اخبلر الكلية
زوار موقعنا الكرم : لاتبخلوا علينا باقتراحاتكم وانتقاداتكم من اجل الارتقاء بالموقع

بحث منشور الاستاذ المساعد الدكتورة سميرة محمد STUDY TO ASSESS THE ATTITUDE AND PRACTICE OF DIABETIC PATIENT

 

ABSTRACT

 

Background: Diabetes Mellitus, the commonest endocrine disorder affects developed as well as developing

 

country. Prevalence of diabetes in Iraq was estimated to be 10.2 per cent in 2010. This estimate exceeded total prevalence

 

in the Middle East and North Africa region (9.3%) and is (nearly) equivalent to that of the USA (10.3%).

Objectives: The aim of the study is assess attitudes and practices related to insulin therapy and to

 

self-administration of insulin among diabetic patients in Basra City.

 

Methodology: The study was descriptive cross-sectional one, on sample of 100 patients with diabetes mellitus

 

attending outpatient clinic in Basra general Hospital and AL. Mawani Hospital. Structured questionnaire was used for the

 

purpose of data collection, by direct interviewing the patients including information about the socio demographic

 

characteristics, attitudes and practices regarding insulin therapy and self-administration if insulin ; the data collection was

 

carried out from November 2013 to February 2014.

 

Results: Regarding sex (58%) of the sample were females, (4%) of the sample was younger than 25 years,

 

Majority were married (90%), (12%) were illiterate, (28%) complete primary school, (46%) complete secondary school

 

(14%) had higher educational level, (50%) were unemployed, and (53%) of them had positive family history of diabetes.

 

Most of them (71%) diagnose after developmental of symptoms.

 

All patients in study consult regularly for their condition, (50%) of them prefer private clinic as facility for

 

consultation. (43%) of them check their blood glucose only when them fell ill. Hospitals considered as source of insulin for

 

( 41%) of patients, (66%) prefer the arm as a site of injecting insulin. Only (20%) of them use the insulin syringe for single

 

injection, (4%) of them dispose the used insulin needles in a special container at home, (97%) of them eat some food

 

shortly after insulin. Only (54%) had good practice level of correctly practicing self-administration of insulin. The rate of

 

correct practices among males was higher than the rates among females for the majority of the items, and among those who

 

were recently diagnosed

 

Conclusions: The patients in this study showed variations in attitudes regarding their illness, insulin therapy and

 

self-administration of insulin. The level of correctly practicing self-administration of insulin was low. Except for the

 

disposal of used insulin needles in a special container at home, the rate of correct practices regarding self –administration

 

of insulin among males was higher than the rates among females for the majority of the items.

 

International Journal of General Medicine

 

and Pharmacy (IJGMP)

 

ISSN(P): 2319-3999; ISSN(E): 2319-4006

 

Vol. 3, Issue 4, July 2014, 65-74

 

© IASET

 

66 Samira Muhammed Ebrahim, Utoor Talib Jassim & Doaa Mohammed Baji

 

Impact Factor (JCC): 2.9545 Index Copernicus Value (ICV): 3.0

 

Recommendations: Teaching program can be conducted in diabetes clinic regarding insulin and its

 

administration. And hospital and other health institutions should apply responsible steps to facilitate passage for better

 

educational level for patient with insulin self-administration.

 

KEYWORDS: Attitude, Practice, Diabetic Patient, Insulin, Self – Administration

 

INTRODUCTION

 

Diabetes Mellitus, the commonest endocrine disorder affects developed as well as developing country. In 2011,

 

336 million population have diabetes and estimated to reach 552 million by 2030 globally. Low and middle-income

 

countries have 80% diabetes burden. Diabetes will be the seventh leading cause of death in 2030[1].

 

Prevalence of diabetes in Iraq was estimated to be 10.2 per cent in 2010. This estimate exceeded total prevalence in the

 

Middle East and North Africa region (9.3%) and is (nearly) equivalent to that of the USA (10.3%)[2].

 

Persons with type 1 diabetes account for 5%-10% of those with diabetes, and with life style modifications, blood

 

sugar control, and insulin injections, they can live long productive live [3]..

 

Insulin therapy is a cornerstone of treatment in type 1 diabetes and, in many cases, also critical to the management

 

of type 2 diabetes [4]. Insufficient knowledge of insulin contributes to errors in its use that may cause adverse patient

outcomes. [5].

