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Research Article | DOI: https://doi.org/10.31579/2641-8975/025
1 Department of Internal Medicine, Endocrine & Diabetes, Al Nahdha Hospital, Oman.
2 Health psychologist, 10 Broom Park, Aberdeen, UK.
*Corresponding Author: Shiju Raman Unni, Department of Internal Medicine, Endocrine & Diabetes, Al Nahdha Hospital, Oman.
Citation: Shiju Raman Unni, Hani Naguib and Mary Mccallum, (2022). Knowledge, Beliefs and Practices of People diagnosed with Type-1 Diabetes towards Diabetes Mellitus and Diabetic Foot Syndrome. J. Diabetes and Islet Biology, 5(1); DOI:10.31579/2641-8975/025
Copyright: © 2022 Shiju Raman Unni 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.
Received: 20 September 2021 | Accepted: 28 December 2021 | Published: 05 January 2022
Keywords: diabetic foot; knowledge; beliefs, practice; oman; diabetes mellitus
Background: Diabetes Mellitus (DM) is associated with significant morbidity and mortality. Diabetic foot syndrome is one of the most common devastating preventable complications of diabetes mellitus (DM).
Objectives: We aimed to evaluate the knowledge, Beliefs and Practices (KBP) among Omani patients with type 1 diabetes mellitus (T1DM) regarding DM and Diabetes foot.
Design: A cross sectional descriptive study was used.
Settings: A secondary care, polyclinic named Bawshar in Muscat, Oman where patients were seen three days per week.
Sample Size:A convenient sample of 100 participants between age group 16 to 30 years were involved.
Materials and methods: A validated semi- structured questionnaire was used to assess KBP of T1DM with six domains. During the study period from November 2019 to December 2019. .The data was analysed by using Statistical Package for the Social Sciences (SPSS) Statistics Inc., Chicago, US version 20.
Results: There were 50 females, 50 males; 5 % of patients were illiterate and 30% of them were working. 65% were students. Only 50% checked their foot regularly and only 55% check there blood glucose regularly .57% don’t know the cause of diabetes, 25% don’t know the complications of the same while 20% don’t know cause of diabetic foot and 25% don’t know the symptoms of diabetic foot. 20% beliefs checking blood glucose is the responsibility of the doctor and 85% beliefs walking bare foot is high risk factor for DM foot.
Conclusions: In reality healthcare providers must be trained to counsel people with DM to plan adequate interventions that enable an understanding of the offered information. A well-structured ,Behaviour change counselling (BCC) like Motivational interviewing (MI)are considered the ideal practices for this patients, to prevent DM complications.
The prevalence of diabetes mellitus (DM) is still increasing year by year [1] and it is estimated that the number of people with diabetes will increase 1.5 times from 463 million in 2019 to 700 million in 2045 [2] According to World health organisation data in 2019 diabetes mellitus was direct cause of 1.5million deaths. [3] .The prevalence of DM in Oman has increased over the past three decades in parallel with rapid economic growth, urbanization, and changes in lifestyle behaviours. [4] According to NCD survey in Oman the prevalence of DM is 14.5%. [5].
Diabetic foot syndrome (DFS) is one of the common and most devastating preventable complications of diabetes mellitus (DM). It is associated with morbidity and premature mortality due to long-term complications. Lower extremity disease, which includes foot ulceration, peripheral neuropathy, peripheral arterial disease, or amputation, is twice as common as in people with diabetes when compared with healthy individuals. In Oman, around half (47 %) of all lower limb amputations are performed in those with diabetes [6].
A study conducted in 2002, highlighted the importance of proper education and awareness programs in changing attitudes toward DM. The study clearly shown that diabetes education and care management can significantly improve patient outcomes, glycaemic control and quality of life a study in India found inverse relation between knowledge and diabetic foot complications, which is more the knowledge less the complications [7, 8].
However, a knowledge, attitude and practice gap still exists in T1DM management .Our study was conducted to assess the KBP among100 adult Omani patients with T1DM in a diabetic clinic at Bausher polyclinic. The findings of this study will help in designing effective educational program for prevention and control of this dreaded disease in Oman.
