Factors affecting study efficiency and item non-response in health surveys in developing countries: the Jamaica national healthy lifestyle survey

Social support and ideal cardiovascular health in urban Jamaica: A cross-sectional study

Recent studies have suggested that high levels of social support can encourage better health behaviours and result in improved cardiovascular health. In this study we evaluated the association between social support and ideal cardiovascular health among urban Jamaicans. We conducted a cross-sectional study among urban residents in Jamaica's south-east health region. Socio-demographic data and information on cigarette smoking, physical activity, dietary practices, blood pressure, body size, cholesterol, and glucose, were collected by trained personnel. The outcome variable, ideal cardiovascular health, was defined as having optimal levels of ≥5 of these characteristics (ICH-5) according to the American Heart Association definitions. Social support exposure variables included number of friends (network size), number of friends willing to provide loans (instrumental support) and number of friends providing advice (informational support). Principal component analysis was used to create a social support score using these three variables. Survey-weighted logistic regression models were used to evaluate the association between ICH-5 and social support score. Analyses included 841 participants (279 males, 562 females) with mean age of 47.6 ± 18.42 years. ICH-5 prevalence was 26.6% (95%CI 22.3, 31.0) with no significant sex difference (male 27.5%, female 25.7%). In sex-specific, multivariable logistic regression models, social support score, was inversely associated with ICH-5 among males (OR 0.67 [95%CI 0.51, 0.89], p = 0.006) but directly associated among females (OR 1.26 [95%CI 1.04, 1.53], p = 0.020) after adjusting for age and community SES. Living in poorer communities was also significantly associated with higher odds of ICH-5 among males, while living communities with high property value was associated with higher odds of ICH among females. In this study, higher level of social support was associated with better cardiovascular health among women, but poorer cardiovascular health among men in urban Jamaica. Further research should explore these associations and identify appropriate interventions to promote cardiovascular health.

Patterns of item nonresponse behaviour to survey questionnaires are systematic and associated with genetic loci

Response to survey questionnaires is vital for social and behavioural research, and most analyses assume full and accurate response by participants. However, nonresponse is common and impedes proper interpretation and generalizability of results. We examined item nonresponse behaviour across 109 questionnaire items in the UK Biobank (N = 360,628). Phenotypic factor scores for two participant-selected nonresponse answers, 'Prefer not to answer' (PNA) and 'I don't know' (IDK), each predicted participant nonresponse in follow-up surveys (incremental pseudo-R2 = 0.056), even when controlling for education and self-reported health (incremental pseudo-R2 = 0.046). After performing genome-wide association studies of our factors, PNA and IDK were highly genetically correlated with one another (rg = 0.73 (s.e. = 0.03)) and with education (rg,PNA = -0.51 (s.e. = 0.03); rg,IDK = -0.38 (s.e. = 0.02)), health (rg,PNA = 0.51 (s.e. = 0.03); rg,IDK = 0.49 (s.e. = 0.02)) and income (rg,PNA = -0.57 (s.e. = 0.04); rg,IDK = -0.46 (s.e. = 0.02)), with additional unique genetic associations observed for both PNA and IDK (P < 5 × 10-8). We discuss how these associations may bias studies of traits correlated with item nonresponse and demonstrate how this bias may substantially affect genome-wide association studies. While the UK Biobank data are deidentified, we further protected participant privacy by avoiding exploring non-response behaviour to single questions, assuring that no information can be used to associate results with any particular respondents.

Evaluation of key survey components of bio-behavioral surveillance among HIV high-risk subpopulation in Western India

Background

High-quality data are of prime importance in any health survey because survey data are considered as a gold standard for nationally representative data. The quality of data collection largely depends on the design of the questionnaire, training, and skills of the interviewer.

Objectives

In the present study, we tried to evaluate three key components, such as questionnaire design, human resource and training of the field staff for Integrated Biological and Behavioural Surveillance carried out among the HIV high-risk subpopulation.

Methods

A mixed-methods approach was used. Qualitative and quantitative data collection was carried out in the year 2015 with cross-sectional survey design in western states of India. The in-depth interviews of 10 stakeholders, structured interviews of the survey respondents (n = 560), and field investigators (n = 71) were conducted. Data triangulation was used to find out the concurrence of the qualitative and quantitative data.

