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Year : 2017  |  Volume : 10  |  Issue : 5  |  Page : 1174-1178
The effect of life skills training program on quality of life and its dimensions in patients with type 2 of diabetes

1 Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery School, University of Medical Sciences, Tehran, Iran
2 Master of Science Student, School of Nursing and Midwifery, University of Medical Sciences, Tehran, Iran
3 Faculty of Management, University of Medical Sciences, Tehran, Iran

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Date of Web Publication6-Nov-2017


Background and Objective: Diabetes is a major cause of death and disability and worsening of public health which is a concern in the world. Patients with diabetes had significantly poorer mental health than normal subjects and patients are psychologically vulnerable. Therefore, life skills training can promote mental health and quality of life (QOL) of patients with diabetes. The aim of this study is to analyze the effect of life skills training on QOL in patients with type 2 of diabetes. Methodology: This research is a quasi-experimental study in which the effect on QOL and life skills training and its dimensions in patients with type 2 diabetes referred to health centers in Babolsar city. In this study, 100 patients with type 2 diabetes selected by convenience sampling in both experimental and control groups (each n = 50) were enrolled. To prevent data leakage, two centers were selected to test samples and controls separately; in this case, the experimental group and control group were selected from Arabkheil and Bahnamir health centers. For six 90 min, sessions for test group were trained in life skills. Moreover, after 6 weeks through QOL questionnaire (short-form 36), training effects in both groups were measured and compared. Data using Chi-square tests and t-test and Fisher's exact SPSS20 were analyzed using statistical software. Results: The mean scores at posttest in QOL (P = 0.005) and of energy and vitality (P = 0.002), mental health (P < 0.001), social functioning (P = 0.041), general health (P = 0.008) was a significant difference. Conclusion: The results of this study showed that life skills education program had an impact on the QOL in patients with type 2 diabetes.

Keywords: Life skills training, patients with type 2 of diabetes, quality of life

How to cite this article:
Nasiri Ziba F, Meresht FS, Seyedfatemi N, Haghani H. The effect of life skills training program on quality of life and its dimensions in patients with type 2 of diabetes. Ann Trop Med Public Health 2017;10:1174-8

How to cite this URL:
Nasiri Ziba F, Meresht FS, Seyedfatemi N, Haghani H. The effect of life skills training program on quality of life and its dimensions in patients with type 2 of diabetes. Ann Trop Med Public Health [serial online] 2017 [cited 2021 Jan 24];10:1174-8. Available from:

   Introduction Top

Diabetes is a chronic metabolic disease that has been diagnosed with chronic high blood sugar and damage vital parts of the patient and thus reduce the length of his life.[1] Diabetes is the fourth leading cause of death in Western societies as well as the fourth most common reason for visits to doctors and health-care costs in the United States accounted for 15%.[2] Statistics prevalence of diabetes in Iran is different from its prevalence as reported by the Deputy Ministry of Health as 3.2%.[3] 90%–95% of diabetes include type II diabetes. If this type of diabetes is not treated, it may become insulin dependent.[4] Diabetes care costs of 2.5%–15% of the annual budget allocated to the health of the world.[5] One of the physical problems of diabetic patients is damage to the organs such as cardiovascular, eye, kidneys, nervous system, gums and teeth, legs, nerve injury and insufficiency in the blood stream.[5] Physical illness injures ability, and physical and functional power of patients and therefore will cause a frustrating situation for the patient, which lead to a decrease in self-esteem and lack of hope.[6] Diabetics are more likely to become prone to stress than nondiabetic patients.[7] Given that many of the difficulties of life today are inevitable therefore to build and strengthen abilities and skills in extreme conditions guarantee that mental health is necessary.[8] Quality of life (QOL), including physical health, psychological status, social relationships, spiritual beliefs, and personal, will be assessed on the basis of subjective experiences which has been linked to abnormalities in each dimension that affects the QOL on other aspects.[9] The World Health Organization describes QOL of people in terms of culture and values of society and goals, expectations, standards, and define one's own interests. The QOL is closely related to physical, mental, and personal beliefs, self-reliance, individual mass communication, and society.[11] Regardless of the treatment of diabetes, improving QOL and psychological parameters of these variables are unlikely to succeed. Therefore, it is necessary to use therapies to improve the QOL and mental health caused by diabetes. The most important of these therapies teaches life skills.[11] The World Health Organization has defined life skills as the ability to perform adaptive and positive behavior so that one can deal with the challenges and necessities of daily life.[10] Therefore, life skills training can promote mental health and QOL of patients with diabetes.

