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ISSN: 1920-4159
Journal of Applied Pharmacy
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A Cross-sectional Study Assessing Knowledge Attitude and Practice of Diabetic Patients at Tertiary Care Hospitals of Twin of Pakistan

Sana Kanwal*, Tahir Aqeel Malik, Noman M, Arsalan- ur -Rehman, Riaz M, Abd-ur-Rehman H and Bilal Shah SM

Department of Pharmacy, The University of Lahore, Islamabad campus, Pakistan

*Corresponding Author:
Sana Kanwal
Lecturer Clinical Pharmacy Department of Pharmacy
The University of Lahore, Islamabad campus, Pakistan
Tel: 092-051- 2604494
E-mail: [email protected] pharm.uol.edu.pk

Received date: October 23, 2015; Accepted date: November 21, 2015; Published: November 29, 2015

Citation: Kanwal S, Malik TA, Noman M, Rehman A, Riaz M, et al. (2015) “A Cross-sectional Study Assessing Knowledge Attitude and Practice of Diabetic Patients at Tertiary Care Hospitals of Twin of Pakistan”. J App Pharm 8:210. doi: 10.4172/1920-4159.1000210

Copyright: © 2015 Kanwal S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Diabetes mellitus is one of the prevalent chronic diseases that can be managed by life style modification. Disease can be controlled effectively by providing proper knowledge and awareness regarding disease. The lack of knowledge among the patients has been regarded as the major factor in disease propagation. The present study aims to assess the knowledge, attitude and practice of diabetic patients.

Objective: To assess knowledge, attitude and practice of diabetic patients at tertiary care hospitals of twin cities of Pakistan.

Methodology: Descriptive cross-sectional study was conducted in tertiary health care centers of Rawalpindi and Islamabad. Respondents were diabetic patients seeking health care from tertiary care centers. Data was collected using a structured questionnaire and analyzed by SPSS. Descriptive statistics and chi square test were applied to determine frequency and association relation between dependent and independent variables.

Results: Among 250 patients 159 were male and 91 were female. Diabetes was more prevalent among people of 40-70 years age. Most of the patients were less educated, only few of them were graduates (14.7%). Most of the patients had positive family history of Diabetes (60%). Most of the patients had inadequate knowledge about disease (54%). Only 35% patients knew normal fasting blood glucose level range.

Conclusion: Lack of knowledge and awareness about disease was common among diabetic patients which indicated loopholes in patient counseling. The study highlights the need for conducting awareness program regarding diabetes management and lifestyle modification among diabetic patients. Moreover health care providers should be trained to provide effective counseling to diabetic patients.

Keywords

Diabetes; Knowledge; Attitude; Practice; Twin cities; Pakistan

Introduction

Diabetes mellitus is a disease of metabolic dysregulation, most notably abnormal glucose metabolism, accompanied by characteristic long-term complications [1]. Diabetes is one of the most prevalent chronic diseases. As of 2013, 382 million people have been suffering from diabetes worldwide [2]. Rate of diabetes is higher in the developing countries [3]. According to a survey carried out by the Diabetic Association of Pakistan prevalence of diabetes in Pakistan is around 10% [4]. According to World Health Organization (WHO) Pakistan is currently 8th in the world ranking of diabetes. Considering rising trend of diabetes prevalence it will become 4th by the year 2025 with nearly 14.3 million diabetics [5]. Diabetes resulted in 1.5 million deaths in 2012, making it the 8th leading cause of death. More than 80% of diabetic deaths occur in low and middle-income countries [6]. The increase morbidity rate of diabetes in developing countries is most likely due to trend of urbanization and lifestyle changes, including changes in dietary habits. This has suggested an environmental (i.e., dietary) effect, but there is little understanding of the mechanism as well [7]. Patient counselling is important in adequate management of diabetes mellitus. The ultimate goal of this counselling is to provide information directed at encouraging the safe and appropriate use of drugs, thereby enhancing therapeutic outcomes [8]. Diabetes management depends not only on drug therapy but also on physical exercise, diet, and other lifestyle changes. Several studies have confirmed that the complications of diabetes can be reduced by proper control of blood glucose. Patients’ understanding regarding disease improves when pharmacists provide them with useful, practical information [9-11]

Patient education is an important intervention for prevention of complications [12,13]. A study conducted in Nepal using the same procedure of KAP questionnaire it clearly indicates the need for educational interventions to improve the knowledge, attitude and practices of the diabetic patients [14].

Methodology

Study design: Descriptive cross-sectional study.

Setting: Tertiary health care centres of twin cities (Rawalpindi and Islamabad) of Pakistan.

Respondent: Diabetic patients seeking health care from tertiary health care settings.

Ethical requirements: Consent was taken from the patients. Permission was granted by the ethical committee of The University of Lahore Islamabad campus.

Data collection tool: Structured questionnaires were administered to diabetic patients however questions were asked verbally to illiterate patients.

