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  • Research note
  • Open Access

Self-care practices and associated factors among diabetes patients attending the outpatient department in Bahir Dar, Northwest Ethiopia

  • 1Email author,
  • 2 and
  • 3
BMC Research Notes201811:800

https://doi.org/10.1186/s13104-018-3874-8

  • Received: 18 September 2018
  • Accepted: 22 October 2018
  • Published:

Abstract

Objective

The aim of this study was to assess diabetes self-care practice and associated factors among diabetes patients attending Felege-Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia.

Result

Prevalence of desirable self-care behaviors toward Diabetes Mellitus was 28.4% (95% CI 24.0–32.7%). There were significant association between the combined treatment modality of tablet with insulin (AOR: 2.72; 95% CI 1.01, 7.40), primary and secondary education level (AOR: 4.82; 95% CI 1.88, 12.35 and AOR: 3.08; 95% CI 1.26, 7.53, respectively). A considerable number of the patients had poor self-care practice, especially lack of social support and treatment modality, which have critical roles in controlling diabetes. Therefore, attention should be given to improve self-care practice.

Keywords

  • Self-care
  • Diabetes mellitus
  • Factors
  • Adult diabetes patient

Introduction

Diabetes mellitus (DM) is a metabolic diseases characterized by hyperglycemia. It is a defect in insulin secretion, insulin action, or both [1]. DM is a global emergency: one death occurred every six seconds; one limb lost every 20 s [2]. More than 21 million people have DM in Africa and it will double by 2035. In Ethiopia, the expected number of diabetes was > 2.135 million [3]. DM was a cause of admission and boost disease-related complications [4]. Uncontrolled DM causes 2–4 times heart attacks, 2–6 times strokes, and 10–15 years shortens lifespan [5].

The goal of DM care is good metabolic control and render complications by the participation of health care professionals and client themselves [6, 7]. It required adequate self-care practices to keep the disease under control [8]. Self-care is self-limited, voluntary, and outside professional [9, 10]. In the previous studies, what was documented, high proportion of good practice of regular exercise (60%); planned dietary regimen (76%), taking medications (88.4%) [11, 12]. There was a poor self-care practice reported in the previous studies: poor regular exercising, regularly inspected and provided feet care [1316].

Factors that redder self-care practice in DM patients were being male, housewife [17, 18], married, belonging to higher socioeconomic status, educational status [1517, 19]; treatment modality [20, 21]. From all of the above review, studies available in the study area were limited in addressing factors that influence self-care practice. Therefore, this study aimed to assess self-care practices and associated factors among diabetes patients.

Main text

Methods

Institution—based cross sectional study was conducted from January 1st to April 8th, 2017 at FHRH. Currently, FHRH has provided promotive, preventive, curative and rehabilitative services. The service was rendered by physician and nurses. Patients with DM were visited the hospital on every 2 month basis. The sample size was determined by assuming 5% marginal error, 95% CI and 45% proportion of DM self-care practice [16]. The final sample size including 10% non-response rate become 418 DM patients. All diabetes patients aged ≥ 18 years and who have been on regular follow for DM were included in this study.

Patients’ records were listed in follow up appointment order and used as a sampling frame. Then, Systematic random sampling was employed to select eligible participants. Based on the decision to collect data over the course of 1 month, sampling interval was determined by dividing the expected number of diabetic patients per month into the sample size which gives a sampling interval of three. Thus, every three-patient coming to a follow-up service was interviewed until the total sample size was then reached.

Trained four B.Sc. nurses collected data through face to-face interview and medical chart review. The questionnaire contains socio-demographic, economic, social support [22] and clinical factors. Clinical related factors like diabetes complication was gathered objectively by using checklists. Self-care practice patient with DM was evaluated by self-reported 18-item Summary of Diabetes Self-Care Activities (SDSCA) [23]. SDSCA scale measured frequency of self-care activity in the last 7 days; specifically general and specific diet, physical activity, blood glucose testing, foot care and medication. SDSCA was calculated by summing of the mean score for each dimension divided by the sum of the number of questions under each scale. After calculating an overall mean score, it was classified as having desirable self-care if scored ≥ 3 or not desirable self-care if scored < 3.

Structured questionnaire was prepared in English and translated into Amharic, then to check the consistency of the tool the Amharic version translated into English. The questionnaire was carefully evaluated and pre-tested on 5% of the sample size in patients with DM at Debretabor Hospital prior to actual data collection. The collected data entered into EPI—data version 3.1 and analyzed using SPSS version 20. Household wealth index was determined by using principal component analysis. The association was investigated by logistic regression. Variables with P-value < 0.2 in bi-variable analysis were selected for multivariable analysis. Finally, 95% CI and AOR were presented and interpreted.

