Diabetes Knowledge, Attitude and Practice (KAP) Study among Iranian Inpatients with Type-2 Diabetes: A Cross Sectional Study
Article in Diabetes and Metabolic Syndrome Clinical Research and Reviews · November 2015
DOI: 10.1016/j.dsx.2015.10.006
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Original Article
Diabetes knowledge, attitude and practice (KAP) study among Iranian in-patients with type-2 diabetes: A cross-sectional study
Mahtab Niroomand
a, Seyedeh Najmeh Ghasemi
a, Hamidreza Karimi-Sari
b,*, Sara Kazempour-Ardebili
c, Parisa Amiri
d, Mohammad Hossein Khosravi
baDivisionofEndocrinology,DepartmentofInternalMedicine,ShahidBeheshtiUniversityofMedicalSciences,Tehran,Iran
bStudents’ResearchCommittee,BaqiyatallahUniversityofMedicalSciences,Tehran,Iran
cPreventionofMetabolicDisordersResearchCenter,ResearchInstituteofEndocrineSciences,ShahidBeheshtiUniversityofMedicalSciences,Tehran,Iran
dResearchCenterforSocialDeterminantsofEndocrineHealth,ResearchInstituteforEndocrineSciences,ShahidBeheshtiUniversityofMedicalSciences, Tehran,Iran
Introduction
Diabetes is one of themost common chronic conditions in humanhistory.Itisamajorpublichealthconcernworldwidewith aprevalenceof8%intheUnitedStates[1,2]and7.7%inIran[3].
Progressionof type-2diabetes in mostcases resultsin chronic complications,whichlowerspatients’qualityoflifeandincreases theirmorbidityandmortality;italsoimposesagreateconomic
burden on health systems [4,5].The final outcome of diabetes dependsonpatients’knowledgeandmedicalmanagement[6].
Ithasbeenprovedthatself-careisthecornerstoneofdiabetes treatments, since this has been proven in various studies and populations[6,7].Priortobeginninganeducationalprogramfor diabeticpatients,theircurrentlevelofknowledge(K),attitude(A), andpractice(P)shouldbeevaluated.
CurrentpracticeinmanagementofdiabetesinIranfocuseson medical treatment and little attention is paid to educational programs and self-care of diabeticpatients [5,8,9].While prior studieshaveemphasizedtheimportanceofdiabeteseducation[9], somerecent articleshave highlightedbarrierstoimplementing diabeteseducationalprogramsinIran[10]andhavealsopresented successfulexperiencescarriedoutforimprovingtheknowledge, attitude,andpracticeoftype-2diabeticpatients [8,11].Patients ARTICLE INFO
Keywords:
Attitude
Diabetescomplications Diabetesmellitus Knowledge Patientspractice
SUMMARY
Aim:RecentstudieshighlightbarriersofdiabeteseducationalprogramsinIranandalsopresentsome successfulexperiencescarriedoutforimprovingtheknowledge,attitude,andpractice(KAP)oftype-2 diabeticpatients.Hence,evaluationofpatients’KAPseemstobeneeded.Wedesignedamulticenter studyevaluatinglevelofKAPintype-2diabeticpatientsinthecapitalcityofTehranandidentifying variablesthataffectthisKAPlevel.
Methods:Thismulticenteranalyticalcross-sectionalstudywasapprovedbyShahidBeheshtiUniversity ofMedicalSciencesEthicsCommittee.Questionnairesweredesignedforevaluationofdiabetes-related KAPinpatients.Aftervalidatingthequestionnairesbyendocrinologists,test–retestmethodwasusedfor questionnairereliabilitybycheckingin15diabeticpatients.Twohundredtype-2diabeticpatients admittedto4hospitalsofTehranfilledoutthequestionnaires.UsingSPSSsoftware,thelevelofKAPand itsconfounderswereevaluatedinpatients.
Results:Twohundredtype-2diabeticpatientswiththemeanageof60.17yearswereevaluated(106 male and 94 female). The mean diabetes duration was 13.06 years. The levelsof patients’ good knowledge, attitude, and practice were 61.41%, 50.44% and 52.23%, respectively. Age, treatment methods,DMduration,andexistenceofdiabeticretinopathyhadsignificantcorrelationswithKAPlevel.