Results

Comprehensive and standardized survey questionnaire, structured training agenda, and strategic preparation for recruiting human resources were the overall strengths of the survey. However, during the implementation of the survey, there were some difficulties reported in data collection process. Overall, the respondents and investigators felt that the questionnaire was long and exhaustive. Difficulties were faced while collecting data on sexual history. The field staffs were not adequately experienced to work with sensitive population.

Conclusions

In order to have accurate, reliable data, especially on sexual behavior; emphasis should be given on simple questionnaire with the use of community-friendly language, skilled and experienced interviewers for data collection, and extensive field training.

Missing-data analysis: socio- demographic, clinical and lifestyle determinants of low response rate on self- reported psychological and nutrition related multi- item instruments in the context of the ATTICA epidemiological study

Background

Missing data is a common problem in epidemiological studies, while it becomes more critical, when the missing data concern a multi-item instrument, since lack of information in even one of its items, leads to the inability to calculate the total score of the instrument. The aim was to investigate the socio-demographic, lifestyle and clinical determinants of low response rate in two self- rating multi item scales, estimating the individuals’ nutritional habits and psychological disorders, as well as, to compare different missing data handling techniques regarding the imputation of missing values in this context.

Methods

The sample from ATTICA epidemiological study was used, with complete baseline information (2001–2002) regarding their demographic characteristics [n = 2194 subjects (1364 men: 64 years old (SD = 12 years) and 830 women: 66 years old (SD = 12 years))]. Adherence to the Mediterranean diet and depressive symptomatology were assessed at baseline, with the MedDietScore scale and the Zung’s Self- rating Depression Scale (SDS), respectively. Logistic and Poisson regression analysis were used, in order to explore the low response’s determinants in each scale. Seven missing data handling techniques were compared in terms of the estimated regression coefficients and their standard errors, under different scenarios of missingness, in the context of a multivariable logistic regression model examining the association of each scale with the participants’ likelihood of being hypertensive.

Results

Older age, lower educational level, poorer health status and unhealthy lifestyle habits, were found to be significant determinants of high nonresponse rates, both in the MedDietScore scale and the Zung’s SDS. Female participants were more likely to have missing data in the items of the MedDietScore scale, while a significantly higher number of missing items in the depression scale was found for male participants. Concerning the analysis of such data, multiple imputation was found to be the most effective technique, even when the number of missing items was large.

Conclusions

The present work augments prior evidence that higher non-response to health surveys is significantly affected by responders’ background characteristics, while it gives rise to research towards unrevealed paths behind this claim, especially in the era of nutritional epidemiology.

Educational Health Disparities in Cardiovascular Disease Risk Factors: Findings from Jamaica Health and Lifestyle Survey 2007-2008

OBJECTIVES

Socioeconomic disparities in health have emerged as an important area in public health, but studies from Afro-Caribbean populations are uncommon. In this study, we report on educational health disparities in cardiovascular disease (CVD) risk factors (hypertension, diabetes mellitus, hypercholesterolemia, and obesity), among Jamaican adults.

METHODS

We analyzed data from the Jamaica Health and Lifestyle Survey 2007-2008. Trained research staff administered questionnaires and obtained measurements of blood pressure, anthropometrics, glucose and cholesterol. CVD risk factors were defined by internationally accepted cut-points. Educational level was classified as primary or lower, junior secondary, full secondary, and post-secondary. Educational disparities were assessed using age-adjusted or age-specific prevalence ratios and prevalence differences obtained from Poisson regression models. Post-secondary education was used as the reference category for all comparisons. Analyses were weighted for complex survey design to yield nationally representative estimates.

RESULTS

The sample included 678 men and 1,553 women with mean age of 39.4 years. The effect of education on CVD risk factors differed between men and women and by age group among women. Age-adjusted prevalence of diabetes mellitus was higher among men with less education, with prevalence differences ranging from 6.9 to 7.4 percentage points (p < 0.05 for each group). Prevalence ratios for diabetes among men ranged from 3.3 to 3.5 but were not statistically significant. Age-specific prevalence of hypertension was generally higher among the less educated women, with statistically significant prevalence differences ranging from 6.0 to 45.6 percentage points and prevalence ratios ranging from 2.5 to 4.3. Similarly, estimates for obesity and hypercholesterolemia suggested that prevalence was higher among the less educated younger women (25-39 years) and among more educated older women (40-59 and 60-74 years). There were no statistically significant associations for diabetes among women, or for hypertension, high cholesterol, or obesity among men.

