Determinants of knowledge, attitude and practice in patients with both type 2 diabetes and chronic kidney disease in Fiji

Chronic disease relapses: A cross-sectional study of the associated factors and socioeconomic inequalities during the COVID-19 pandemic in Peru

OBJECTIVES

To investigate the prevalence, associated factors and socioeconomic inequalities in chronic disease relapses (CDR) during 2020 in Peru.

METHODS

A secondary analysis was made of the National Household Survey on Living Conditions and Poverty (ENAHO) 2020. Participants older than 18 years who suffered from a chronic disease and with information about the occurrence of a CDR in the last 4 weeks prior to the survey were included. Adjusted prevalence ratios (aPRs) were estimated to determine the associated factors. Socioeconomic inequality in CDR was estimated using concentration curves (CC) and the Erreygers concentration index (ECI).

RESULTS

Data from 38,662 participants were analyzed; the prevalence of CDR in the last 4 weeks prior to the survey was 16.5% (95% CI: 15.8-17.2). Being female (aPR 1.29; 95% CI: 1.21-1.37), with regards to being male; being 30-39 (aPR 1.22; 95% CI: 1.05-1.42), 40-49 (aPR 1.29; 95% CI: 1.12-1.48), 50-59 (aPR 1.60; 95% CI: 1.41-1.82), and 60 years or older (aPR 1.80; 95% CI: 1.58-2.04), compared to 18-29; reaching up to primary (aPR 1.18; 95% CI: 1.07-1.31), or secondary education (aPR 1.13; 95% CI: 1.02-1.24), in contrast to tertiary education; presenting some physical, psychological or cognitive limitation (aPR 1.33; 95% CI: 1.21-1.46), with respect to experiencing no limitations; and being affiliated to a health insurance (aPR 1.18; CI 95%: 1.09-1.29), opposed to not having health insurance; were associated with a higher probability of CDR. Residing in the natural region of the coastal area (aPR 0.83; 95% CI: 0.74-0.92) was associated with a lower probability of relapse compared to residing in the jungle area. In people with limitations and residents of the jungle areas, the prevalence of CDR was concentrated in those with higher per capita spending.

CONCLUSIONS

Approximately 1 in 6 Peruvians with chronic diseases had a relapse within the last 4 weeks prior to the survey of 2020 and certain geographic and sociodemographic factors were found to be associated with CDR. It was also found that a higher concentration of CDR was observed in the population with the highest per capita spending with some limitations, as well as in residents of the jungle, implying the need for appropriate policy interventions that address CDR with a special focus on these populations.

Knowledge, Attitude, and Practice Regarding Diabetes Mellitus Among Type 2 Diabetic Patients Attending Primary Health Care Centers in the Jazan Region of Saudi Arabia

Background

Diabetes mellitus is a disease whose dramatic increase in prevalence worldwide poses a global health crisis. Saudi Arabia has the seventh highest rate of diabetes in the world and the second highest rate in the Middle East. The incidence of diabetes has risen due to insufficient knowledge, attitude, and practice surrounding the disease. Saudis’ quality of life has decreased due to the recent rise in diabetes-related mortality and illnesses. Hence, leading healthy lives requires patients to have positive attitudes and self-awareness, which will eventually contribute to reducing diabetes mellites-related complications.

Methods

A cross-sectional study among patients with type 2 diabetes mellites (T2DM) in the Jazan region of Saudi Arabia was conducted to assess Saudi adults’ knowledge, attitude, and practice (KAP) regarding the disease. The patients participated in the study by filling in a questionnaire. Data analysis was carried out using R software, version 4.0.5 (R Studio: Integrated Development for R, Boston, MA) and the analysis included general sample demographics. KAP scores were the dependent variables. Following the sample description, regression analysis was performed to examine the adjusted relationships between KAP factors and independent variables. The impact of all independent variables on KAP variables was examined using multiple linear regression analysis. A p-value of less than 0.05 was considered significant, and the beta coefficient was applied to estimate the associations between the independent variables and the KAP variables. 