Conclusions: TheresultsofthisstudyshowedthatrecenteducationalprogramsinIranimprovedKAP level. Patients’ KAP increases as their condition worsens/progresses. Hence education should be consideredasapriorityfornewlydiagnosedpatientsandthosewithlowerKAPlevelsbeforeoccurrence ofdiabetescomplications.
ß2015DiabetesIndia.PublishedbyElsevierLtd.Allrightsreserved.
Abbreviations:KAP,knowledgeattitudeandpractice;DM,diabetesmellitus;HTN, hypertension;BMI,bodymassindex;HbA1C,glycatedhemoglobin;R-CVI,C-CVI, andS-CV,Irelevanceclarityandsimplicitycontentvalidityindex.
* Correspondingauthor.Tel.:+982181264354;fax:+982181264354.
E-mailaddress:[email protected](H.Karimi-Sari).
ContentslistsavailableatScienceDirect
Diabetes & Metabolic Syndrome: Clinical Research &
Reviews
j ou rna l hom e pa ge : w w w. e l s e v i e r. co m/ l o ca t e / dsx
http://dx.doi.org/10.1016/j.dsx.2015.10.006
1871-4021/ß2015DiabetesIndia.PublishedbyElsevierLtd.Allrightsreserved.
areatleastonceeducatedatthefirstyearoftheirinitialdiagnosis of diabetes. [8] Hence evaluation of knowledge, attitude, and practiceamongpatientsinTehran(capitalofIran),wherethemost educationalprogramshadbeenheld,seemstobeneeded.
While studies toevaluatepatients’ knowledge,attitude, and practice(KAPstudies) have been performed in many countries aroundtheworld,fewstudieshaveinvestigatedthesituationin Iran[9,12,13].Themostofthesestudieshavebeenpublishedin Persianandfailedtodevelopavalidandreliablequestionnaire.
We designed a multicenter study to evaluate the levels of knowledge,attitude,andpracticeoftype-2diabeticpatientsinthe capitalofIranandalsotoidentifyvariablesthataffecttheirKAP level.
Methods
In this multicenter analytical cross-sectional study, a simple randomsamplingmethodwasusedtoselect200type-2diabetic patientswhowereadmittedto4govermentalhospitals(Loghman- e-Hakim, Imam Hossein, Shahid Labbafinejad, and Shohada-ye- Tajrish)ofTehran,thecapitalofIranfromFebruarytoSeptember 2014. According to the American Diabetes Association (ADA) 2013diagnostic criteria, diabetes is defined as the presence of fasting plasma glucose 126mg/dL (7mmol/L), symptoms of hyperglycemiaanda plasmaglucose200mg/dL(11.1mmol/L), orglucose200mg/dL(11.1mmol/L)2hafterglucoseload,and/or hemoglobin A1C 6.5% [2], and any known cases of diabetes mellitusreceivinganti-diabeticmedication.Inclusioncriteriawere:
type-2diabeticpatientsolderthan18yearsadmittedtosurgery, internalmedicine,ophthalmology,urology,andotorhinolaryngolo- gywardsbyanyindicationsexceptdiabetes-relatedcomplications (suchasglycemiamanagement,diabeticfoot,diabeticretinopathy, nephropathyandneuropathy)withatleast1yearpasttheinitial diagnosisofdiabetes(this1yearwasforassuringatleastonetime training about diabetes). Exclusion criteria were patients with gestational diabetes mellitus, patients younger than 18 years, outpatients,patientswithdiabetesdurationlessthan1year,and patientsadmittedforuncontrolleddiabetes.
Afterapprovingthevalidityandreliabilityofthequestionnaire, 200patientswereenrolled.Theyfilledoutthequestionnaireand their level of knowledge, attitude, and practice as well as the affectingfactorswereevaluated.
Measurementsanddefinitions
Body mass index (BMI) was calculated using weight (kg) divided by the height squared (m2) and the BMI 30 was consideredasobesity.Thenumberofyearssinceinitialdiagnosis was considered disease duration. All laboratory findings were measuredusingParsAzmoonlabkits(ParsAzmoonCo.,Tehran, Iran)at theCentral LaboratoryofLabbafinejad HospitalCentral Laboratory.Fasting plasma glucose wasmeasured using gluco- seoxidasebyaParsAzmoonkit,andglycatedhemoglobin(HbA1C) concentration was determined using a Nyco Card Reader yy analyser[14].
