Adherence to Self-care Practices among Diabetes Mellitus Patients at a Tertiary Hospital in Eastern Uganda
Abstract:
Adherence to self-care practices among diabetes mellitus
patients is vital in achieving optimal glycemic control and delaying the progression
of the disease complications. There is limited information regarding diabetes self-care among diabetic
patients in Eastern Uganda, where the disease is most prevalent. The aim of this
study was to determine the level of adherence to diabetes mellitus self-care practices
and the associated factors among adult diabetic outpatients at a tertiary hospital
in Eastern Uganda. A cross-sectional study was conducted at Mbale Regional Referral
Hospital in Eastern Uganda between September and October 2020, on a sample of 156
diabetic patients recruited through systematic random sampling. A structured questionnaire
was used to collect data through self-report. Descriptive and Logistic regression
analyses were conducted using STATA version 15.0, and a 5% level of significance.
Most of the study participants were female
(63.8%) with an average age of 52.3 years (SD 13.8). The prevalence of adherence
to self-care was 36.5%. The factors associated with adherence to self-care were
good diabetes knowledge (AOR=2.5; 95% CI= 1.2-5.3, p = 0.016), and high self-efficacy
(AOR=3.9; 95% CI= 1.8 – 8.7, p = 0.001). Less than half of the patients attending
the diabetic clinic at Mbale Regional Referral Hospital in Eastern Uganda adhere
to self-care practices. Patients ought to receive comprehensive, consistent, and
contextualized diabetes education to enrich their knowledge, as well as a boost
of their self-efficacy through interventions like counseling, positive feedback,
role models, and peer education.
References:
[1] Abate TW, Tareke M,
Tirfie M. Self-care practices and associated factors among diabetes patients
attending the outpatient department in Bahir Dar, Northwest Ethiopia. BMC Res
Notes [Internet]. 2018;11(1):800. Available from: https://doi.org/10.1186/s13104-018-3874-8.
[2] Adongo R, Id A, Id VB,
Bavo T, Id A, Afaya A, et al. Medication adherence and self-care behaviours
among patients with type 2 diabetes mellitus in Ghana. 2020; Available from: https://doi.org/10.1371/journal.pone.0237710.
[3] Chali SW, Salih MH,
Abate AT. Self-care practice and associated factors among Diabetes Mellitus
patients on follow up in Benishangul Gumuz Regional State Public Hospitals,
Western Ethiopia: A cross-sectional study. BMC Res Notes [Internet]. 2018 Nov
26 [cited 2022 Feb 18];11(1):1–8. Available from: https://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-018-3939-8.
[4] Saeedi P, Petersohn I,
Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes
prevalence estimates for 2019 and projections for 2030 and 2045: Results from
the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res
Clin Pract. 2019 Nov 1; 157:107843.
[5] International Diabtes
Federation. IDF Diabetes Atlas (9th ed.) [Internet]. 2019 [cited 2022 Feb 18].
Available from: https://idf.org/52-about-diabetes/451-diabetes-risk-factors.html.
[6] Williams R, Karuranga
S, Malanda B, Saeedi P, Basit A, Besançon S, et al. Global and regional
estimates and projections of diabetes-related health expenditure: Results from
the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res
Clin Pract. 2020 Apr; 162:108072.
[7] International Diabetes
Federation. Uganda’s Diabetes Mellitus Prevalence [Internet]. 2020 [cited 2022
Feb 18]. Available from: https://idf.org/our-network/regions-members/africa/members/29-uganda.html.
[8] Uganda Diabetes
Association. Diabetes in Uganda: The facts [Internet]. 2017 [cited 2022 Feb
18]. Available from: http://ugandadiabetesassociation.org/index.php?option=com_content&view=article&id=12&Itemid=150.
[9] Mayega RW, Makumbi F,
Rutebemberwa E, Peterson S, Östenson CG, Tomson G, et al. Modifiable
Socio-Behavioural Factors Associated with Overweight and Hypertension among
Persons Aged 35 to 60 Years in Eastern Uganda. PLoS One. 2012 Oct 15;7(10).
[10] World Health
Organization. Diabetes [Internet]. 2018 [cited 2022 Feb 18]. Available from: https://www.who.int/news-room/fact-sheets/detail/diabetes.
[11] Gurmu Y, Gela D, Aga
F. Factors associated with self-care practice among adult diabetes patients in
West Shoa Zone, Oromia Regional State, Ethiopia 11 Medical and Health Sciences
1117 Public Health and Health Services. BMC Health Serv Res [Internet]. 2018
Sep 24 [cited 2022 Feb 18];18(1):1–8. Available from: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-3448-4.