Javadi et al. performed a quasi-experimental study entitled, “effect of life skills training on the QOL of nursing Khorramabad.” Results showed that life skills training is a QOL.[12] Davidson et al. conducted a study on the QOL of diabetic patients. They concluded that diabetic patients are low and the QOL improved with skills training and increased life.[13] Soliemanian et al. study titled “effectiveness of life skills training on the QOL of suffering mood disorder” has done concluded that scores of QOL and control groups had no statistically significant difference in experiment.[14] Rabin showed that teaching self-control skills provides diabetics with high QOL.[15] Sanchez showed that QOL in patients with insulin-dependent diabetes is low leveled.[16] Gangwisch and Heymsfield showed that QOL in the conditions affecting the mental health of patients with diabetes has a major role.[17]

Given the importance of the available data on the life skills, it was necessary to study the QOL of patients, especially among diabetics. It is hoped that the results of this research would be an important step to improve the QOL in patients with diabetes, especially type 2 diabetes.

   Methodology Top

This study is a quasi-experimental study with pre- and post-test with control group. The researcher of the study from the School of Nursing and Midwifery, Iran, obtained permits and permission from the Ethics Committee of the University of Medical Sciences in Iran. Fifty patients were referred from the city's health center in Babolsar (Bahnamir and Arabkheil) with type 2 diabetes. Based on the inclusion criteria and obtaining informed consent, study samples were conveniently selected from each center and to ensure the homogeneity of the two groups; Bahnamir health center patients were selected as the control group while the experimental group were selected as Arabkheil health center patients. Criteria for inclusion of people with type 2 diabetes are at least 1 year of confirming the disease, be literate, and lack of upper limb disabilities and limitations, no history of mental illnesses in patients' medical records, and monthly visits to health-care centers in Babolsar city. The exclusion criteria are patient dissatisfaction.

In the first meeting, the researcher after obtaining informed written consent from patients, a pretest was conducted in both groups of control and experimental using Sherbun 36-item quality of life standard questionnaire SF-36 (1992). This includes general health questionnaire (questions 1 and 2), mental health (questions 33–36), the role of limitation due physical reasons (questions 13 and 16), role of limitations due to emotional (emotional problems) (questions 17 and 19), pain physical (questions 21 and 22), social functioning (questions 20 and 32), vitality (questions 23-31), and physical function (question 3-12). After pretest, the test group undertook weekly training sessions while the control group did not have any training. In the experimental group, the life skills training program was participatory and group-based, and in the sessions it was tried to avoid traditional and one-way training. Their skills, knowledge, and empathy for one session, effective communication and interpersonal relations, meeting of decision-making and problem-solving, critical thinking and creative sessions, coping with emotions and stress, and a meeting to review and discuss the remaining issues were considered past and after 6 weeks through 36-item QOL questionnaire, Sherbun training effects in both groups were measured and compared. To determine research objectives, descriptive statistics (mean and standard deviation) and inferential statistics (independent t-test) were used. The independent t-test compliance with the statistical assumptions such as normality and equality of variances is done. Assuming equal variances using the Levene test and pretest assuming normal Kolmogorov–Smirnov were studied. The data were analyzed using the software SPSS20 (ver. 20; SPSS, Inc., Chicago, IL, USA)..

   Results Top

After collecting information about the variables, the Kolmogorov–Smirnov test was carried out which indicated all variables are normal, so the parametric tests were used to evaluate and test hypotheses.

A sample of the study, 100 patients with type II of diabetes in which fifty were included in the experimental group and fifty in the control group. Results showed that the experimental group and the control group were 42% male and 58% female and 46% male and 54% female, respectively. In the test group, 90% were married and 10% were single and 94% were married and 6% in the control group were single.

In the experimental group, 16% had elementary degrees, 24% middle, 40% diplomas and 20% higher diplomas, and in the control group, 38% had elementary degrees, 20% middle, 32% diplomas and 10% higher diplomas. 56% of subjects in the experimental group and 44% in the control group did not have complications of diabetes. In the experimental group, 28% and in the control group, 34% had chronic disease.