Systolic and diastolic blood pressuresweremeasured by an expertnurse using an automatic monitoring system (Cardioset FX7,SaIRANMedicalIndustry-Iran).
DiabeteswasdefinedaccordingtoADA2013criteria[2]and whetherpatients were receiving anti-diabeticmedications, and systolic blood pressure higher than 140mmHg or diastolic 90mmHgwasconsidered ashypertension[15].Knowncasesof dyslipidemiareceivingmedicationwereconsideredasdyslipide- mia.Proliferative(newvesselsorneovascularizationofthedisk andvitreousorpreretinalhemorrhage)andnon-proliferative(at leastonemicroaneurysm/hemorrhage)wereboth consideredas
diabetic retinopathy [16]. Previously known cases of diabetic nephropathy (presence of macroalbuminuria, or ‘‘severely in- creasedalbuminuria’’inthenewnomenclature)wereconsidered as nephropathy. Existence of at least one of polyneuropathy, autonomic neuropathy, radiculopathies, mononeuropathies,and mononeuropathymultiplexwasconsideredasneuropathy.
Ethicalconsideration
Thisstudywasapprovedby theEthics Committeeof Shahid Beheshti UniversityofMedicalSciences (MeetingFeb2014,No.
151).Thedetailsofthestudywereexplainedtothepatientsand written informed consent was obtained from all patients.
Enrollmentin thestudydidnot disruptthepatients’treatment process.Allpatients’informationwaskeptsecureandanonymous.
Statisticalanalysis
Datawereanalyzedusingstatisticspackageforsocialscience (SPSS)version21forWindows.Allcontinuousdataareexpressed asmean(SD),andcategoricalvariablesareexpressedasnumber and percent. Quantitativevariables werecheckedfornormality using the Kolmogorov–Smirnoff test. Differences of continuous variablesbetweengroupswereanalyzedusingindependentt-test for Gaussian data and Mann–Whitney for non-Gaussian data.
Additionally,Chi-squaretestwasrunforcomparisonofdichoto- mousvariableswhichwereexpressedaspercentages.
Moreover,thecorrelationbetweenvariableswastestedusingthe Pearsontestandtwo-tailedSpearman’srankcorrelationconsidering the Gaussianandnon-Gaussiandistributionofvariables,respec- tively.
Theeffectofmedicationonknowledge,attitude,andpractice wasmeasured byOne-WayANOVAand Tukey’spost-hoc tests.
P-valueslessthan0.05wereconsideredsignificant.
Questionnairedesign
Aquestionnairewasdesignedbyresearchersandvalidatedby eight endocrinologists. To check the questionnaire’s reliability, fifteen patients completed the questionnairetwo times witha 1-weekinterval.
The questionnaire had four parts including demographic information, knowledge(10 questions),attitude(10 questions), andpractice(11questions).Questionsoftheknowledgepartwere multiplechoicequestionswith0–1and0–4scores,basedonthe numbersofcorrectchoices.Questionsoftheattitudepartwere 2 to +2 Likert-like (strongly agree, agree, no idea, disagree, and stronglydisagree). Eachquestioninthepracticepartbelongs1 pointforcorrectpracticeand0pointincaseofincorrectpractice.
Thetotalscoresrangeswerebetween0and22forknowledgepart, 20to+20for attitudepart,and 0to10 forpracticepart.The knowledge, attitude and practice scores were changed to percentageby dividingthetotalscoreof each partby themax scoreofsamepart,andthentheKAPlevelmeansKAPpercent.
The content validity ratio (CVR=(ne N/2)/(N/2)) and rele- vance,clarity,andsimplicitycontentvalidityindex(R-CVI,C-CVI, and S-CVI) were used for instrument validation. The internal consistency of the questionnaire was checked using pretest–
posttestandCronbach’salpha.Thereliabilityofeachquestionwas alsocheckedbyMcNemarandKappatests.
