DMSES Pretest
F‐DMSES Posttest
Variable
Mean Difference
P Valuea
Mean Difference
P Valuea
Mean Difference
P Valuea
Gain framed vs loss framed
0.69
.44
1.15
.84
11.69
.005
1.27
.94
Gain framed vs lecture
0.35
.82
1.98
.001
8.69
.51
14.24
.001
Loss framed vs lecture
1.04
.16
3.13
.001
3.00
.70
12.96
.002
Mean Difference
P Valuea
Abbreviations: ATKADS, A Test of Knowledge About Diabetes Self‐Care; F‐DMSES, Filipino Diabetes Management Self‐Efficacy Scale.
a
Tukey's test.
4
|
DISCUSSION
diabetes performed the actual self‐care. Further, some important
diabetes‐management concepts were highlighted through text, espe-
In this quasi‐experimental study, the effects of gain‐ and loss‐framed
cially during the message framing at the ends of the videos. On the
informational videos on increasing diabetes‐management knowledge
other hand, only the text and narration were present in the lecture‐
and self‐efficacy were compared with lecture‐type education in two
type method, which possibly caused its inferior effect in increasing
outpatient diabetes centres in Manila, Philippines. The two videos pro-
knowledge scores when compared with the two videos.
vided innovative approaches for nurses to deliver health teachings to
The level of self‐efficacy of the patients in this study (Table 3) was
patients with type 2 diabetes, which led to significant improvements
found to be similar to that from some studies in Asian countries
in knowledge and self‐efficacy. Specifically, following the interven-
(Masoudiyekta et al., 2018; Tokdemir & Kav, 2017). The increasing
tions, each group had a modest increase in knowledge scores
F‐DMSES scores corroborated the effectiveness of the two
(Table 2). However, based on the post hoc analysis, it was evident that
message‐framed videos on diabetes‐management self‐efficacy. The
both message‐framed video groups were superior to the lecture‐type
F‐DMSES scores of the two video groups were significantly higher
group in increasing diabetes management knowledge (Table 4). These
when compared with the lecture‐type groups (Table 4). Educational
results support other reports that are published elsewhere (Gazzinelli
interventions for patients are known to be effective in increasing
et al., 2010; Geller et al., 2010; Zossou, Van Mele, Vodouhe, &
self‐efficacy, which is vital to influence the adequacy of patients'
Wanvoeke, 2010; David & Asamoah, 2011; Cai & Abbott, 2013;
diabetes self‐management (Masoudiyekta et al., 2018; Tokdemir &
Jensen et al., 2013; Wieland et al., 2013; Cusimano, Chipman,
Kav, 2017). Numerous factors have been identified as related to
Donnelly, & Hutchison, 2014).
nonadherence to treatment regimens, such as complexity of regimens,
The effectiveness of informational videos in increasing knowledge
beliefs regarding drug efficacy, side effects, and drug cost (Fennimore
is explained by the cognitive theory of multimedia learning (Mayer,
& Ginex, 2017). Although participants in this study reported moderate
2002). The blend of animation and narration can generate a powerful
self‐efficacy at the baseline, it is noteworthy that the information
harmonization between the visuospatial sketchpad and phonological
delivered in the videos about self‐management increased their self‐
loops, which are the temporary storage mechanisms of the working
efficacy levels after the intervention (Masoudiyekta et al., 2018;
memory. The former is the storage system for visual and spatial infor-
Tokdemir & Kav, 2017).
mation, while the latter houses speech‐based information. Thus, the
The results in this study affirm the claim of Bandura (1986) that
video allows learners to use every channel simultaneously and avoid
self‐efficacy is improved by four mechanisms: mastery experience,
overloading one stimulus pathway (Mayer, 2002). In this study, the
modelling, social persuasion, and judgement of bodily states. These
videos presented the information about diabetes self‐care through
four mechanisms were applied in the two videos. Mastery experience
animation and narration. The nurse in the videos narrated the vital
and modelling were provided by having a nurse deliver vital informa-
concepts of diabetes management, while the patient with type 2
tion on diabetes management while a patient with diabetes
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PARAGAS JR AND BARCELO
demonstrated actual diabetes self‐care. Social persuasion was pro-
validity and reliability of the instruments. Participants' memory capac-
vided by the nurse through encouraging patients and by presenting
ity and preferred learning style might have affected the results but
either positive consequences of adherence to diabetes self‐care in
were not assessed; however, the nurse contact and the content of
the gain‐framed video or negative effects of nonadherence in the
the videos and the lecture were the same. The only difference was
loss‐framed video. Judgement of bodily states could be related to
the approach of providing information to control these biases. Never-
the possible stimulation of emotions after hearing the positive or neg-
theless, the study revealed a modest effect size after addressing the
ative consequences. Experimental studies claim that the message‐
various biases regarding external validity.
framing approach may impact individuals' motivations to carry out
healthy behaviours. (Rothman et al., 2006). By comparison, with the
lecture‐type group, only the mastery experience (the delivery of health
education by the nurse) and social persuasion (encouragement for the
patients to comply with their diabetes self‐care) were present of the
four possible mechanisms. This may be the reason for its relative ineffectiveness at increasing self‐efficacy scores.