Results

A total of 424 participants were involved in this study, with 194 male participants and 230 female participants. The mean duration of having T2DM was 7.63 ± 7.19 years. More than half of the study participants had a degree (58.49%), and nearly half were employed (42.45%). Married participants had higher knowledge and attitude scores than single and divorced or widowed participants (9.19 ± 3.38, 80.14 ± 14.72, respectively). In comparison, divorced or widowed participants had higher practice scores than single and married participants (16.35 ± 7.42). Participants with higher education attainment had higher knowledge and attitude scores than those with no degree (9.54 ± 3.39, 80.58 ± 17.57, respectively), whereas participants with no degree demonstrated higher practice scores (16.85 ± 8.3) than those with degrees. In examining the study participants’ KAP scores, we found knowledge to be insufficient in 51.2% and sufficient in 48.8% of the participants. Of the participants, 7.8% were found to have negative attitude levels and 92.2% were found to have positive attitude levels. Finally, study participants’ practice levels were found to be negative in 24.8% and positive in 75.2% of participants.

Conclusions

This study revealed that patients have gaps in their knowledge, attitude, and practice in regard to T2DM. In this study, associations and correlations were established between KAP scores and the sociodemographic characteristics of the patients. The findings of this study could be helpful to policymakers, decision-makers, health care professionals, and patient advocacy groups in developing interventions to improve the health outcomes in T2DM patients.

Health Care Workers' Perceptions on Factors Affecting Diabetes Self-Management Among Type 2 Diabetes Mellitus Patients in Fiji: A Qualitative Study

Background

Type 2 Diabetes Mellitus (T2DM) is known as a major cause of mortality globally. Diabetes self-management refers to daily activities undertaken to control or reduce the impact of diabetes on health and well-being to avoid further illness. Health Care Workers' (HCWs) can assist patients to be aware of self-care and solve the challenges diabetes presents. The management of diabetes can improve once HCWs promote measures that facilitate self-care activities by providing necessary information and supporting patients' initiatives to make lifestyle changes. This study aimed to explore HCWs perceptions on factors affecting diabetes self-management among T2DM patients of Fiji.

Methods

A qualitative study design was conducted to explore HCWs perceptions on factors affecting diabetes self-management using two Focus Group Discussions (FGDs) in Labasa, Fiji in 2021. The study settings were the Diabetic Hub Center, special outpatient department Labasa hospital and Nasea health Center Labasa. The study settings are located in an urban area. These health facilities provide special outpatient clinics to T2DM patients including clinics for other medical conditions. Nasea Health Center had 1,300 patients, the special outpatient's department Labasa hospital had 560 patients and the diabetic hub center Labasa had 295 patients at the time of the study. These patients either had T2DM or T2DM with other medical conditions. Purposive sampling was employed to recruit HCWs. The data were collected using an interview guide in semi-structured interviews and the interviews were audio recorded. The recorded data was transcribed verbatim and analyzed using thematic analysis process.

Results

The participants were 9 HCWs with age range of 25-49 years. A counselor, a medical officer, physiotherapist, nurses and dieticians were among the HCWs. Three major themes and seven sub themes were identified. These included Theme 1- "availability of services" with the sub themes of clinical services for T2DM and other support services available for T2DM patients. Theme 2- "barriers and challenges to diabetes self-management" with the sub themes of health system factors, socioeconomic factors and health system factors. Theme 3- "Needs for diabetes management" with the sub themes resources and skilled personnel.

Conclusion

The findings of this study demonstrate health system challenges such as lack of material resources and human resources compounded the factors affecting diabetes self-management. HCWs training as diabetes educators and developing policy on diabetes self-management are highly recommended to facilitate diabetes self-management.

Assessing Outpatients' Knowledge, Attitude, and Practice Toward Managing Diabetes in Saudi Arabia

INTRODUCTION

When it comes to non-communicable diseases like diabetes, inadequate knowledge, attitude, and practice are often linked to poor health outcomes. This study aims to assess the patients' knowledge, attitude, and practice (KAP) of diabetes in the outpatient department of a university teaching hospital in Saudi Arabia.

METHODOLOGY

In this cross-sectional study, diabetes type 2 patients attending outpatient departments at a university teaching hospital, Riyadh, were assessed regarding their knowledge, attitude, and practice toward diabetes using a validated KAP scale. Descriptive and inferential analysis was done to determine the factors associated with KAP score using SPSS version 26.0 software (SPSS Inc., Chicago, IL, U.S.).

RESULTS

Males made up 69.7% of the sample (n = 165), while 56.9% were between the ages of 41 and 75. The level of knowledge and practice had "good" in 37.6%, and 47.9%, respectively, but level of attitude had "positive" in 30.9% of patients. The association between knowledge tier and gender (p0.014) and insurance status (p0.008), respectively, was shown to be significant. However, the attitude tier was only significantly associated with gender (P = .003). The practice tier also showed a significant age association (P = .049). As regards, the mean scores for diabetes-related knowledge were higher only among insured participants (P = .03) than for other participants' sociodemographic factors. Meanwhile, the mean attitude scores were also higher among males (P = .006) than for other sociodemographic characteristics. A comparison of the participants' sociodemographic characteristics found no statistically significant variations in practice scores.