CONCLUSION

Educational health disparities were demonstrated for diabetes mellitus among men, and for obesity, hypertension, and hypercholesterolemia among women in Jamaica. Prevalence of diabetes was higher among less educated men, while among younger women the prevalence of hypertension, hypercholesterolemia, and obesity was higher among those with less education.

Maintaining data integrity in a rural clinical trial

Background Clinical trials conducted in rural resource-poor settings face special challenges in ensuring quality of data collection and handling. The variable nature of these challenges, ways to overcome them, and the resulting data quality are rarely reported in the literature.

Purpose To provide a detailed example of establishing local data handling capacity for a clinical trial conducted in a rural area, highlight challenges and solutions in establishing such capacity, and to report the data quality obtained by the trial.

Methods We provide a descriptive case study of a data system for biological samples and questionnaire data, and the problems encountered during its implementation. To determine the quality of data we analyzed test—retest studies using Kappa statistics of inter- and intra-observer agreement on categorical data. We calculated Technical Errors of Measurement of anthropometric measurements, audit trail analysis was done to assess error correction rates, and residual error rates were calculated by database-to-source document comparison.

Results Initial difficulties included the unavailability of experienced research nurses, programmers and data managers in this rural area and the difficulty of designing new software tools and a complex database while making them error-free. National and international collaboration and external monitoring helped ensure good data handling and implementation of good clinical practice. Data collection, fieldwork supervision and query handling depended on streamlined transport over large distances. The involvement of a community advisory board was helpful in addressing cultural issues and establishing community acceptability of data collection methods. Data accessibility for safety monitoring required special attention. Kappa values and Technical Errors of Measurement showed acceptable values. Residual error rates in key variables were low.

Limitations The article describes the experience of a single-site trial and does not address challenges particular to multi-site trials.

Conclusions Obtaining and maintaining data integrity in rural clinical trials is feasible, can result in acceptable data quality and can be used to develop capacity in developing country sites. It does, however, involve special challenges and requirements. Clinical Trials 2007; 4: 572—582. http://ctj.sagepub.com

The relationship between relative deprivation and self-rated health among Palestinian women in refugee camps in Lebanon

Background

Relative deprivation (RD) has been advanced as a theory to explain the relationship between income inequality and health in high-income countries. In this study, we tested the theory in a low-income protracted refugee setting in a middle-income country.

Methods

Using data from the 2010 Socioeconomic Survey of Palestine Refugees in Lebanon, we examined the relationship between RD and health among a representative sample of Palestinian refugee women (N=1047). Data were gathered utilizing a household questionnaire with information on socio-demographics and an individual-level questionnaire with information on the health of each respondent. We examined self-rated health (SRH) as the main health measure but also checked the sensitivity of our results using self-reported chronic conditions. We used two measures for absolute SES: total household monthly expenditures on non-food goods and services and total household monthly expenditures on non-health goods and services. With refugee camp as a reference group, we measured a household’s RD as a household’s rank of absolute SES within the reference group, multiplied by the distance between its absolute SES and the average absolute SES of all households ranked above it. We investigated the robustness of the RD–SRH relationship using these two alternative measures of absolute SES.

Results

Our findings show that, controlling for absolute SES and other possible confounders, women report significantly poorer health when they live in households with a higher score on our RD measure (because of either lower relative rank or lower relative SES compared to households better off in the reference group which we take to be the refugee camp). While RD is always significant as a determinant of SRH under a variety of specifications, absolute SES is not consistently significant. These findings persist when we use self-reported chronic conditions as our measure of health instead of SRH, suggesting that the relationship between health and RD may be operating through a psychosocial mechanism.