Demographic data on two experimental and control groups using the Chi-square test and Fisher's exact test were compared with each other. In all cases, no significant difference was observed between the groups, indicating similar in both groups regard is raised [Table 1].
Table 1: Distribution of demographic characteristics in both test and control groups

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In the analysis of information obtained from QOL, questionnaire showed that the QOL of the control group and test before training classes no significant difference between the two groups in this respect are perfectly matched (t = 0.383, df = 98, P = 0.703) [Table 2].
Table 2: Comparison of quality of life between the two groups before the intervention and control test

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After classes, life skills' training, life quality both experimental and control groups, and independent t-test were compared. The overall mean QOL groups equal to 60.28 with SD was 7.81 compared with the control group with an average of 56.25 with SD 6.32 is a significant difference (t = 2.88, df = 98, P = 0.005) [Table 3].
Table 3: Comparison of test and control groups after the intervention quality of life

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In comparing the different aspects of QOL questionnaire scores after the intervention of energy and vitality, mental health, social functioning, and general health groups had significantly different from the control group (P < 0.05) [Table 4].
Table 4: Comparison of quality of life between the test and control groups after interventiond

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   Discussion and Conclusion Top

This study aimed to evaluate the effect of life skills training on the QOL in patients with type II diabetes in the city of Babolsar. Findings showed that between experimental and control groups, there was no significant difference in terms of QOL. In a different study measuring the effect of life skills training, Khani et al. conducted a study on the QOL of diabetes and life skills training to improve the psychological impact of the Symptom Checklist-90-R (SCL-90-R) has been studied. In this study, the World Health Organization QOL questionnaire (WHOQOL-26) was used. The results showed that satisfaction with life skills training to promote physical and mental satisfaction, and as a result, the QOL of patients with diabetes plays an important role in the experimental group than the control group increased average QOL.[18] Javadi et al. did a study of nurses in the hospitals of Khorramabad on QOL and livelihood skills training effect has been studied. Results showed that life skill training causes a significant improvement in physical functioning, bodily pain, general health, vitality, social functioning, mental health, physical health, and QOL in nursing. However, two areas of emotional and physical function test showed no significant difference between the two groups.[12] Davidson et al. conducted a study on the QOL of diabetic patients. He concluded that diabetic patients are low and the QOL with improved skills training and increased life.[13] Soliemanian et al. (2015) study the QOL of those suffering from mood disorders and concluded that the average scores of the two groups in the pre- and post-test with control effect, the QOL and mental health subscales, health, social relationships, and physical health had significant difference, but the difference was not significant in terms of environmental health.[14] Grey et al. conducted a study on diabetic patients and showed that life skills education has more effect on diabetes patients.[19] Zoffmann and Lauritzen (2006) showed life skills training increased their self-control.[20] Low QOL leads to unrealistic perception about life in terms of objectives, expectations, and priorities in life. That is why life skills training increased the lead to individual control and decision-making skills and problem-solving teaches him to be reasonable and effective. Such training also improves physical condition and at least partial treatment is effective in improving the mental state of patients. According to the concept of QOL, any improvement is evident in the life of improved QOL and improvements in this regard with life skills training are possible.

Diabetes mellitus has psychological problems, including depression, anger, social impairment, etc. in addition to physical problems. People were with higher emotional intelligence than acute and chronic physical and mental disorders and have a higher level of health. Hence, with emotion regulation can be everyday stressed and physical and mental illnesses that education be protected.

Thus, this study suggest that life skills training through specialized and experienced consultants and instructors in specialized centers can reduce the physical problems caused by the disease, stable mental status, and mental health experience which also affects his body. Based on the results of this study, life skills training improves diabetic patients in mental function, vitality, mental health, social functioning, general health, and QOL; SF-36 questionnaire was based. It is suggested that along with existing medical services, life skills training should be done to improve the quality of life of patients, in specialized centers and hospitals, and also by physicians related to these patients. Because of the QOL and physical diseases affect each other mutually and QOL of the patients to determine the extent of his physical condition.


