SELF-MANAGEMENT EXPERIENCE OF PATIENT WITH TYPE 2 DIABETES IN SUMBAWA BESAR, WEST NUSA TENGGARA: A QUALITATIVE STUDY

Background: The number of patients with diabetes mellitus (DM) in Indonesia was reported to increase every year. Indonesia included into ranked sixth countries for diabetes (20-79 years) and ranked third as the deadliest diseases, (IDF, 2017; WHO, 2016). However, research about self-management experience for people with Type 2 DM is insufficient. Objectives: The purpose of this study was to explore the Self-management Experience of Patient with Type 2 DM in Sumbawa Besar, West Nusa Tenggara. Methods: Purposive sampling with one-on-one depth interview were used to obtain the participants experiences about selfmanagement. six participants were selected randomly from 30 participants in community. Data saturation was achieved and analyzed by Colaizzi’s (1978) seven-step method. Results: Six themes emerged from study were: dietary adjustment, using medicine to decrease blood glucose, taking exercise, taking care of DM by oneself, social support and looking for information regarding DM were consider as important theme for DM population in Sumbawa Besar, West Nusa Tenggara. Conclusion: the result of this study showed that each patient with DM has ability to carry out self-management based on their belief, value and knowledge. Basic information about diabetes was the most important aspect before patients can perform self-management successfully.


INTRODUCTION
Furthermore, Indonesia included into ranked sixth countries for diabetes  years), ranked third as the deadliest diseases and ranked forth for undiagnosed diabetes, (IDF, 2017;WHO, 2016). Lack of self-awareness, economic factor, health insurance, uneven reach of health services or facility, lack of knowledge and more trust with traditional medicine than modern medicine become the main reason why these condition can be occurred, (Pranata, 2017). As a result, patients with DM may do not know how to manage them self during sickness. This terminology was popular as self-management.
Self-management is the individual capacity of patient to handle his health problem such as, symptoms, physical and psychosocial consequences and lifestyle changes, (Barlow et all, 2002). Efficacy for Sometimes there are not using footwear when doing activities, remain to consume diet with high glucose level and not exercise regularly, (Pranata, 2019;Pranata, Hs, & Sujianto, 2016 (Polit & Beck, 2015). Husserl defined phenomenology as "the science of essence of consciousness", and promoted the meaning of lived experience as a rigorous way of understanding the world, (Groenewald, 2004).
Phenomenological method analysis was developed based on Husserl's descriptive phenomenology, (Morrow, Rodriguez, & King, 2015). From this philosophical stance, the meaning of an experience of patients about self-management is described within emergent themes and common patterns specifically. Colaizzi's (1978) phenomenological approach was used because it provides a clear structure for analyzing data, (Gill, 2014). Interviews lasted 15-20 minutes and were digitally recorded and transcribed verbatim.

Data Analysis
The interview results were analyzed by the researcher according to Colaizzi's phenomenological analytic method, (Colaizzi, 1978). It consists of seven steps (Polit & Beck, 2015)
Questions were asked in a logical sequence in semi structured interviews; after each interview, the participant was given a copy of their transcript to affirm the accuracy of the data, and they could give any additional information after the interviews. The researcher attempted to remain as neutral as possible, be aware of presuppositions about how the self-management in community is.
Together the research team discussed the findings during the analysis process to make sure that themes that emerged from narratives of participants' descriptions reflected their experiences. The provision of verbatim quotations provided a check to ensure that the researchers faithfully presented the participants' experience.

Ethical Approval
Participants provided written informed consent procedures to participate in this study. This study was accepted in the hospital's review board and local government.

RESULTS AND DISCUSSIONS
Six emergent themes were identified to illustrate the self-management experiences among patients with Type 2 DM. These themes were: (i) dietary adjustment, (ii) using medicine to decrease blood glucose (iii) taking exercise, (iv) taking care of DM by oneself, (v) social support and (vi) looking for information regarding DM. .

4) Taking Care of Dm By Oneself
The term of taking care of DM by oneself describe about patient ability to make choices independently those how to deal with symptoms caused by diabetes and checked them self by considering with his physical, emotional, knowledge and believe.

a) Checking blood sugar by oneself
The patient checks his blood sugar level independently to ensure his health condition:

c) Controlling eat desire
This shows patient effort to take care of his self to keep his blood sugar still stable.  Bandura, 1978Bandura, , 1986Bandura, , 1989bBandura, , 1989aBandura, , 2002.
In addition, the health, insurance and support systems of family must also be another consideration to make selfmanagement can be successful, (Vas et al., 2017 Moreover, better understanding of disease and good awareness among patients with DM makes self-management will be successful.