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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 29  |  Issue : 4  |  Page : 1060-1065

Self-care knowledge among type 2 diabetic patients attending primary healthcare centers, Cairo governorate


1 Department of Family Medicine, Faculty of Medicine, Menoufia University, Egypt
2 Family Medicine, MOH, Egypt

Date of Submission10-Jun-2015
Date of Acceptance15-Aug-2015
Date of Web Publication21-Mar-2017

Correspondence Address:
Aml A Salama
Department of Family Medicine, Faculty of Medicine, Shbeen El-koom District, Menoufia Governorate, 32511
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.202508

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  Abstract 

Objective
The aim of this study was to assess knowledge about self-care among type 2 diabetic patients attending primary healthcare centers.
Background
Self-care in diabetes has been defined as an evolutionary process of development of knowledge or awareness by learning how to survive with the complex nature of diabetes in a social context. Because the vast majority of day-to-day care in diabetes is handled by the patients and/or their families, there is an important need for reliable and valid measures for self-care in diabetes.
Patients and methods
The study was a cross-sectional study carried out on 200 diabetic patients attending the outpatient clinic in Ramlet Bolak Primary Health Care Unit in west Cairo city who were registered during 2014–2015. The sample size was calculated on the basis of the total number of type 2 diabetic patients during the past 12 months and the prevalence rate from previous studies, which was from 4.07 to 19.8%, using Epi Info at 95% confidence interval. The center was chosen because of its high flow of diabetic patients who were visiting the health unit regularly every month across different socioeconomic strata. The selected patients were assessment on their knowledge and practice of self-care and were subjected to laboratory investigations (HbA1c).
Results
The studied groups were divided on the basis of HbA1c into the controlled and the uncontrolled group. The mean score of knowledge on what is diabetes, its complications, symptoms of hypoglycemia, symptoms of hyperglycemia, importance of kidney function follow-up, follow-up by ECG, and follow-up by fundus examination was higher in the controlled group. Further, the mean score of practice regarding diabetes self-care, such as following a diet regimen, physical activity, foot care, frequency of visiting the physician, and self-monitoring of blood glucose and taking medication was higher in the controlled group.
Conclusion
There was a statistically significant relation between the level of knowledge about diabetes self-care and lifestyle modification and HbA1c. This means that, with increasing knowledge and practice about self-care, good diabetic control will be achieved.

Keywords: knowledge, self-care, type 2 diabetes mellitus


How to cite this article:
Farahat TM, Salama AA, Essa LE. Self-care knowledge among type 2 diabetic patients attending primary healthcare centers, Cairo governorate. Menoufia Med J 2016;29:1060-5

How to cite this URL:
Farahat TM, Salama AA, Essa LE. Self-care knowledge among type 2 diabetic patients attending primary healthcare centers, Cairo governorate. Menoufia Med J [serial online] 2016 [cited 2020 Oct 1];29:1060-5. Available from: http://www.mmj.eg.net/text.asp?2016/29/4/1060/202508


  Introduction Top


Diabetes mellitus (DM) is one of the most common noncommunicable diseases and is one of the major public health challenges facing the world. There has been a rapid increase in the incidence of DM. Much of this increase occurs in developing countries and results from aging, following an unhealthy diet, obesity, and a sedentary lifestyle [1].

Self-management and education about diabetes are essential elements of diabetes care [2],[3].

Components of diabetes self-care involve the following: following a diet plan, reduction of weight if obese, increasing physical activity, smoking cessation, self glucose monitoring, foot care, and psychological support [4].


  Objective Top


The aim of the study was to assess the level of knowledge and practice of self-care among type 2 diabetic patients attending primary healthcare centers in west Cairo governorate.


  Patients and Methods Top


This was a cross-sectional study conducted in Ramlet Bolak Primary Health Care Unit, which was randomly selected from among healthcare units of west Cairo governorate. The sample size was calculated on the basis of the total number of type 2 diabetic patients during the period of the study and the prevalence rate from previous studies, which was from 4.07 to 19.8%, using the Epi Info program (Atlanta, Georgia, USA) with 95% confidence interval (CI), depending on the total number of adult population in the selected area. The center was chosen because of its high flow of diabetic patients visiting the health unit regularly every month across different socioeconomic strata.

Assessment was done before starting the study by detecting the flow in the center and by checking the medical file of each patient. The study was conducted from June 2014 to June 2015.