Thequestionnaireitemswerescoredfornecessity,relevance, clarity,andsimplicitybyeightendocrinologistsandtheCVRR-CVI, C-CVI, and S-CVI were measured. Level of significance was considered 0.75accordingtoLawshe’sTable.Noneoftheitems hadCVRandCVIlowerthan0.75.Fifteenpatientscompletedthe questionnaire2 timeswitha 1-weekinterval todetermine the questionnaire’sreliability.Theinternalconsistencywasapproved (overall
a
=0.788. knowledge parta
=0.755, attitude parta
=0.769,andpracticeparta
=0.845).Therewerenosignificant M.Niroomandetal./Diabetes&MetabolicSyndrome:ClinicalResearch&Reviewsxxx(2015)xxx–xxx2
differencebetweenfirstandsecondanswersinallquestionnaire items(P>0.05).TheKappaindexwasnotlowerthan0.2inany item.Thevalidityandreliabilitycheckingprocessesareshownin Fig.1.
Results
Patients’demographics
Twohundredtype-2diabeticpatientswiththemeanageof 60.1713.56yearsandthemeanBMIof29.036.57kg/m2were evaluated(106 maleand94femalepatients).Statinconsumption, hypertension,anddyslipidemiaweresignificantlyhigherinfemale patientsincomparisontomalepatients(P<0.05).Buttherewereno significantdifferencesinotherpatients’characteristicsandriskfactors amongmaleandfemalepatients(Table1).Therewerenosignificant differences between male and female patients in laboratory findings(P>0.05,Table2).Thetotallevelofpatients’knowledge was61.4112.35(Table3),totallevelofpatients’attitudewas 47.1828.85(Table4),andtotallevelofpatients’practicewas 52.2318.02(Table5).
Factorsaffectingknowledge,attitude,andpractice
Therewasasignificantcorrelationbetweenageandpractice, with older age having a negative impact on good practice
(r= 0.179,P=0.012).Thediseasedurationalsocorrelatedwith patients’ levels of knowledge, attitude, and practice (r>0.2, P<0.001), where longer duration improved these scores. The patients’ knowledge,attitude, and practice scoreswere signifi- cantlyhigherinpatientsoninsulintherapyincomparisontoother medications(P<0.05).Thelevelofknowledgewassignificantly higherinpatientswithapositivefamilyhistoryincomparisonto patientswithanegativefamilyhistory(63.112.3vs.58.511.9, P=0.012).Knowledge,attitude,andpracticescoresweresignificantly higherinpatientswithdiabeticretinopathy(P<0.05).Practicewas betterinpatientswithdiabeticnephropathy(P=0.0002),whereas knowledge and practice were better in patients with diabetic neuropathy(P<0.05,Table6).
Discussion
Thepatientsinthepresentstudyhadahighgeneralknowledge scoreandhad goodattitudeandpracticescorescomparedwith previousevaluationsinIran.ManystudiesaboutIraniandiabetic patients’ KAPlevelarepublishedindomesticlanguageinother citiesofIran[9,12,13].Thediabeticpatients’KAPwasingoodlevel aftersomesuccessfulexperiencescarried outforimprovingthe KAPlevelinTehran[8,11],wherethemosteducationalprograms hadbeenheld.ButthislevelofKAPisnotoptimalyetandcouldbe betterbycontinuingtheseeducationprograms.
Fig.1.Flowchartofquestionnairevalidityandreliabilitycheckingprocess.
ThepresentstudyisinconcordancewithFelekeetal.inthat bothexaminedtherelationshipbetweenageanddiseaseduration withpatients’ knowledgeand practice;withthedifference that they did not evaluate patients’ attitude and that gender was correlatedwithpracticein theirstudy wheremale participants showedbetterpractice.AllpatientsinFelekeetal.’sstudyshowed
lowerknowledgeandpracticeinNorthwestEthiopiaincompari- sontothepresentstudy(Iran)[17].
InIndia,Rathodetal.describedthegeneralpopulationofIndia andshowedlowerKAPlevel,butRajandAngadishowedhigher KAPlevelincomparisonofthepresentstudy.InRajandAngadi’s study,longerdiseaseduration wassignificantly associatedwith Table1
Characteristicsandriskfactorsindiabeticpatients.