Discussion

Our findings underscore the importance of examining RD under conditions of poverty and in diverse socio-cultural contexts. They also highlight that public health approaches should be concerned with reducing social inequalities in low-income settings in addition to alleviating poverty.

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RD is an explanatory pathway in the relationship between income inequality and health.

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We investigated RD among women in Palestinian refugee camps in Lebanon.

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Women report poorer health when they live in households with a higher RD score.

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Evidence points to the importance of reducing social inequalities in deprived settings.

Diabetes mellitus in Jamaica: sex differences in burden, risk factors, awareness, treatment and control in a developing country

OBJECTIVE

The objective of this study was to provide valid estimates of the burden of and risk factors for diabetes mellitus by sex in Jamaica, a predominantly Black, middle-income and developing country.

METHODS

The Jamaica Health and Lifestyle Survey 2008 examined a nationally representative sample of 2848 Jamaicans aged 15-74. Parameter estimates and 95% confidence intervals [CI] were weighted for non-response as well as age and sex of the source population. Sex differences in risk factors and diabetes prevalence, awareness, treatment and control were estimated in multivariable models. Population-attributable fractions (PAFs) of obesity on diabetes mellitus were estimated in both sexes.

RESULTS

The prevalence of diabetes mellitus was 7.9% (95% CI: 6.7-9.1%), significantly higher in women than men 9.3% vs. 6.4% (P = 0.02) and increasing with age. Seventy-six percentage of persons with diabetes mellitus were aware of their status; urban women and rural men were less likely to be aware. Diabetes control (43% overall) was less common in higher-income men, but more common in higher-income women. Persons without health insurance were less likely to control their diabetes. The prevalence of diabetes risk factors was higher in women than men. Increased waist circumference (≥94 cm [men]/≥80 cm [women]), overweight/obesity (body mass index ≥ 25 kg/m(2)) and low physical activity/inactivity were associated with PAFs for diabetes mellitus of 27%, 37% and 15%, respectively, in men and 77%, 54% and 24%, respectively, in women.

CONCLUSIONS

Prevalence of diabetes mellitus and its risk factors is high in Jamaica, especially among women, and national programmes to stem the diabetes mellitus epidemic should take these sex differences into consideration.

Perception of women on cancer screening and sexual behavior in a rural area, Jamaica: Is there a public health problem?

BACKGROUND

The Ministry of Health in Jamaica recommends that cervical cancer screening be undergo by women 25-54 years old. The age range is based on international standards, but this is in need for revision based on the parish of St. Thomas.

AIMS

The study aimed to evaluate the perception and practice of Pap smear and the sexual practices of women in St. Thomas in order to aid policy.

PATIENTS AND METHODS

This is a cross-sectional descriptive study of 210 women (15-54 years) from St. Thomas, Jamaica.

RESULTS

Eighty eight percent of the sample had done a Pap smear and 24% indicated that they did this at least once every 12 months. The Pap smear results revealed that 83.2% of the sample was normal and 11.5% of the participants knew that their Pap smear was abnormal. Eighty percent of those with abnormal Pap smear were aged between 20-35 years. Sixty percent indicated that they did not believe they were infected with any STDs, but the Pap smear results showed that 76.4% of them had STDs. Eighty-three percent of the sample indicated having one sexual partner; 22.1% indicated that they began having sex before 15 years; 71% began having sex at 15-20 years; 76% of the sample used a condom and 12% reported that they had never practiced safe sex.

CONCLUSION

This study finds that the age interval for conducting Pap smear screening should be lowered to 20 years for women in the parish of St. Thomas, Jamaica.

Reported hours of sleep, diabetes prevalence and glucose control in jamaican adults: analysis from the Jamaica lifestyle survey 2007-2008

Background. There are limited data on sleep duration and diabetes from developing countries. We therefore examined the relationship between reported hours of sleep, diabetes prevalence and glucose control in Jamaican adults. Methods. Data on reported hours of sleep and diabetes (based on glucose measurement and medication use) from a national survey of 15-74-year-old Jamaicans were analyzed. Results. The 2,432 participants (31% M, Age 42 ± 16 years, BMI 27.6 ± 6.6 kg/m(2), diabetes prevalence 12%) reported sleeping 8.2 ± 1.8 hours. In men, sleeping less than 6 hours (OR (95% CI) = 2.65 (1.09-6.48)) or more than 10 hours (OR (95% CI) = 4.36 (1.56-12.19)) was associated with diabetes when adjusted for age, BMI, and family history of diabetes. In women sleeping less than 6 hours was associated with a reduced likelihood of diabetes after adjusting for the same confounders ((OR (95% CI) = 0.43 (0.23-0.78)). There was no significant association between sleep and glucose control. Conclusion. Insufficient and excessive sleep was associated with increased diabetes prevalence in Jamaican men but not women.