Study Design:
This cross sectional descriptive study was conducted during november 2019– december 2019 at the outpatient clinic of Basher polyclinic in Muscat region of Sultanate of Oman by using a questionnaire to evaluate the KBP of Omani patients diagnosed with T1DM.
Study population:
100 T1DM patients participated in the study. Inclusion criteria were: patients aged between 16 to 30 years who are known to have diabetes were included in the study. Exclusion criteria were 1) patients who denied consent to be part of the study. 2) Patients who already had diabetic foot syndrome, amputated foot, or foot ulcers and 3) patients with type 2 Diabetes Mellitus.
Assessment tool:
The questionnaire was combined, modified, revised and validated to better align with the Omani diabetes and Omani diabetic foot guidelines.13 the revised questionnaire covered six domains: demographic details, patient-reported diabetes-related foot disease, foot self-care, diabetes care education, foot care education, and professional foot care. A questionnaire containing 24 closed-ended and multiple choice type questions on KBP was developed to investigate the relationship between knowledge attitudes and practice of T1DM patients. The questionnaire includes knowledge of measures to prevent diabetic foot, attitudes to prevent it and self-care practices of the person with T1DM. One point was awarded for each correct answer. The questionnaire was beta-tested 5 patients to assess the validity, suitability of content, clarity and flow of questions. Necessary corrections and modifications were made based on the results of the pilot study. The questionnaire was prepared in English but prior to use in the study, was translated to Arabic. The Arabic version of the questionnaire was reviewed for language, clarity, and structure and was administered in face-to-face interviews to collect the data. (Appendix 1).
Data synthesis and analysis:
A total of 9 items were included in the knowledge section which included elementary knowledge of diabetes, benefits of exercise, complications of diabetes, prevention of diabetic foot. For the nine items knowledge question, the maximum attainable score was ‘9’ and the minimum score was ‘0’. Likewise, in the Belief section, a total of 8 items were included which consisted of respondents Belief towards diabetes. A 6 point Likert scale was used to measure attitude.
Statistical analysis:
Data were analysed in a database created using a Mic-rosoft Offi ce Excel 2007™ spreadsheet, and later transferred to SPSS (Statistical Package for the Social Sciences) version Policarpo NS, Moura JRA, Melo Júnior EB, Almeida PC, Macêdo SF, Silva ARV 38Rev Gaúcha Enferm. 2014 set; 35(3):36-42.17.0 To calculate statistical measurements and standard de Viation for variables addressed in the collection instrument Data were analysed in a database created using a Microsoft Offi ce Excel 2007™ spreadsheet, and later transferred to SPSS (Statistical Package for the Social Sciences) version Policarpo NS, Moura JRA, Melo Júnior EB, Almeida PC, Macêdo SF, Silva ARV38Rev Gaúcha Enferm. 2014 set; 35(3):36-42.17.0 to calculate statistical measurements and standard deviation for variables addressed in the collection instrument Data were analysed in a database created using a Microsoft Offi ce Excel 2007™ spreadsheet, and later transferred to SPSS (Statistical Package for the Social Sciences) version Policarpo NS, Moura JRA, Melo Júnior EB, Almeida PC, Macêdo SF, Silva ARV38Rev Gaúcha Enferm. 2014 set; 35(3):36-42.17.0 to calculate statistical measurements and standard deviation for variables addressed in the collection instrument Data were analysed in a database created using a Microsoft Offi ce Excel 2007™ spreadsheet, and later transferred to SPSS (Statistical Package for the Social Sciences) version Policarpo NS, Moura JRA, Melo Júnior EB, Almeida PC, Macêdo SF, Silva ARV38Rev Gaúcha Enferm. 2014 set;35(3):36-42.17.0 to calculate statistical measurements and standard deviation for variables addressed in the collection instrument Data were analysed in a database created using a Microsoft Offi ce Excel 2007™ spreadsheet, and later transferred to SPSS (Statistical Package for the Social Sciences) version Policarpo NS, Moura JRA, Melo Júnior EB, Almeida PC, Macêdo SF, Silva ARV38Rev Gaúcha Enferm. 2014 set;35(3):36-42.17.0 to calculate statistical measurements and standard deviation for variables addressed in the collection instrument Data were analysed in a database created using a Microsoft Office Excel 2007™ spreadsheet, and later transferred to SPSS (Statistical Package for the Social Sciences) version 17.0 to calculate statistical measurements and standard deviation for variables addressed in the collection instrument.