CONCLUSION

Unfortunately, this study found that outpatient diabetes patients had insufficient knowledge, practice, and a negative attitude toward diabetes type 2. This imposes a great burden on healthcare workers and hence the healthcare system to improve patient scores via diabetes education programs or pharmacist-led patient counseling initiatives.

Knowledge, Attitude, and Practices (KAP) of Diabetics Towards Diabetes and Diabetic Retinopathy in Riyadh, Saudi Arabia: Cross-Sectional Study

BACKGROUND

Diabetes mellitus (DM) and its complication present a major morbidity burden among Saudi population. Awareness and proper knowledge of this highly prevalent disease is crucial to enhance early detection and proper intervention. Therefore, the main aim of this study was to identify the knowledge, attitude, and practices (KAP) of diabetic patients towards diabetes and diabetic retinopathy in Riyadh, Saudi Arabia.

METHODS

This cross-sectional study was conducted in 50 randomly selected primary care centers and two university hospitals in Riyadh, Saudi Arabia, between May and December 2018. Diabetic patients ≥18 years old were enrolled in the study. A validated KAP-45 questionnaire was used to assess the KAP levels of diabetics towards diabetes and diabetic retinopathy.

RESULTS

A total of 313 participants were enrolled in the study. The majority were males 168 (59.8%). The median age was 49 ±24, and the median duration of diabetes was 8 ±11 years. The average knowledge score for diabetes was 10 (good). While the average knowledge score for diabetic retinopathy was 4.5 (suboptimal). The average attitude scores for both diabetes and diabetic retinopathy were 0 and 2 (suboptimal), respectively. The average practice score for diabetes was 5 (good) while it was 3 (low) for diabetic retinopathy. The most common barrier to comply with regular follow-up was inadequate knowledge about the importance of periodic eye exam 47.1% (107). Patients with low socio-economic status had a significantly poor knowledge regarding diabetes (P<0.0001) and diabetic retinopathy (P<0.015), respectively. However, patients with low educational level had a significantly poor knowledge (p<0.0001) and poor practice regarding diabetes (P<0.013), respectively.

CONCLUSION

It is important to improve education and awareness of DM and diabetic retinopathy among diabetics, as it's essential for controlling the disease and reducing its complications, by improving patient compliance to treatment and follow-up.

Knowledge, Attitude and Practice of Elderly Outpatients with Type 2 Diabetes Mellitus in National Geriatric Hospital, Vietnam

BACKGROUND

Diabetes-related complications have become increasingly prevalent and complicated to manage, especially among frail older adults with co-morbidities, poor physical function, and impaired cognition. Thus, knowledge, attitude, and practice (KAP) of elderly diabetic patients play an essential role in controlling the disease and its complications.

PATIENTS AND METHODS

A cross-sectional study was conducted on 176 diabetic patients at the outpatient clinics, National Geriatric Hospital, Hanoi, Vietnam from August to November 2015. Patients' knowledge, attitude, and practice regarding diabetes mellitus were assessed using a structured questionnaire. Exploratory factor analysis and multivariate Tobit regression model were used to identify factors associated with knowledge, attitude, practice about diabetes mellitus.

RESULTS

Of 176 diabetic patients, patients' knowledge was divided into two main groups: "Diabetes definition and management" (mean score = 57.7 ± 25.6) and "Targets for diabetic control" (mean score = 66.1 ± 30.4). Patients scored high points of attitudes toward diabetes severity and its complications (mean score = 95.8 ± 13.0); however, knowledge and practice scores were only moderate (mean score = 68.1 ± 16.8). There were only 8.5% of people having daily self-blood glucose monitoring. Advanced age, low educational level, rural area, and duration of diabetes less than 5 years were negative associated with knowledge, attitude, and practice regarding diabetes mellitus. This study also shows that frailty and co-morbidities/diabetic complications could impair patients' knowledge.

CONCLUSION

Older patients with diabetes had high levels of perceived severity attitudes on diabetes mellitus. However, the knowledge and practice levels were still inadequate. Pragmatic diabetic health literacy, counseling and education programs, as well as home-based treatments are viable options to improve health outcomes.