A total of 200 diabetic patients completed the study. Human rights and ethical considerations were followed during the study with total confidentiality of any obtained data. Consent was taken from the participants. The Menoufia Faculty of Medicine Committee for Medical Research Ethics formally approved the study before commencement. An official permission letter was obtained from the authorities of Menoufia University and the Menoufia Faculty of Medicine Committee for Medical Research Ethics, which was directed to the administrators of the selected healthcare center. The diabetic patients attending the selected healthcare center were interviewed using a predesigned questionnaire to assess their knowledge about diabetes self-care. The questionnaire was translated into the Arabic language before use. It was submitted to a panel of four experts, who were professors of family medicine and community medicine, to test its validity. The questionnaire included personal data such as age, residence, and socioeconomic status. Assessment was made as per El-Gilany et al. [5]. Knowledge on diabetes was assessed using questions about self-care – for example, what is diabetes, complications of DM, importance of a diet regimen, symptoms of hyperglycemia and hypoglycemia, and follow-up by kidney function fundus examination and ECG. Practice of self-care parameters such as following a diet regimen, physical activity, foot care, frequency of visiting the physician, and self-monitoring of blood glucose and taking medication was also assessed.

The data were tabulated and analyzed using statistical package for the social sciences program (SPSS, version 20; SPSS Inc., Chicago, Illinois, USA) with significance less than 5%. Quantitative data were expressed as mean and SD and compared using t-test.


  Results Top


The present study included 200 cases; 71% of them were female and 29% were male (male to female ratio: 1: 2.44). The mean age of the studied group was 51.43 ± 12.32 years.

Regarding occupation, about 64% of them were unemployed, 15% were traders or businessmen, 8% were skilled workers or farmers, 6% were professionals, 4% were retired, and 3% were unskilled workers.

Regarding residence, about 53% lived in semiurban areas, 38% lived in rural areas, and 9% lived in urban areas.

Regarding the socioeconomic state, 78% had a low socioeconomic standard, 12% had middle socioeconomic standard, and 10% had high socioeconomic standard ([Table 1]).
Table 1 Demographic data of the studied group

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The present study shows that there was a highly significant difference between the controlled and uncontrolled groups as regards knowledge about diabetes self-care ([Table 2]).
Table 2 Comparison of the studied groups as regards their knowledge about diabetes and diabetes control

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Regarding medical care practice, the present study showed that there was a higher percentage of patients in the uncontrolled group who did not follow the medical parameters for control of DM (such as frequent visits to the physician, annual fundus examination, annual kidney function test and ECG, foot examination at every visit, regular dental examination, HbA1c evaluation every 3 months, having a machine to measure blood glucose, frequent measurement of blood glucose) ([Table 3]).
Table 3 Medical care and glucose testing parameters in the studied groups

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As regards diet control, the present study shows that there was a highly significant difference between the controlled and uncontrolled groups with respect to following the doctor's instruction about restricting a high-calorie diet. A higher percentage of adherence was found in the controlled group.

There was a significant difference between the controlled and uncontrolled groups as regards following a diet regimen and having written instructions about a diet regimen. A higher percentage of patients following a diet regimen and having written instructions about a diet regimen were present in the controlled group, as shown in [Table 4].
Table 4 Comparison of diet control in the studied groups

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Regarding foot care parameters, the present study showed that a high percentage of nonadherence to foot care parameters (daily foot wash, drying foot after washing, daily foot inspection, cutting nails) was prevalent in the uncontrolled group (67.7, 71.5, 75.3, and 74.05%, respectively), as shown in [Table 5].
Table 5 Comparison of foot care parameters in the studied groups

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  Discussion Top


In the present study 29% of diabetic patients were male and 71% were female, as shown in [Table 1]. These results are in agreement with those reported by Khamseh et al. [6]. In their study there were more diabetic women than diabetic men (65.5 vs. 34.5%). Tan and Magarey [7] reported a proportion of 65% women and 35% men among the participants in their study. These results disagreed with those reported by Ozcelik et al. [8], who reported that men constituted 62% of the studied group and women of 38%.

As regards patient education 52% were illiterate, 10% could read and write, 7% had basic education, 8% had secondary school level education, 11% had intermediate educational level, 12% were university graduates. There was a statistically significant difference between educational level and control of diabetes.

This finding highlights the importance of education in adapting oneself to life with diabetes and raising awareness of the disease. The major differences between the results of patients with lower education and those of patients with higher education led to the conclusion that there is a highly significant difference between education level and diabetes self-care and control. These results are in line with literature data showing that patients' knowledge and beliefs about diabetes and awareness of most recent hemoglobin A1c test are affected by their education level [9].

In addition, Murugesan et al. [10] reported that patients with lower education level had low awareness. These results are in agreement with those of the present study.

Pace et al. [11] reported that a low education level is a factor that can affect adherence to the pharmacological treatment, because the drugs for the treatment of diabetes are considered complex and require comprehension of their use by the patients. Our study concurs with this.

[Table 1] shows that 64% of our cases were unemployed or housewives, 3% were unskilled workers, 8% were skilled workers, 15% were traders, 4% were retired, and 6% were professionals. Similar results were reported by Murugesan et al. [10]. In their study the proportion of unemployed and retired persons was higher in the diabetic group. Further, in the study by Khamseh et al. [6], 32 (21.6%) participants were employed, 86 (58.1%) were housewives, and 28 (18.9%) were retired.