Results

Out of 418, 416 participants were interviewed making the response rate 99.5%. Of all participants 250 (60.1%) were married and 109 (26.2%) were farmers. The mean age (SD) of the respondents was 41.10 ± 15.65 years with minimum age 18 and maximum age 83 (Table 1).
Table 1

Socio-demographic characteristics of participant at FHRH, Bahir Dar, Northwest Ethiopia, 2017 (n = 416)

Variables

Category

Frequency

Percent

Sex

Male

240

57.5

Female

176

42.3

Age

18–34

160

38.5

35–44

73

17.5

45–54

87

21.9

≥ 55

96

23.1

Residency

Urban

173

41.6

Rural

243

58.4

Marital status

Single

123

29.6

Married

250

60.1

Divorced

28

6.7

Widowed

15

3.6

Educational status

Can’t read and write

133

32.0

Read and write

70

16.8

Primary school (1–8)

72

17.3

Secondary school (9–12)

55

13.2

College/University

86

20.7

Occupational

Farmer

109

26.2

Civil servant

92

22.1

Private worker

52

12.5

Merchant

76

18.3

House wife

59

14.2

Others

28

6.7

Income

Very poor

83

20.0

Poor

83

20.0

Middle

84

20.2

Rich

83

20.0

Very rich

83

20.0

Clinical and psychosocial characteristics

The mean duration (SD) of diabetes treatment was 6.28 ± 4.87 years. Eighty-eight participants (21.2%) had diabetes retinopathy, which evidenced by a review of patients’ charts, and 209 (50.2%) had poor social support (Table 2).
Table 2

Clinical and psychosocial characteristics of participant at FHRH, Northwest Ethiopia, 2017 (n = 416)

Variables

 

Frequency

Percent

Types of diabetes mellitus

 Type 2

242

58.2

 Type 1

174

41.8

Treatment modality

 Oral hypoglycemic with insulin

32

7.7

 Only oral hypoglycemic

117

28.1

 Only insulin

266

63.9

 Only diet

6

1.3

Duration of DM (years)

  ≤ 8

291

70.0

 9–16

107

25.7

 ≥ 17

18

4.3

Taking another medication

 Yes

75

18.0

 No

341

82.0

DM complication

 Diabetes retinopathy

88

21.2

 Diabetes neuropathy

52

12.5

 Sexual dysfunction

52

12.5

 Foot ulcer

70

16.8

Social support

 Poor

209

50.2

 Moderate

138

32.2

 Strong

69

16.6

The overall prevalence of desirable self-care toward DM was 28.4% (95% CI 24.0–32.7%). DM patients who were taking a tablet combined with insulin had more likely to have a good self-care practice when compared to those other treatment regimes. Patients who were primary level education (AOR: 4.82; 95% CI 1.88, 12.35), widowed (AOR: 4.05; 95% CI 1.41, 11.58), and who have taken pill other medication (AOR: 2.87; 95% CI 1.43, 5.76) were more likely to have a good self-care practice. Whereas patients who were housewives (AOR: 0.34; 95% CI 0.13, 0.89) and who had poor social support (AOR: 0.29; 95% CI 0.15, 0.59) were more likely to have a poor self-care practice (Table 3).
Table 3

Predictors of self-care behavior among patients with diabetes at FHRH, Northwest Ethiopia, 2016 (n = 416)

Variable

Self-care practice(n)

COR (95% CI)

AOR (95% CI)

Poor

Good

Social support

 Strong

38

31

1

1

 Moderate

97

41

0.52 (0.29, 0.94)

0.50 (0.25, 1.02)

 Poor

163

46

0.35 (0.19, 0.62)

0.29 (0.15, 0.59)a

Educational

 Can’t read and write

109

24

0.54 (0.28, 1.02)

1.21 (0.46, 3.16)

 Read and write

53

17

0.78 (0.38, 1.60)

1.60 (0.61, 4.23)

 Primary school

41

31

1.85 (0.96, 3.57)

4.82 (1.88, 12.35)a

 Secondary school

34

21

1.51 (0.74, 3.08)

3.08 (1.26, 7.53)a

 College/University

61

25

1

1

Marital status

 Widowed

18

10

1.27 (0.56, 2.88)

4.05 (1.42, 11.58)a

 Divorced

9

6

1.53 (0.53, 4.44)

1.86 (0.47, 7.39)

 Single

98

26

0.61 (0.37, 1.02)

0.95 (0.49, 1.86)

 Married

174

76

1

1

Occupational

 Civil servant

60

32

1

1

 Farmer

89

20

0.42 (0.22, 0.80)

0.50 (0.19, 1.32)

 Private worker

32

20

1.17 (0.57, 2.37)

0.95 (0.38, 2.34)

 Merchant

50

26

0.97 (0.51, 1.84)

0.85 (0.36, 2.00)

 House wife

47

12

0.48 (0.22, 1.03)

0.34 (0.13, 0.89)a

 Othersb

20

8

0.75 (0.29, 1.89)

0.55 (0.16, 1.82)

Income

 Very poor

73

10

0.25 (0.11, 0.56)

0.27 (0.12, 0.69)a

 Poor

63

23

0.66 (0.34, 1.29)

0.77 (0.36, 1.68)

 Middle

58

27

0.84 (0.44, 1.62)

0.96 (0.43, 2.10)

 Rich

53

30

1.03 (0.54, 1.96)

1.13 (0.53, 2.42)

 Very rich

51

28

1

1

Taking both oral and insulin

 Yes

16

282

2.77 (1.33, 5.73)