We would like to thank professors and School of Nursing and Midwifery, Tehran University of Medical Sciences and Research Council and hardworking staff of health centers and the city of Babolsar and dear patients in this study were involved with patience and tolerance, gratitude comes into action.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Heydari S, Nouri TM, Hosseini F, Inanlou M, Golgiri F, Shirazi F. Geriatric family support and diabetic type-2 glycemic control. Salmand 2008;3:573-80.  Back to cited text no. 1
American Diabetes Association. Nasional Diabetes Fact Sheet; 2011. Available from: [Last updated on 2017 Jul 19; Cited on 2017 Jul 19].  Back to cited text no. 2
Pour JS, Jafari M, Asgar MG, Dardashti HD, Teymoorzadeh E. The impact of self-care education on life quality of diabetic patients. J Health Adm 2013;16:26-36.  Back to cited text no. 3
Trasoff D, Delizo J, Du B, Purnajo C, Morales J. Diabetes in the Middle East. Epinex Diagnostics, Inc. Corporate Information Series 4, 2008. Available from: [Last updated on 2017 May 30].  Back to cited text no. 4
Farsaie SH, Amini M. How to Live Better with Diabetes. Isfahan: Arkan Danesh Press; 2009.  Back to cited text no. 5
Bonomi AE, Patrick DL, Bushnell DM, Martin M. Validation of the United States' version of the World Health Organization Quality of Life (WHOQOL) instrument. J Clin Epidemiol 2000;53:1-12.  Back to cited text no. 6
Mahdavi Hazavah AR, Nourozi Nejad A. A Project about Monitoring and Evaluation of Country' Plan in Prevention and Control of Diabetes, Deputy of Health of Ministry of Health, Medicine and Medical Education, Management Center of Diseases; 2001.  Back to cited text no. 7
Kord Noghabil R, Sharifi HP. Preparation of a life skills curriculum plan for high school student. J Educ Innov 2005;12:11-34.  Back to cited text no. 8
King CR, Hinds PS, editors. Quality of Life from Nursing and Patient Perspectives: Theory, Research, Practice. Massachusetts: Jones and Bartlett; 1998.  Back to cited text no. 9
World Health Organization. Life Skills Training Program. Translated by Noori R, Khani M. Tehran: Publication of Cultural Department and the Prevention of Well-Being; 2000.  Back to cited text no. 10
Ahari SS, Arshi S, Iranparvar M, Amani F, Hosein Siahpoosh Sadeghie AS, Arshi S, et al. The effect of complications of type II diabetes on patients' quality of life. J Ardabil Univ Med Sci 2009;8:394 402.  Back to cited text no. 11
Javadi M, Sepahvand MJ, Mahmudi H, Sori A. The effect of life skills training on quality of life of nurses. Sci J Hamadan Nurs Midwifery 2013;21:32-42.  Back to cited text no. 12
Davidson M, Boland A, Li J. Skills training for youth with diabetes mellitus has long-lasting effects on metabolic control and quality of life. J Pediatr 2000;137:107-14.  Back to cited text no. 13
Soliemanian AA, Jajarmi M, Falahati M. Effectiveness of training life skills on the quality of life of spouses of veterans with affective disorders. Q Iran J War Public Health 2015;7:197-205.  Back to cited text no. 14
Rabin R. Helping you control your diabetes for life. J Pediatr 2003; 142:21.  Back to cited text no. 15
Sanchez JM. Quality of life in insulin treated diabetes related quality of life in diabetes. Diabetes Care 2005;25:2238.  Back to cited text no. 16
Gangwisch JE, Heymsfield SB. The correlative study between sleep quality and psychological health of secondary insomnia of diabetes. Chin J Behav Sci 2008;17:74.  Back to cited text no. 17
Khani F, Samsam Shariat MR, Mehdad A. The effect of life skills training on improving scl-90 psychological indicators and quality of life in patients with diabetes. Knowl Res Appl Psychol 2014;15:81-91.  Back to cited text no. 18
Grey M, Boland EA, Davidson M, Yu C, Tamborlane WV. Coping skills training for youths with diabetes on intensive therapy. Applied Nursing Research 1999;12:3-12.  Back to cited text no. 19
Zoffmann V, Lauritzen T. Guided self-determination improves life skills with type 1 diabetes and A1C in randomized controlled trial. Patient Educ Couns 2006;64:78-86.  Back to cited text no. 20

Correspondence Address:
Fatemeh Sadeghi Meresht
School of Nursing and Midwifery, Iran University of Medical Science, Tehran
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ATMPH.ATMPH_276_17

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  [Table 1], [Table 2], [Table 3], [Table 4]


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