In the F‐DMSES scores between the two message‐framed videos,
one cautionary note is that the loss‐framed video group had a significantly higher pretest score when compared with the gain‐framed
video (Table 4). However, it is noteworthy that in spite of this advantage, the gain‐framed group obtained a higher F‐DMSES score after
the intervention (though not a significant one). Thus, it is vital to
5
CO NC LUSIO N
|
The message‐framed informational videos were shown to be effective
in increasing the diabetes management knowledge and self‐efficacy of
patients with type 2 diabetes. Therefore, the message‐framed videos
can be used by nurses in providing health education to patients. However, when these two videos were compared in relation to increasing
self‐efficacy, the gain‐framed approach was superior to the loss‐
framed approach. Thus, this study recommends the use of gain‐framed
informational videos to increase the knowledge and self‐efficacy of
patients with type 2 diabetes.
establish the average increase of each video group to ascertain
whether the increase was significantly different. The linear growth
5.1
|
Practice implications
model used in this study validated the average increase in the self‐
efficacy observed in the gain‐framed video group. Results showed that
the gain‐framed video group scored significantly higher than the loss‐
framed video group. This result is in accordance with the literature
suggesting that gain‐framed information is more persuasive than
loss‐framed at promoting disease‐prevention behaviours since gain‐
framed information makes people risk averse and thus more likely
to engage in relatively safe disease‐prevention behaviours (Fucito,
Latimer, Salovey, & Toll, 2010; Gerend & Cullen, 2008; Latimer
et al., 2008; Rothman & Salovey, 1997).
Culture is another vital factor that could shape the influential
power of message framing (Uskul, Sherman, & Fitzgibbon, 2009).
The present study involved Filipino older adults, and the enormous
effect of gain‐framed messages in increasing self‐efficacy may have
reflected their cultural value of always having a positive outlook on life
(de Guzman et al., 2011).
Nurses are concerned about the knowledge and self‐efficacy of
patients when delivering information about self‐care to patients with
type 2 diabetes. Although nurses will need education themselves in
how to develop appropriately message‐framed educational content
for their patients, the message‐framed informational videos can be
used to increase diabetes‐management knowledge and self‐efficacy
among patients during health education. This may preserve consistency, eye contact, and quality while saving time in health education.
Thus, the video may lessen the workloads of nurses in health‐care
centres and various outpatient settings. Furthermore, this study adds
to the nursing literature about the positive effects of message framing,
particularly among older Filipino adults, in increasing their self‐
efficacy.
Similar studies may be conducted to examine the effects of
message‐framed videos in relation to changes in the self‐care behaviour of patients. Follow‐up studies may be conducted to establish
the sustainability of the video effects on knowledge and self‐efficacy.
4.1
|
Limitations
This study faces some important limitations. A purposive, non‐
Studies are essential to compare the effects of message‐framed videos
in the self‐care knowledge, self‐efficacy, and behaviours of patients in
other countries and cultures.
randomized sampling was utilized, which could give selection threat
and maturation bias. However, the study carefully set inclusion criteria
ACKNOWLEDGEMENTS
for all the participants, established their similarity regarding socio-
The authors would like to sincerely acknowledge the staff members of
demographic and clinical characteristics, and acquired their average
the diabetes centres at Ospital ng Maynila Medical Center and Bagong
baseline scores before the intervention to minimize these biases.
Barangay Health Center, Manila, and to the patients who participated
The attrition bias was not evident because all the participants finished
in this study. Also, the authors would like to sincerely thank the
the full course of study. Moreover, the risks of the “Hawthorne Effect”
validators of the videos as well as the questionnaires used in the study
and of people influencing the results were minimized by keeping all
and to all of the administrators who contributed in the approval pro-
participants unaware of group allocation. Potential bias associated
cess to conduct this study. Furthermore, the authors would like to rec-
with instrumentation was reduced through the demonstration of the
ognize and thank Mr Learsi Afable for his great assistance during data
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PARAGAS JR AND BARCELO
collection, Ms Genevieve Sepulveda for her unconditional help in
creating the video, and Mr. John Mark Gutierrez for his helpful editing
of this article.
CONF LICT OF INT E RE ST
The authors declare no conflict of interest.
AUTHORSHI P STATEMENT
EP conceptualized the study. EP and TB designed the study. EP
collected the data. EP and TB analysed and interpreted the data. EP
and TB prepared the manuscript. All authors approved the final version for submission.
ORCID
Emmanuel Dayao Paragas Jr.
https://orcid.org/0000-0001-6326-
1476
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How to cite this article: Paragas Jr ED, Barcelo TI. Effects of
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