The natural history of pedal puncture wounds in diabetics: a cross-sectional survey

Background

Surgeons usually witness only the limb-threatening stages of infected, closed pedal puncture wounds in diabetics. Given that this catastrophic outcome often represents failure of conservative management of pre-infected wounds, some suggest consideration of invasive intervention (coring or laying-open) for pre-infected wounds in hope of preventing contamination from evolving into infection, there being no evidence based guidelines. However, an invasive pre-emptive approach is only justifiable if the probability of progression to catastrophic infection is very high. Literature search revealed no prior studies on the natural history of closed pedal puncture wounds in diabetics.

Methods

A survey was conducted via an interviewer-administered questionnaire on 198 adult diabetics resident in the parish of St. James, Jamaica. The sample was selected using a purposive technique designed to mirror the social gradient and residential distribution of the target population and is twice the number needed to detect a prevalence of puncture wounds of 14% with a range of 7-21% in a random sample of the estimated adult diabetic population.

Results

The prevalence of a history of at least one closed pedal puncture wound since diagnosis of diabetes was 25.8% (CI; 19.6-31.9%). The only modifiable variable associated at the 5% level of significance with risk of pedal puncture wound, after adjustment by multivariable logistic regression, was site of interview/paying status, a variable substantially reflective of income more so than quality-of-care.

Of 77 reported episodes of closed pedal puncture wound among 51 participants, 45.4% healed without medical intervention, 27.3% healed after non-surgical treatment by a doctor and 27.3% required surgical intervention ranging from debridement to below-knee amputation. Anesthetic foot (failure to feel the puncture) and sole of the forefoot as site of puncture were the variables significantly associated with risk of requiring surgical intervention.

Conclusions

That 72.7% of wounds healed either spontaneously or after non-surgical treatment means that routine, non-selective surgical intervention for pre-infected closed pedal puncture wounds in diabetics is not justifiable. However the subset of patients with an anesthetic foot and a wound on the sole of the forefoot should be marked for intensive surveillance and early surgical intervention if infection occurs.

Trial Registration

ClinicalTrials.gov: NCT01151891

Diabetes awareness in general population in Cameroon

BACKGROUND

A good knowledge about diabetes could lead to early diagnosis and improved management.

OBJECTIVE

To evaluate the level of diabetes awareness in Cameroonians, and to identify factors that influence this awareness.

METHODS

In subjects aged ≥ 25 years (n=1000, 93.4% of response), details regarding risk factors, symptoms, treatment and complications of type 2 diabetes were collected. One mark was attributed to each true answer and a global diabetes awareness score was computed. Influence of age, gender, educational level, occupational level, notion of a relative having a chronic condition and presence of chronic disease were analyzed.

RESULTS

Eighty percent of subjects scored more than the total mean score. The highest score obtained by participants (0.10%) was 28/30. The mean total score was higher in men (p < 0.02) and in subjects with a relative having a chronic condition (p < 0.001). In multivariate analyses, age classes (p < 0.01), educational level (p < 0.001) and relatives with a chronic condition (p < 0.001) were associated to the global diabetes awareness score.

CONCLUSIONS

Diabetes awareness was generally good. This may be due to the fact that the study was conducted in an area where health promotion and health education on diabetes have been intensively delivered for the past 4 years.

Re-testing theories on the correlations of health status, life satisfaction and happiness

BACKGROUND

Empirical evidences have shown that happiness, life satisfaction and health status are strongly correlated with each other. In Jamaica, we continue to collect data on health status to guide policies and intervention programs, but are these wise?