Tool validity: Focus group discussion and pilot testing were carried out to determine reliability of data collection tool.

Data analysis: Data was coded and analysed by SPSS (version 16). Descriptive statistics were applied to find frequency and chi square test was applied to determine the association between dependent and independent variables.

Sample technique and sample size: Five well known tertiary health care centres (public/ private) of Rawalpindi and Islamabad were visited from where patients were selected using convenient sampling technique. There were 250 diabetic patients conveniently selected who were seeking health care in outpatient department and diabetic clinics within tertiary health care hospitals during April to June, 2015.

Result and Analysis

In our study 250 diabetic patients were selected among which 63.6% (n=159) were male and rest of 36.4% (n=91) were female. Sociodemographic characteristics are shown in Table 1 and 2 Most of the patients had positive family history of diabetes (59% n=147) whereas 41% patients had no family history of disease.

  Socio Demographic  Characteristics
  Frequency Percent
Gender Male 159 63.6
Female 91 36.4
Total 250 100.0
Age 12-25 12 4.8
26-45 80 32.0
46-55 85 34.0
56-65 66 26.4
>65 7 2.8
Total 250 100.0
Education <Matric 91 36.4
Matric 89 35.6
High school 48 19.2
Graduate 17 6.8
Masters 5 2.0
Total 250 100.0
Monthly income
(Rs)
>50,000 25 10.0
30,000-50,000 89 35.6
15,000-30,000 116 46.4
5,000-15,000 20 8.0
  Total 250 100.0

Table 1: Socio demographic characteristics.

  Family History
  Frequency Percent
Response Yes 147 58.8
No 102 40.8
Don’t know 1 0.4
Total 250 100.0

Table 2: Family history.

Knowledge regarding diabetes was assessed by asking questions given in Table 3. Only 35% (n=87) patients knew that diabetes is characterized by higher blood glucose level than normal. Majority of patients (36% n=90) characterized diabetes by increase urination. Knowledge regarding normal blood glucose level range was also assessed. Out of 250 patients only 35% (n=88) knew the normal range of blood glucose level rest of the patients were unaware as indicated in Table 3-5.

Assessing knowledge of diabetic patients
Diabetes is a condition in which body contains?
  Frequency Percent
  A high level of sugar in the blood than normal 87 34.8
A low level of sugar in the blood than normal 28 11.2
Don't know 135 54.0
Total 250 100.0
Symptoms of diabetes are?
  Frequency Percent
  Increased frequency of urination 90 36.0
Increased thirst and hunger 64 25.6
Increased tiredness 53 21.2
Slow healing of wounds 5 2.0
Don't know 38 15.2
Total 250 100
The important factors that help in controlling blood sugar? Frequency Percent
  Controlled and planned diet 45 18.0
Regular exercise 71 28.4
Medication 72 28.8
Don't know 62 24.8
  250 100
The normal value of fasting blood glucose (mg/dl) Frequency Percent
  40-60 36 14.4
60-110 88 35.2
110-150 18 7.2
150-170 4 1.6
>180 1 .4
Don't know 103 41.2
  250 100

Table 3: Assessing knowledge of diabetic patients.

Assessment of attitude of diabetic patients
 Upon normalizing blood glucose level
  Frequency Percent
  Medicine should be stopped immediately 76 30.4
Medicine should be stopped gradually 34 13.6
Medicine should be continued 21 8.4
Don't know 119 47.6
  250 100
Do you think diabetes can be managed?
  Frequency Percent
  Yes 92 36.8
No 93 37.2
Don’t know 65 33
  250 100
Diabetes if not treated?
  Frequency Percent
  Can lead to eye infection 28 11.2
Can lead to kidney problems 76 30.4
Can lead to foot ulcers 17 6.8
Can lead to heart problems 17 6.8
Don't know   112   44.8
  Total 250 100.0

Table 4: Assessment of attitude of diabetic patients.

Assessment of practice of diabetic patients
Do you miss taking the doses of your diabetes medication?
  Frequency Percent
  No 93 37.2
Occasionally 72 28.8
Once a week 45 18.0
Once a month 40 16.0
Total 250 100.0
Are you following a planned diet?
  Frequency Percent
  Yes 117 47
No 133 53
Total 250 100.0
When your blood pressure was last checked?
  Frequency Percent
  1 week ago 106 42.4
1 month ago 82 32.8
2 months ago 26 10.4
6 months ago 15 6.0
1 year ago 21 8.4
Total 250 100.0
Do you exercise regularly?
  Frequency Percent
  Yes 74 29.6
No 176 70.4
Total 250 100.0

Table 5: Assessment of practice of diabetic patients.

Attitude and practice were also assessed as given in Table 4 and 5. Most of the patients didn’t know whether the medicine should be continued or not. Among rest of patients most of them thought that once the blood glucose level get normalized medicine should be stopped immediately. More than half of the studied patients (53%) were not following the planned diet. Only 30% (n=74) patients were practicing exercise regularly Table 6-14.