[12] Rajasekharan D,
Kulkarni V, Unnikrishnan B, Kumar N, Holla R, Thapar R. Self-Care Activities
Among Patients with Diabetes Attending a Tertiary Care Hospital in Mangalore
Karnataka, India. Ann Med Health Sci Res [Internet]. 2015 [cited 2022 Feb
18];5(1):59. Available from: /pmc/articles/PMC4350065/.
[13] Kwanjo Banda C,
Gombachika BT, Nyirenda MJ, Sinjani Muula A, Petersen F, Brew-Sam N.
Self-management and its associated factors among people living with diabetes in
Blantyre, Malawi: a cross-sectional study. AAS Open Research 2021 2:161
[Internet]. 2021 Dec 23 [cited 2022 Feb 18]; 2:161. Available from: https://aasopenresearch.org/articles/2-161.
[14] Mukeshimana M, Hakizimana
G, Mwali C, Umuhoza C, Uwambajimana J, Asingizwe D. The knowledge and practice
of self-care management among patients attending a diabetes clinic in Kigali,
Rwanda. Rwanda Journal [Internet]. 2015 Oct 8 [cited 2022 Feb 18];2(1):24–30.
Available from: https://www.ajol.info/index.php/rj/article/view/123966.
[15] Denyes MJ, Orem DE,
Bekel G. Self-care: a foundational science. Nurs Sci Q [Internet]. 2001 [cited
2022 Feb 18];14(1):48–54. Available from: https://pubmed.ncbi.nlm.nih.gov/11873354/.
[16] Shrivastava SRBL,
Shrivastava PS, Ramasamy J. Role of self-care in management of diabetes
mellitus. J Diabetes Metab Disord [Internet]. 2013 Mar 5 [cited 2022 Feb
18];12(1). Available from: https://pubmed.ncbi.nlm.nih.gov/23497559/.
[17] Lu Y, Xu J, Zhao W,
Han HR. Measuring Self-Care in Persons with Type 2 Diabetes: A Systematic
Review. Eval Health Prof [Internet]. 2016 Jun 1 [cited 2022 Feb
18];39(2):131–84. Available from: https://pubmed.ncbi.nlm.nih.gov/26130465/.
[18] Toobert DJ, Hampson
SE, Glasgow RE. The summary of diabetes self-care activities measure: results
from 7 studies and a revised scale. Diabetes Care [Internet]. 2000 [cited 2022
Feb 18];23(7):943–50. Available from: https://pubmed.ncbi.nlm.nih.gov/10895844/.
[19] Bariyyah NKMH, Bujang
MA, Baharum N, Mastura I, Shah SA. Self-care activities among diabetic patients
and factors affecting glycemic control in primary health care, Malaysia.
Journal of Diabetes and Clinical Practice. 2018;1(1).
[20] Bigdeli MA, Saeed S,
Nazari H, Khodakarim S, Brodati H, Bigdeli MA. Factors Affecting Self-Care in
Patients with Type II Diabetes Using Path Analysis. Iranian Journal of Health
Sciences [Internet]. 2016 Oct 10 [cited 2022 Feb 18];4(3):10–21. Available
from: http://jhs.mazums.ac.ir/article-1-435-en.html.
[21] Nejaddadgar N, Solhi
M, Jegarghosheh S, Abolfathi M, Ashtarian H. Self-Care, and Related Factors in
Patients with Type 2 Diabetes. Asian Journal of Biomedical and Pharmaceutical
Sciences [Internet]. 2017 Apr 21 [cited 2022 Feb 18];7(61):6–10. Available
from: https://www.alliedacademies.org/articles/selfcare-and-related-factors-in-patients-with-type-2-diabetes.html.
[22] Elliott JA, Das D,
Cavailler P, Schneider F, Shah M, Ravaud A, et al. A cross-sectional assessment
of diabetes self-management, education and support needs of Syrian refugee
patients living with diabetes in Bekaa Valley Lebanon Bayard Roberts, Kiran
Jobunputra, Preeti Patel, and Pablo Perel. Confl Health [Internet]. 2018 Sep 12
[cited 2022 Feb 18];12(1):1–10. Available from: https://conflictandhealth.biomedcentral.com/articles/10.1186/s13031-018-0174-9.
[23] de Man J, Aweko J,
Daivadanam M, Alvesson HM, Delobelle P, Mayega RW, et al. Diabetes
self-management in three different income settings: Cross-learning of barriers
and opportunities. PLoS One [Internet]. 2019 Mar 1 [cited 2022 Feb
18];14(3):e0213530. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0213530.