As regards residence, [Table 1] shows that 38% of participants lived in rural areas, 9% lived in urban areas, and 53% lived in semiurban areas. This result is in agreement with the report on rural African Americans, which revealed that the proportion of rural African Americans who perceived their health as fair or poor, far exceeded that of urban African Americans and rural Whites. Previous data have suggested worse self-perceived health status among rural adults [12],[13]. It would appear that being rural and African American is associated with substantially worse perceived health.

The data indicate that rural African Americans are substantially worse than the other groups in terms of glycemic control, which supports the result of the present study.

Regarding the knowledge of patients about diabetes ([Table 2]), there was statistically highly significant difference between the controlled and uncontrolled groups with respect to knowledge about complications of diabetes, symptoms of hypoglycemia, and follow-up by fundus examination.

There was a statistically significant difference between the controlled and uncontrolled groups as regards knowledge about symptoms of hyperglycemia, importance of follow-up tests for kidney function, follow-up by ECG, and control of diabetes. [Table 2] shows that the knowledge about diabetes control is lower s the uncontrolled group. These results concur with those from a study conducted in Warangal, India, in 2012, which reported that only 50% of the patient population was aware of the condition of diabetes and the remaining 50% was unaware. A study by Muninarayana et al. [14] reported that only 50.8% of the population knew about the condition of diabetes.

Therefore, there is a need to educate people on diabetes in rural and urban areas. Knowledge about the complications of diabetes was known to 66% of the patient population. The study conducted by Muninarayana et al. [14] found that 74.2% of diabetics were aware of the complications. Muninarayana et al. [14] and McClean et al. [15] also reported that patient education and patient involvement can lead to better control over this disease.

Regarding diet control in the studied group, [Table 4] shows that there was a significant difference between the controlled and uncontrolled groups regarding follow-diet regimen and having written instructions about a diet regimen. These results are in agreement with those of Howteerakul et al. [16], who reported that adherence to diet control was significantly associated with glycemic control.

Regarding foot care in the controlled and uncontrolled group, [Table 5] shows that there was a significant difference in foot care between the two groups, with a decline in foot care in the uncontrolled group. This result is in agreement with that from the American College of Foot and Ankle Surgeons (2009), which states that patients need to inspect their shoes and feet daily to see whether the shoes are broken, or whether there are blisters, redness, cuts, nail problems, or swelling, as the disease can cause neuropathy, which makes the patient unable to feel any blisters or stones in the shoes. Blood circulation can also be reduced to the foot, which can make it difficult for wounds or ulcers to heal. A study conducted by Al-Asmary et al. [17] revealed that the knowledge and practices of diabetic patients as regards diabetic foot care were generally unsatisfactory. The knowledge that was unknown to diabetic patients consisted of signs that should be checked daily for early management of a wound in the foot and what to do if the patient's foot is cold. The least practiced were regular application of moisturizing agents on the foot and daily checking for skin temperature. Several authors have found similar results. Our study also reported that knowledge about foot care was insufficient in the uncontrolled group.


  Conclusion Top


There was a statistically significant relation between level of knowledge and self-care and HbA1c. This means that with increasing level of knowledge and self-care good diabetic control can be achieved.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Norris SL, Engelgau MM, Narayan KM. Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. Diabetes Care 2001; 24:561–587.  Back to cited text no. 2
    
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American Diabetes Association. Standards of medical care in diabetes. Diabetes Care 2015; 38:S1–S93.  Back to cited text no. 4
    
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El-Gilany A, El-Wehady A, El-Wasify M. Updating and validation of the socioeconomic status scale for health research in Egypt. East Mediterr Health J 2012; 18:962–968.  Back to cited text no. 5
    
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Ozcelik F, Yiginer O, Arslan E, Serdar MA, Uz O, Kardesoglu E, Kurt I. Association between glycemic control and the level of knowledge and disease awareness in type 2 diabetic patients. Pol Arch Med Wewn 2010; 120:399–406.  Back to cited text no. 8
    
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Mainous AG III, Kohrs FP. A comparison of health status between rural and urban adults. J Community Health 1995; 20:423–431.  Back to cited text no. 12
    
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Muninarayana C, Balachandra G, Hiremath SG, Iyengar K, Anil NS. Prevalence and awareness regarding diabetes mellitus in rural Tamaka, Kolar. Int J Diabetes Dev Ctries 2010; 30:18–21  Back to cited text no. 14
    
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McClean MT, McElnay JC, Andrews J. The importance of patient education and patient involvement in the treatment of diabetes. Pharma J 2000; 265:108–110.  Back to cited text no. 15
    
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Howteerakul N, Suwannapong N, Rittichu C, Rawdaree P. Adherence to regimens and glycemic control of patients with type 2 diabetes attending a tertiary hospital clinic. Asia Pac J Public Health 2007; 19:43–49.  Back to cited text no. 16
    
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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Introduction
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Patients and Methods
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