AIMS

The current study aims to fill the gap in the literature by examining life satisfaction, health status, and happiness in order to ascertain whether they are equivalent concepts in Jamaica as well as the coverage of the estimates.

MATERIALS AND METHODS

The current study used a cross-sectional survey of 2000 men 55 years and older from the parish of St. Catherine in 2007 which is it also generalizable to the island. A132-item questionnaire was used to collect the data. The instrument was sub-divided into general demographic profile of the sample; past and Current Good Health Status; health-seeking behavior; retirement status; social and functional status. Ordinal logistic regression techniques were utilized to examine determinants of happiness, life satisfaction and health status.

RESULTS

Happiness was correlated with life satisfaction - Pseudo r-squared = 0.311, -2LL = 810.36, χ(2) = 161.60, P < 0.0001. Life satisfaction was determined by happiness - Pseudo r-squared = 0.321, -2LL = 1069.30, χ(2) = 178.53, P < 0.0001. H ealth status was correlated with health status age, income, education and area of residence - Pseudo r-squared = 0.313, -2LL = 810.36, χ(2) = 161.60, P < 0.0001.

CONCLUSION

The current study refuted the empirical finding that self-reported happiness depends on perceived health status for older men in Jamaica.

The Jamaica asthma and allergies national prevalence survey: rationale and methods

Background

Asthma is a significant public health problem in the Caribbean. Prevalence surveys using standardized measures of asthma provide valid prevalence estimates to facilitate regional and international comparisons and monitoring of trends. This paper describes methods used in the Jamaica Asthma and Allergies National Prevalence Survey, challenges associated with this survey and strategies used to overcome these challenges.

Methods/Design

An island wide, cross-sectional, community-based survey of asthma, asthma symptoms and allergies was done among adults and children using the European Community Respiratory Health Survey Questionnaire for adults and the International Study of Asthma and Allergies in Children. Stratified multi-stage cluster sampling was used to select 2, 163 adults aged 18 years and older and 2, 017 children aged 2-17 years for the survey. The Kish selection table was used to select one adult and one child per household. Data analysis accounted for sampling design and prevalence estimates were weighted to produce national estimates.

Discussion

The Jamaica Asthma and Allergies National Prevalence Survey is the first population- based survey in the Caribbean to determine the prevalence of asthma and allergies both in adults and children using standardized methods. With response rates exceeding 80% in both groups, this approach facilitated cost-effective gathering of high quality asthma prevalence data that will facilitate international and regional comparison and monitoring of asthma prevalence trends. Another unique feature of this study was the partnership with the Ministry of Health in Jamaica, which ensured the collection of data relevant for decision-making to facilitate the uptake of research evidence. The findings of this study will provide important data on the burden of asthma and allergies in Jamaica and contribute to evidence-informed planning of comprehensive asthma management and education programs.

Prevalence of prehypertension and its relationship to risk factors for cardiovascular disease in Jamaica: analysis from a cross-sectional survey

BACKGROUND

Recent studies have documented an increased risk of cardiovascular disease (CVD) in persons with systolic blood pressures of 120-139 mmHg and/or diastolic blood pressures of 80-89 mmHg, classified as prehypertension in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. In this paper we estimate the prevalence of prehypertension in Jamaica and evaluate the relationship between prehypertension and other risk factors for CVD.

METHODS

The study used data from participants in the Jamaica Lifestyle Survey conducted from 2000-2001. A sample of 2012 persons, 15-74 years old, completed an interviewer administered questionnaire and had anthropometric and blood pressure measurements performed by trained observers using standardized procedures. Fasting glucose and total cholesterol were measured using a capillary blood sample. Analysis yielded crude, and sex-specific prevalence estimates for prehypertension and other CVD risk factors. Odds ratios for associations of prehypertension with CVD risk factors were obtained using logistic regression.