2.72 (1.01, 7.40)a

 No

16

102

1

1

Taking other medication

 Yes

42

256

2.37 (1.41, 3.97)

2.87 (1.43, 5.76)

 No

32

85

1

1

aStatically significant; COR crude odds ratio, AOR adjusted odd ratio

bRetires and students

Discussion

In this study, good self-care practice among diabetes patients was 28.4% (95% CI: 24.0–32.7%) towards DM self-care practice in all domains. This level of good self-care practice was much lower than what has been documented in India, Harari, Addis Ababa and Iran [12, 16, 19, 20]. This might be due to a small sample size and difference setting used by the other study. The study conducted in India was small a sample size, whereas in our study relatively large; in Addis Ababa public hospital was a large sample size, whereas in our study smaller. It is much better when compared to what has been documented in other studies of India and Addis Ababa [18, 21].

In our study, those who under tablet combined with insulin therapy were 2.72 (95% CI 1.01, 7.40) more likely to have good self-care practice than those who were treated with other treatment modality. A contrasting result were found a study done in Iran 3.6 (95% CI 2.1, 5.7) and in Addis Ababa 1.94 (95% CI 1.31, 2.87) for those who under insulin treatment modality [19, 20]. Comparatively better self-care score among tablet with a combined of insulin therapy in the present study could be these people might have a diabetes which was uncontrolled by mono-therapy (tablets or insulin alone). The combined of insulin with a tablet therapy has complementary mechanisms of action [24, 25].

Social support was found to be significantly associated with good self-care practice. Similar findings were observed in a study done in Jimma [16], Addis Ababa [19] which showed that social support is important to ensure good self-care practice to the multiple diabetes related tasks among DM patients. Perhaps this might be due to effective social support may need to act as a more gentle guiding force that might be motivated behavioral change for the better self-care practice.

Our finding showed that income was one factor that affects self-care behavior in in diabetes patient. This result corresponds with the study finding in Harari [15], which observed a lower to good self-care practice among participants. This may be due to patients might be riskier life style with respect to income due to monetary condition, less accessibility and affordability of recommended self-care practice.

Our finding showed that participants who had formal education reported desirable self-care practice. This result corresponds to the study documented in Harari [15], Jimma [16] and Urban [20]. This might be a participant who had formal education might be escalated their base line information for self-care and could be successfully practiced self-care activities by reading guideline, and implement professional recommendations into practice.

In our study, participants those who were housewife less likely to have good self-care practice than those who were not; similar to the finding in India [18]. This might be different reasons, like easily appointed for carrying out the routine household work, probably lack information about self-care practice. An individual who had taken additional medication rather than a single dose of diabetes medication was one of the factors that affect self-care behavior in our study. This was not inline a study conducted in Harari [15]. In our study, taking addition medication might be consequence of drug–drug interactions, medication burden, adverse drug events, and functional decline [25].

Generally, this finding revealed that there were considerable numbers of participants had poor self-care practice (71.6%). Marital, economical and occupational status, educational level, taking additional medication, treatment modality and social support have a significant factor in order to provide patient own self-care. This suggests a health care providers aggressively emphasis on self-care practice by segmenting the patients based on social support, income, treatment regimens and educational status to motivate self-care practice.

Limitation

Since the data were collected by health professionals working on follow up clinic there might be social desirability bias. The domain of self-care activities were obtained by self-reports and may be limited by recall bias. Another limitation of this study has not addressed whether participants have received any diabetes education or not.

Declarations

Authors’ contributions

TW initiated the idea, carried out the study, and was involved in drafting and editing the manuscript, and interpretation of the data. MTa contributed edit the proposal, analysis, critically revised the paper, and provided the final version, TMu contributed to the pre-test of the tool; statistical analysis, writing the manuscript, recruit data collectors, and data entry. All authors read and approved the final manuscript.

Acknowledgements

The authors are grateful to Bahir Dar University for all expenses of the research work, data collectors, and all the study participants who voluntarily participated in this study.

Competing interests

The authors declare that we have no competing interests.

Availability of data and materials

The data of this study can’t be shared publicly due to the presence of sensitive (confidential) participants’ information.

Consent to publish

Not applicable.

Ethics approval and consent to participate

In order to follow the ethical and legal standards of scientific investigation, this study was conducted after approval of the proposal by Bahir Dar University institutional review board committee and ethical approval and clearance was obtained from this board. Permission and supportive letter were obtained from respective health bureau and hospital medical director’s office before actual data collection. Participation was voluntary and information also was collected anonymously after obtaining written consent from each respondent by assuring confidentiality throughout the data collection period. Participants also were told the objective of the study and gave the right to refuse, stop or withdraw at any time of data collection.

Funding

The study was funded by the Bahir Dar University. The University was critically reviewed and approved the concept of the study, permitted the study to be conducted, and was involved in data collection process manuscript preparation.

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Authors’ Affiliations

(1)
Nursing Department, College of Medicine and Health Sciences, Bahir Dar University, P.O.BOX:79, Bahir Dar, Ethiopia
(2)
Psychiatry Department, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
(3)
Nutrition Department, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia

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Copyright

© The Author(s) 2018

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