Variable Male(N=106) Female(N=94) P Total(N=200)
Age,years 60.5112.22 59.7715.17 0.704 60.1713.56
60years 47(44.3) 48(51.1) 0.342 95(47.5)
>60years 59(55.7) 46(48.9) 105(52.5)
BMI,kg/m2 29.27.04 28.826.01 0.689 29.036.57
Obesity(BMI35),No.(%) 40(37.7) 35(37.2) 0.942 75(37.5)
Waistcircumference,cm 104.7127.58 104.7225.48 0.997 104.7126.53
Diseaseduration,years 12.739.62 13.368.87 0.659 13.069.26
Treatmentmethods,No.(%) 0.165
Insulin 55(51.9) 49(52.1) 104(52)
OralAnti-HyperglycemicDrugs(OAH) 45(42.5) 44(46.8) 89(44.5)
Withouttreatment 6(5.7) 1(1.1) 7(3.5)
AspirinConsumption,No.(%) 55(51.9) 45(47.9) 0.335 100(50)
StatinConsumption,No.(%) 54(50.9) 61(64.9) 0.032 115(57.5)
Hypertension,No.(%) 48(45.3) 65(69.1) 0.001 113(56.5)
Dyslipidemia,No.(%) 40(37.7) 63(67) <0.001 103(51.5)
Nephropathy,No.(%) 32(30.2) 29(30.9) 0.520 61(30.5)
Retinopathy,No.(%) 60(56.6) 61(64.9) 0.146 121(60.5)
Neuropathy,No.(%) 42(39.6) 46(48.9) 0.119 88(44)
PositiveFamilyHistory,No.(%) 70(66) 57(60.6) 0.260 127(63.5)
SystolicBloodPressure,mmHg 124.1614.45 125.6616.8 0.565 124.8815.66
DiastolicBloodPressure,mmHg 75.268.12 76.869.56 0.278 76.038.85
Table2
Patients’laboratoryfindings.a
Laboratorytest(normalrange) Male(N=106) Female(N=94) P Total(N=200)
FastingPlasmaGlucose(70–100mg/dl) 211.299.97 216.6289.94 0.788 213.493.69
HbA1c(5.7–6.4%) 8.872.86 9.730.77 0.489 9.32.04
Triglyceride(150–199mg/dL) 137.4465.53 159.899.91 0.317 145.4379.36
Cholesterol(<180mg/dL) 174.0948.25 15540.34 0.134 166.9346.02
HDL(>40–60mg/dL) 42.3316.25 43.5613.77 0.843 42.6715.41
LDL(100–129mg/dL) 94.9632.11 73.1826.87 0.059 88.1131.86
BUN(7–20mg/dL) 30.2814.49 34.622.99 0.248 32.4819.33
Creatinine(0.7–1.3mg/dLformenand0.6–1.1mg/dL forwomen)
1.611.16 1.621.39 0.961 1.621.26
aFastingplasmaglucose;glycosylatedhemoglobin(HbA1c);triglyceride;cholesterol;highdensitylipoprotein(HDL);lowdensitylipoprotein(LDL);bloodureanitrogen (BUN);andcreatinine.
Table3
Descriptionofpatients’knowledgescoreindetail.Eachquestionbelongsto0–1and 0–4scores,basedonthenumbersofcorrectchoices.
Knowledge Score
K1.Whatarediabetessymptoms?(0–4) 1.780.875 K2.Whatistheeffectofexerciseonglucose
controlling?(0–1)
0.9250.264 K3.Isdietaryinterventionnecessaryin
controllingglucose?(0–1)
0.890.314 K4.Whatisnecessaryforcontrollingdiabetes?(0–4) 3.010.962 K5.Whatissuitablebloodpressurefor
adiabeticpatient?(0–1)
0.070.256 K6.Whichindexissuitableforawarenessabout
diabetescontrolinpastmonths?(0–1)
0.0950.294 K7.Whichoneisthenormalbloodglucose
inahealthyperson?(0–1)
0.2950.457 K8.Whichonecouldcausetype-2diabetes?(0–4) 2.910.889 K9.Whichoneisthecorrectfootcare
inadiabeticperson?(0–1)
0.590.493 K10.Whatistheeffectofdiabetesoneyes?(0–4) 2.950.434 Totalknowledgepercentage(0–100) 61.4112.35
Table4
Descriptionofpatients’attitudeindetail;eachitembelongs 2to+2Likert-like (stronglyagree,agree,noidea,disagree,andstronglydisagree)scores.