P=0.001
  The normal value of fasting blood glucose(mg/dl) Total
40-60 60-110 110-150 150-170 180> I don't know
Gender Male 27 63 13 3 0 53 159
Female 9 25 5 1 1 50 91
Total 36 88 18 4 1 103 250

Table 6: Knowledge regarding normal blood glucose value among diabetic patients of different genders.

P=0.023
  Do you exercise regularly? Total
Yes no
Gender Male 55 104 159
Female 19 72 91
Total 74 176 250

Table 7: Exercise practice among diabetic patients of different genders.

P<0.001
  When your blood pressure was last checked? Total
1 week ago 1 month ago 2 months ago 6 months ago 1 year ago
Age 12-25 8 3 0 1 0 12
26-45 41 30 5 2 2 80
46-55 30 41 7 7 0 85
56-65 27 8 12 0 19 66
65> 0 0 2 5 0 7
Total 106 82 26 15 21 250

Table 8: Blood pressure monitoring practice among diabetic patients of different age groups.

P=0.008
  Diabetes is a condition in which body contains? Total
A high level of sugar in the blood than normal A low level of sugar in the blood than normal I don't know
Education <Metric 38 3 50 91
Metric 18 8 63 89
High school 14 17 17 48
Graduate 12 0 5 17
Masters 5 0 0 5
Total 87 28 135 250

Table 9: Knowledge regarding diabetic complication among diabetic patients of different educational status.

P<0.001
  Diabetes if not treated may leads to? Total
 Eye disease Kidney     Foot ulcers  Heart problems I don't know
problems
Education <Metric 2 32 4 1 52 91
Metric 8 24 7 1 49 89
High school 12 17 2 11 6 48
Graduate 5 3 1 3 5 17
Masters 1 0 3 1 0 5
Total 28 76 17 17 112 250

Table 10: Compliance to anti diabetic medication among diabetic patients of different educational status.

P<0.001
  Do you miss taking the doses of your diabetic medication? Total
No Occasionally Once a week Once a month
Education <Metric 9 37 36 9 91
Metric 41 13 7 28 89
High school 27 17 1 3 48
Graduate 11 5 1 0 17
masters 5 0 0 0 5
Total 93 72 45 40 250

Table 11: Attitude regarding management of diabetes among diabetic patients of different educational status.

P=0.004
  Do you think diabetes can be managed? Total
Yes No Don’t know  
Education <Metric 22 44 25 91
Metric 29 45 15 89
High school 21 4 23 48
Graduate 16 0 1 17
Masters 4 0 1 5
Total 92 93 65 250

Table 12: Compliance to dietary modification among diabetic patients of different educational status.

P=0.04
  Are you following a planned diet? Total
Yes No Seldom  
Education <Metric 24 67 0 91
Metric 65 24 0 89
High school 12 34 2 48
Graduate 10 7 0 17
Masters 5 0 0 5
Total 116 132 2 250

Table 13: Dietary practice among diabetic patients of different educational status.

P<0.001
  Do you exercise regularly? Total
Yes No
Education <Metric 21 70 91
Metric 19 70 89
High school 20 28 48
Graduate 9 8 17
Masters 5 0 5
Total 74 176 250

Table 14: Exercise practice among diabetic patients of different educational status.

Chi-square test was applied to determine association between variables (dependent and independent). Significant association was found between Gender and Knowledge (Table 6) Most of females didn’t know normal value of blood glucose level (P=0.001) and significant association was found between Gender and Exercise habit (P=0.023), i.e., females were less likely to follow exercise practice than males (Table 7). Moreover significant association was found between Age and B.P monitoring frequency (P<0.001). Diabetic patients between 12-25 ages monitored their last B.P value most recently, i.e., 1 week ago. Patients between 46-55 ages were more likely to take medicine regularly (Table 8). Patients who were more educated had better knowledge regarding disease aetiology, normal fasting blood glucose value, potential complications moreover they had regular exercise practice and better compliance to medication (Table 9-11,14). Education status appeared to be associated with positive attitude regarding disease management (P=0.004) and compliance to planned diet (P=0.04) (Table 12 and 13).

Conclusion

Lack of awareness among diabetic patients is the prime factor causing diabetic complications. Education and awareness regarding disease aetiology, risk factors, management, complications and life style modification should be provided to patients for achieving better outcome. The results also reflected the loopholes in our health care system regarding patients counselling. It highlighted the need for educational intervention such as public awareness programs regarding diabetes management. Moreover health care professionals need to be trained enough to provide counselling in effective manner.

Limitations

Impact of education and counselling practices need to be assessed by conducting interventional studies in future. Moreover as data has been collected via questionnaire hence practice couldn’t be reliably assessed. In order to assess disease management practices of patients reliably, household data need to be collected in this regard. Large scale study should be conducted in order to design diabetes awareness program at national level.

References

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