[24] Baumann LC, Opio CK,
Otim M, Olson L, Ellison S. Self-care beliefs and behaviors in Ugandan adults
with type 2 diabetes. Diabetes Educ [Internet]. 2010 [cited 2022 Feb
18];36(2):293–300. Available from: https://pubmed.ncbi.nlm.nih.gov/20067944/.
[25] Bagonza J,
Rutebemberwa E, Bazeyo W. Adherence to anti diabetic medication among patients
with diabetes in eastern Uganda; a cross sectional study. BMC Health Serv Res
[Internet]. 2015 Apr 19 [cited 2022 Feb 18];15(1). Available from: https://pubmed.ncbi.nlm.nih.gov/25898973/.
[26] Kalyango JN, Owino E,
Nambuya AP. Non-adherence to diabetes treatment at Mulago Hospital in Uganda:
prevalence and associated factors. Afr Health Sci [Internet]. 2008 Jun [cited
2022 Feb 18];8(2):67. Available from: /pmc/articles/PMC2584325/.
[27] Mafabi D. More
patients sleep on the floor than beds at Mbale hospital. The Daily Monitor
[Internet]. 2013 Jun 18 [cited 2022 Feb 18]; Available from: https://www.monitor.co.ug/SpecialReports/More-patients-sleep-on-floor-than-beds-at-Mbale-hospital/-/688342/1886140/-/767b0u/-/index.html.
[28] Olaka D. Busitema
University Faculty of Health Sciences Opens in Mbale [Internet]. Uganda Radio Network.
2013 [cited 2022 Feb 18]. Available from: https://ugandaradionetwork.com/a/story.php?s=57599.
[29] Yamane T. Statistics:
an introduction analysis. Harper and Row; 1973.
[30] Habib A, johargy A,
Mahmood K. Design and Determination of The Sample Size In Medical Research.
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN [Internet]. 2014
[cited 2022 Feb 18]; 13:21–31. Available from: www.iosrjournals.orgwww.iosrjournals.org.
[31] Kumar A, Dogra S, Kaur
A, Modi M, Thakur A, Saluja S. Approach to sample size calculation in medical
research. Curr Med Res Pract [Internet]. 2014 [cited 2022 Feb 18];4(2):87–92.
Available from: https://www.academia.edu/13800960/Approach_to_sample_size_calculation_in_medical_research.
[32] Pourhoseingholi MA,
Vahedi M, Rahimzadeh M. Sample size calculation in medical studies.
Gastroenterol Hepatol Bed Bench [Internet]. 2013 [cited 2022 Feb 18];6(1):14.
Available from: /pmc/articles/PMC4017493/.
[33] Omair A. Sample size
estimation and sampling techniques for selecting a representative sample.
Journal of Health Specialties [Internet]. 2014 [cited 2022 Feb 18];2(4):142.
Available from: https://www.academia.edu/24683129/Sample_size_estimation_and_sampling_techniques_for_selecting_a_representative_sample.
[34] Taherdoost H. Sampling
Methods in Research Methodology; How to Choose a Sampling Tech-nique for
Research. International Journal of Academic Research in Management (IJARM)
[Internet]. 2016 [cited 2022 Feb 18];5. Available from: https://hal.archives-ouvertes.fr/hal-0254679.
[35] Garcia AA, Villagomez
ET, Brown SA, Kouzekanani K, Hanis CL. The Starr County Diabetes Education
Study: development of the Spanish-language diabetes knowledge questionnaire.
Diabetes Care [Internet]. 2001 [cited 2022 Feb 18];24(1):16–21. Available from:
https://pubmed.ncbi.nlm.nih.gov/11194219/.
[36] AlQahtani AH,
Alzahrani AS, Alzahrani SH, Alqahtani SM, AlOtaibi AF, Khan AA. Levels of
Practice and Determinants of Diabetes Self-Care in Primary Health Care in
Jeddah City, Saudi Arabia. Cureus [Internet]. 2020 Jun 25 [cited 2022 Feb
18];12(6). Available from: https://www.cureus.com/articles/33698-levels-of-practice-and-determinants-of-diabetes-self-care-in-primary-health-care-in-jeddah-city-saudi-arabia.
[37] Karve S, Cleves MA,
Helm M, Hudson TJ, West DS, Martin BC. Good and poor adherence: optimal
cut-point for adherence measures using administrative claims data. Curr Med Res
Opin [Internet]. 2009 Sep [cited 2022 Feb 18];25(9):2303–10. Available from: https://pubmed.ncbi.nlm.nih.gov/19635045/
[38] Bursac Z, Gauss CH,
Williams DK, Hosmer DW. Purposeful selection of variables in logistic
regression. Source Code Biol Med. 2008 Dec 16;3(1):17.