Attitude Score
A1.Diabetesmellitusistreatable. 0.221.57
A2.Diabetesmellitusistreatablewithdietaryandexercise. 0.311.53 A3.Medicationcanbediscontinuedincaseofincreasing
bloodglucoseandsymptomsrelease.
0.521.59 A4.Diabetesreduceslifeexpectancy. 0.9551.22 A5.Herbalmedicationshavelesscomplicationthan
physicians’medications.
0.2651.48 A6.Lipidandbloodpressurecontrolisnecessaryin
diabeticpatients.
1.730.67 A7.Regularexercisehelpscontrollingdiabetes. 1.880.548 A8.Initiatinginsulinexacerbatesdiabetesandits
complications.
0.5051.22 A9.Properdiabetestreatmentcouldblockagerenal
failureandblindness.
1.550.843 A10.Smokingexacerbatesvascularcomplicationsdue
todiabetes.
5.779.44
Totalattitudepercentage(0–100) 47.1828.85
M.Niroomandetal./Diabetes&MetabolicSyndrome:ClinicalResearch&Reviewsxxx(2015)xxx–xxx 4
higherknowledgewhichisinagreementwiththefindingsofthe presentstudy[18,19].
Demaio et al., evaluating KAP in general population in Mongolia, reported that one fifth of them had no knowledge aboutdiabetesandhadahighrateofincorrectconceptionsabout diabetesanditssymptoms.Onethirdofthestudypopulationwas notawareofdiabetespreventabilitybychanginglifestyleintheir study[20].
In Nepal, Upadhyay’s study showed less knowledge and practiceandsimilarattitudeincomparisontopresentstudy,with thisdifferencethattheyevaluatednewly-diagnosedpatients[21].
ButSinghetal.assessedpatientsintwogroups:governmentaland non-governmentalhospitalsofNepal.Patientsinnon-governmen- talhospitalshadthesameknowledgeasthepatientsinthepresent study,whilethoseingovernmentalhospitalshadlessknowledge.
Theydidnotassesspatients’attitudeandpractice[22].
Similartothepresentstudy,lowknowledgeofdiabeticpatients aboutoptimalbloodpressureandimportanceofitscontrolwas pointedoutinastudyinAustraliadonebyWongetal.[23].
InSaadiaetal.’sstudyinSaudiArabiapatientshadthesame knowledgeasthepresentstudywhiletheirattitudeandpractice werelower.Saadiaetal.assessedfemalediabeticpatients[24].Age andtypeoftreatmentwereassociatedwithknowledge,attitude, andpracticeinTanandMagarey’sstudyinMalaysiawhichisin accordancewiththepresentstudy[25].
Age was negatively correlated with practice, while the knowledgeandattitudewereatgoodlevelinoldpatients.Hence focusingonpracticeofolderpatientscouldbeconsideredinfuture educational programs. Since there was a significant positive correlationbetweendiseasedurationandcomplicationswithKAP level,theeducationscouldbemore usefulfornewlydiagnosed patientsbeforeoccurringthediabetescomplications.
Inthepresentstudy,surveyswithhighvalidityandreliability were applied under the supervision of endocrinologists, and knowledge,attitudeandpracticeweresimultaneouslyevaluated indiabeticin-patientswhichcanbepointedasthestrengthofthe study.
Studylimitations
Allof thepatients inthepresentstudyhadtype-2diabetes;
hence,theobtainedresultsarenotextrapolatedtopatientswith type-1diabetes.Furthermore,reachablesampleswereevaluated inthepatientsandthesamplesizewaslimited.
Conclusion
Withrecenteducationalprogramsfortype-2diabeticpatients in Iran theKAP level is improved. But this level of KAP is not optimalandneedsmoreevaluationsaboutbarriersofKAPinIran.
Theresultsofthisstudyshowedthatpatientswithlongerduration of diabetes, those developing diabetic retinopathy and those receiving insulinhad abetterKAPscore.Thismaysuggest that patients’ KAP increases as their condition worsens/progresses.
Future educations should beconsidered as a priority in newly diagnosedpatientsandwhomwithlowerKAPlevels.
Funding
This study was extracted from the residential thesis of Dr.
Ghasemiandit wassupportedbya grantfromShahidBeheshti UniversityofMedicalSciences.