RESULTS

The prevalence of prehypertension among Jamaicans was 30% (95% confidence interval [CI] 27%-33%). Prehypertension was more common in males, 35% (CI 31%-39%), than females, 25% (CI 22%-28%). Almost 46% of participants were overweight; 19.7% were obese; 14.6% had hypercholesterolemia; 7.2% had diabetes mellitus and 17.8% smoked cigarettes. With the exception of cigarette smoking and low physical activity, all the CVD risk factors had significantly higher prevalence in the prehypertensive and hypertensive groups (p for trend < 0.001) compared to the normotensive group. Odds of obesity, overweight, high cholesterol and increased waist circumference were significantly higher among younger prehypertensive participants (15-44 years-old) when compared to normotensive young participants, but not among those 45-74 years-old. Among men, being prehypertensive increased the odds of having > or =3 CVD risk factors versus no risk factors almost three-fold (odds ratio [OR] 2.8 [CI 1.1-7.2]) while among women the odds of > or =3 CVD risk factors was increased two-fold (OR 2.0 [CI 1.3-3.8])

CONCLUSION

Prehypertension occurs in 30% of Jamaicans and is associated with increased prevalence of other CVD risk factors. Health-care providers should recognize the increased CVD risk of prehypertension and should seek to identify and treat modifiable risk factors in these persons.

Knowledge and perceptions of diabetes in a semi-urban Omani population

Background

Diabetes mellitus is a major public health problem in the Sultanate of Oman. This study aimed to evaluate the knowledge and perception of diabetes in a sample of the Omani general population, and the associations between the elements of knowledge and perception, and socio-demographic factors.

Methods

The study was carried out in two semi-urban localities. A total of 563 adult residents were interviewed, using a questionnaire specifically designed for the present study. In addition to demographic information, the questionnaire contained questions on knowledge related to diabetes definition, symptoms, risk factors, complications and preventative measures, as well as risk perception for diabetes.

Results

Knowledge of diabetes was suboptimal. The percentages of correct responses to questions on diabetes definition, classical symptoms, and complications were 46.5%, 57.0%, and 55.1%, respectively. Only 29.5%, 20.8% and 16.9% identified obesity, physical inactivity and a positive family history, respectively, as risk factors for diabetes. A higher level of education, a higher household income, and the presence of a family history of diabetes were found to be positively associated with more knowledge.

Conclusion

This study demonstrated that there is lack of awareness of major risk factors for diabetes mellitus. Level of education is the most significant predictor of knowledge regarding risk factors, complications and the prevention of diabetes. Given that the prevalence of diabetes has increased drastically in Oman over the last decade, health promotion seems essential, along with other means to prevent and control this emerging health problem.

Comparison of generic versus specific quality-of-life scales for mesh hernia repairs

BACKGROUND

With the use of mesh shown to considerably reduce recurrence rates for hernia repair and the subsequent improvement in clinical outcomes, focus has now been placed on quality-of-life outcomes in patients undergoing these repairs, specifically, as they relate to the mesh prosthesis. Traditionally, quality of life after hernia surgery, like many other medical conditions, has been tested using the generic SF-36 survey. The SF-36 quality-of-life survey, although well studied and validated, may not be ideal for patients undergoing hernia repairs. We propose a new quality-of-life survey, the Carolinas Comfort Scale (CCS), pertaining specifically to patients undergoing hernia repair with mesh; our goal was to test the validity and reliability of this survey.

STUDY DESIGN

The CCS questionnaire was mailed to 1,048 patients to assess its acceptability, responsiveness, and psychometric properties. The survey sample included patients who were at least 6 months out after hernia repair with mesh. Patients were asked to fill out the CCS and the generic SF-36 questionnaires, four questions comparing the two surveys, and their overall satisfaction relating to their hernia repair and mesh.

RESULTS

The reliability of the CCS was confirmed by Cronbach's alpha coefficient (0.97). Test-retest validity was supported by the correlation found between two different administrations of the CCS; both Spearman's correlation coefficient and the kappa coefficient were important for each question of the CCS. Assessment of its discriminant validity showed that both the mean and median scores for satisfied patients were considerably lower than those for dissatisfied patients. Concurrent validity was demonstrated by the marked correlations found between the CCS and SF-36 questionnaire scales. When comparing the two surveys, 72% of patients preferred the CCS questionnaire, 80% believed it was easier to understand, 66% thought it was more reflective of their condition, and 69% said they would rather fill it out over the SF-36.

CONCLUSIONS

The CCS better assesses quality of life and satisfaction of patients who have undergone surgical hernia repair than the generic SF-36.