[39] Kang H. The prevention
and handling of missing data. Korean J Anesthesiol [Internet]. 2013 May [cited
2022 Feb 18];64(5):402. Available from: /pmc/articles/PMC3668100/.
[40] Dasappa H, Prasad S,
Sirisha M, Prasanna SVNR, Naik S. Prevalence of self-care practices and
assessment of their sociodemographic risk factors among diabetes in the urban
slums of Bengaluru. J Family Med Prim Care [Internet]. 2017 [cited 2022 Feb
18];6(2):218. Available from: /pmc/articles/PMC5749060/.
[41] Huang M, Zhao R, Li S,
Jiang X. Self-Management Behavior in Patients with Type 2 Diabetes: A
Cross-Sectional Survey in Western Urban China. PLoS One [Internet]. 2014 Apr 17
[cited 2022 Feb 18];9(4):e95138. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0095138.
[42] Bukhsh A, Khan TM,
Nawaz MS, Ahmed HS, Chan KG, Goh BH. Association of diabetes knowledge with
glycemic control and self-care practices among Pakistani people with type 2
diabetes mellitus. Diabetes Metab Syndr Obes [Internet]. 2019 [cited 2022 Feb
18]; 12:1409. Available from: /pmc/articles/PMC6698595/.
[43] Jackson IL, Adibe MO,
Okonta MJ, Ukwe C v. Knowledge of self-care among type 2 diabetes patients in
two states of Nigeria. Pharm Pract (Granada) [Internet]. 2014 [cited 2022 Feb
18];12(3). Available from: https://pubmed.ncbi.nlm.nih.gov/25243026/.
[44] Mamo M, Demissie M. Self-care
practice and its associated factors among diabetic patients in Addis Ababa
public hospitals: A cross sectional study. J Diabetes Metab [Internet]. 2016
[cited 2022 Feb 18];07(06). Available from: https://www.iomcworld.com/proceedings/self-care-practice-and-its-associated-factors-among-diabetic-patients-in-addis-ababa-public-hospitals-a-cross-sectional--32225.html.
[45] Adejoh SO. Diabetes
Knowledge, Health Belief, and Diabetes Management Among the Igala, Nigeria: https://doi.org/101177/2158244014539966
[Internet]. 2014 Jun 26 [cited 2022 Feb 18];4(2). Available from: https://journals.sagepub.com/doi/full/10.1177/2158244014539966.
[46] Vilchez-Cornejo J,
Romani L, Reategui S, Gomez-Rojas E, Silva C. Factors associated with the
Performance of Self-care Activities in Diabetic Patients in Three Ucayali
Hospitals Faculty of Human Medicine URP. Rev Fac Med Hum [Internet]. 2020
[cited 2022 Feb 18];20(2):254–60. Available from: http://revistas.urp.edu.pe/index.php/RFMH.
[47] Ghannadi S, Amouzegar
A, Amiri P, Karbalaeifar R, Tahmasebinejad Z, Kazempour-Ardebili S. Evaluating
the Effect of Knowledge, Attitude, and Practice on Self-Management in Type 2
Diabetic Patients on Dialysis. J Diabetes Res [Internet]. 2016 [cited 2022 Feb
18];2016. Available from: https://pubmed.ncbi.nlm.nih.gov/27478845/.
[48] Takele GM, Weharei MA,
Kidanu HT, Gebrekidan KG, Gebregiorgis BG, Takele GM, et al. Diabetes self-care
practice and associated factors among type 2 diabetic patients in public
hospitals of Tigray regional state, Ethiopia: A multicenter study. PLoS One
[Internet]. 2021 Apr 1 [cited 2022 Feb 18];16(4):1–11. Available from: https://EconPapers.repec.org/RePEc:plo:pone00:0250462.
[49] Formosa C, Muscat R.
Improving Diabetes Knowledge, and Self-Care Practices. J Am Podiatr Med Assoc
[Internet]. 2016 [cited 2022 Feb 18];106(5):352–6. Available from: https://pubmed.ncbi.nlm.nih.gov/27762618/.
[50] Alhaik S, Anshasi HA,
Alkhawaldeh J, Soh KL, Naji AM. An assessment of self-care knowledge among
patients with diabetes mellitus. Diabetes
Metab Syndr [Internet]. 2019 Jan 1 [cited 2022 Feb 18];13(1):390–4. Available
from: https://pubmed.ncbi.nlm.nih.gov/30641730/.