Authorscontribution
Ideadevelopment:MahtabNiroomand;Acquiringdata:Seye- deh Najmeh Ghasemi; data analysis: Hamidreza Karimi-Sari;
draftingthemanuscript:HamidrezaKarimi-Sari,SeyedehNajmeh Table5
Descriptionofpatients’practicescoreindetail;eachitembelongs0and1scoresfor badpracticeandgoodpracticerespectively.
Practice Score
P1.Whenwasyourlastophthalmologistreferral?
(0–1)
0.7150.453 P2.Wouldyouuseherbalmedicationsfor
controllingdiabetes?(0–1)
0.6250.485 P3.Whenwasyourlastnutritionistreferral?(0–1) 0.2750.447 P4.Howmanytimesaweekdoyouexamineyour
feet?(0–1)
0.4550.499
P5.Haveyouglucometer?(0–1) 0.730.445
P6.Whenispropertimetocheckbloodglucoseby glucometer?(0–1)
0.940.238 P7.Howmanydaysaweekdoyouexercise?(0–1) 0.30.459 P8.Howmanymainmealsdoyouhavedaily?(0–1) 0.0650.247 P9.Lastyear,howmanytimesdidyouvisita
doctor?(0–1)
0.480.5
P10.Doyousmoke?(0–1) 0.960.196
P11.Haveyoueverparticipatedinadiabetes educationclass?(0–1)
0.20.401
Totalpracticepercentage(0–100) 52.2318.02
Table6
Correlation of patients’ knowledge, attitude, and practice with confounders.
Pearson(orSpearman)correlationcoefficient(r)andP-value(P).
Variable Knowledge Attitude Practice
Totalscore (0–100)
61.4112.35 47.1828.85 52.2318.02
Age r=0.068P=0.340 r=0.120P=0.093 r=-0.179P=0.012 Agecategories P=0.017 P=0.257 P=0.467 60years 59.2313.27 44.7429.19 53.2118.70
>60years 63.3811.15 49.3828.50 51.3417.42
Gender P=0.213 P=0.149 P=0.101
Male 62.4412.22 49.9527.56 50.2617.53
Female 60.2512.45 44.0427.56 54.4518.4
Obesity P<0.001 P=0.168 P=0.120
Yes 65.529.69 50.9725.82 54.7916.91
No 58.9513.12 45.0830.44 50.6918.55
Hypertension P=0.069 P=0.153 P=0.840
Yes 59.9412.28 49.7330.91 52.4515.79
No 63.3212.24 43.8525.73 51.9320.65
Disease duration
r=0.319 P<0.001
r=0.304 P<0.001
r=0.247 P<0.001 Medication P<0.001 P=0.001 P<0.001
Insulin 65.612.1 51.729.1 57.918
Oralpills 57.810.5 44.726.9 47.315.8 Without
treatment
44.88.9 10.718.6 29.94.4
Familyhistory ofdiabetes
P=0.012 P=0.068 P=0.625
Yes 63.112.3 5028.6 51.816.7
No 58.511.9 42.328.8 53.120.2
Diabetic retinopathy
P=0.002 P=0.006 P<0.001
Yes 63.611.9 51.727.6 5615.9
No 58.112.3 40.329.5 46.419.5
Diabetic nephropathy
P=0.238 P=0.606 P=0.002
Yes 6312.1 48.831.9 58.619.6
No 60.712.3 46.527.5 49.416.6
Diabetic neuropathy
P<0.001 P=0.069 P=0.003
Yes 659.7 51.427.9 56.517.4
No 58.613.5 43.929.2 48.917.8
Ghasemi,MohammadHosseinKhosravi,SaraKazempour-Ardebili;
criticalrevision ofpaper:Mahtab Niroomand; SaraKazempour- Ardebili,studysupervision:MahtabNiroomand,ParisaAmiri.
Conflictsofinterest
Theauthorshavenonetodeclare.
Acknowledgements
The authors would like to thank the staff of Research and DevelopmentDepartmentofShohada-ye-TajrishMedicalCenter, MrsDashtiT.M.S.,thestaffofLoghman-e-Hakim,ImamHosein, ShahidLabbifinejad,andShohada-ye-TajrishHospitals.
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Pleasecitethisarticleinpressas:NiroomandM,etal.Diabetesknowledge,attitudeandpractice(KAP)studyamongIranianin-patients