Profile of the study population:
The demographic baseline characteristics of the study population are shown in Table 1. 39%of the patients were aged between 26 to 30 years there were females (50%) and 50 % males than males. 40% of them were in college and 25% of them in higher secondary school while the remainder were educated with different levels .Nearly one quarter (30%) were working .5% were illiterate and 53% had diabetes for more than 10 years (Table-1)
Knowledge:
Out of 100 subjects, 57% did not know the causes of diabetes .85% of subjects knows the ‘normal’ blood glucose values. 20% of subjects did not know the causes of diabetic foot syndrome and one-fourth (25%) of the subjects did not know symptoms of diabetic foot syndrome. Just over one-fifth(25%), thought that their doctor alone was responsible for foot examination 25% did not know about diabetes complications 36% did not know how to prevent diabetic foot syndrome, 24% did not know risk factors that cause the disease. Only 40% thought they should examine their own feet. (Figure 1 & Table-2).
Beliefs:
The majority acknowledged that walking barefoot and that “diabetic foot syndrome” are big problems 85% and 90% respectively. 80% subjects accepted that patients with diabetes cannot eat everything even if they are compliant with medications. One-fifth (20%) thought that checking their blood sugar was the responsibility of their doctor only. Smaller proportions of respondents believed that diabetes cannot be fully treated (25%) and that uncontrolled diabetes is not serious (7%). (Figure1& Table-2).
Practices:
60% of subjects reported they were checking water temperature before its use, 80
Knowledge is an essential requirement for better compliance with medical therapy.It is a hypothesis that good KBP have impact on adequate diabetes control. Even though 40% of subjects were studying in university and 30% of subjects is working, they had insufficient knowledge regarding the symptoms, complications, prevention and control of their disease condition. Awareness of complications of diabetes was not good among the patients in this study. 57% of the patients in our study did not know the cause of DM; 25% did not know about diabetes complications; 20% don’t know the cause of diabetic foot syndrome; 25% don’t know about symptoms of diabetic foot .Several studies in India observed an inverse relationship between diabetic foot ulcer and foot care knowledge as well as practice as seen in our study also. [9, 10, 11, 12 &13]. While, another study in England as a developed country, also stated poor knowledge of diabetes among ethnic groups [14].
In our study, overall, it was found that T1DM patients had insufficient knowledge regarding the symptoms, complications, prevention and control of their disease condition. However, a study from Malaysia reported a good knowledge, attitude and practice score among diabetic patients [15] .The differences in the results of studies may be due to the differences in educational level of the diabetic patients and accessibility of information and diabetes education. It is well established that patient contributions are very important for better management of diabetes.
In terms of attitude/beliefs a considerable disposition to practice self-examination and self-care was detected Although 85% agreed that walking bare foot carries high risk for development of diabetic foot complications 7
This study revealed a suboptimal level of KBP for the majority of T1DM patients in the study population, who usually are dependent on drugs for disease control while ignoring practical lifestyle modifications. Lack of awareness about diabetes among patients, affects their ability to self-manage and therefore has a negative impact on outcomes. We need a structured, well designed behaviour counselling and interviews by health care workers.
Recommendation
We recommend the ministry of health , Oman to implement continuous awareness program, counselling and education on self-care management of patients with diabetes mellitus such as BCC, Motivational interviewing involving both patients and health care professional together to explore the difficulties of changing diabetes and foot care management to improve their knowledge regarding diabetes mellitus with the emphasis on lifestyle modifications.
Acknowledgments
The authors are grateful to Dr. Thamra al Ghafry (DG,Muscat) for inspiring, editing, and proofreading, and also for Dr. Hanan al Mahrooqi (Bausher polyclinic) for support. We are also grateful to Dr. Hamad al Harthy and Dr. Mohamed al Hinaii (Alnahda Hospital) for continued support during the study.
Authors’ contributions
All authors contributed to the conception, conduct of the study. They contributed to the drafting, revision, and final approval of the manuscript.
Funding and sponsorship
None
Conflict of interest
The author declares that there is no conflict of interests.
Compliance with ethical principles Institutional approval and informed written consent was obtained from all respondents.
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