 

Diabetes is a complex and chronic condition that requires effective self-management by the individual in

 

partnership with healthcare professionals to prevent both acute and chronic complications [6]. Patient education and

self-care practices are also important aspects of disease management that help people with diabetes live normal lives[7]. It is

 

now accepted that the correct place for routine management of the person with diabetes is in primary care with supporting

 

services from specialists[8]. This study is important because it will help health care providers to recognize the feelings,

 

attitudes, and practices of the patients and provide educational support that patients need when they are on insulin. There is

 

a need for patients to gain awareness, because lack of awareness among many diabetic patients could lead to serious

 

complications. The aim of the study is assess attitudes and practices related to insulin therapy and to self-administration of

 

insulin among diabetic patients in Basra City.

 

METHODOLOGY

 

· Design of the Study: Descriptive, Cross Sectional Study.

· Setting of the Study: AL- Basra General Hospital and AL_Mawani Hospital In Basra City.

· The Sample of the Study: Convenient sample of 100 diabetic patients attending outpatient clinic, of both male

 

and female were selected. The sample was selected according to special criteria as patients being on insulin

 

therapy. Structured questionnaire was used for the purpose of data collection; the data collection was carried out

 

from November 2013 to February 2014.

 

The questionnaire that used for direct interviewing the patients by 2 senior nursing students aiming to reduce the

 

anxiety of the patients during the interview. The questionnaire consisted of three parts. First part consisted of questions

 

regarding the socio demographic characteristics of the patients including sex, age, marital status, education, occupation,

 

and family history of diabetes. Second part consisted of questions regarding duration of the disease, how it was diagnosed,

 

A Study to Assess the Attitude and Practice of Diabetic Patient towards Self-Administration of Insulin in Basra City, Iraq 67

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consultation facilities, and information about blood glucose testing. The third part of the questionnaire aimed to gather

 

information regarding insulin administration, fears and problems related to insulin self-administration and the correct

 

practices related to self-administration of insulin. Poor practice level was considered if the participant practice less than

 

(50% of correct practices), from (50% to 69% of correct practices) was considered as fair practice level, and if the

 

participant practice (70% and more of correct practices) then the score considered good.

 

· Statistical Analysis: Analysis was made by using SPSS version 16, data was expressed in

 

(frequency and percentage). Chi-squared test was used to examine the association between the groups and a

 

probability of less than 0.05 was considered to be statistically significant.

 

RESULTS

 

Table (1): showed that (58%) of the sample were females and (42%) were males. Regarding age (4%) of the

 

sample was younger than 25 years, (54%) of them between (25-49) years of age and (42%) were above 50 years of age.

 

Majority were married (90%), regarding the educational level of the respondents (12%) of them were illiterate, (28%)

 

complete primary school, (46%) complete secondary school and only (14%) had higher educational level (46%), (50%)

 

were unemployed, and (53%) of them had positive family history of diabetes.

 

Table 1: Socio- Demographic Characteristics of the Participants

 

Variable No. %

 

Sex

 

Male 42 42

 

Female 58 58

 

Age

 

<25 4 4

 

25-49 54 54

 

50+ 42 42

 

Marital status

 

Single 10 10

 

Married 90 90

 

Education

 

Illiterate 12 12

 

Primary 28 28

 

Secondary 46 46

 

Higher education 14 14

 

Occupation

 

Unemployed 50 50

 

Self employed 28 28

 

Governmental employed 16 16

 

Retired 6 6

 

Family history of diabetes

 

Positive 53 53

 

Negative 47 47

 

Total 100 100

 

Table (2): showed that (35%) of the patients were diagnosed as diabetic for more ten years and over. And (58%)

 

start taking insulin for less than 5 years. Most of them (71%) diagnose after developmental of symptoms and (29%) of

 

them diagnosed accidently.

 

All patients in study consult regularly for their condition, (50%) of them prefer private clinic as facility for

 

consultation. Majority (98%) of them give advices for newly diagnosed patients with diabetes in their family. All the

 

participants received nutritional advices regarding diabetes and (75%) of them follow these advices.

 

68 Samira Muhammed Ebrahim, Utoor Talib Jassim & Doaa Mohammed Baji

 

Impact Factor (JCC): 2.9545 Index Copernicus Value (ICV): 3.0

 

Table 2: Participant's Attitudes toward their Illness

 

Question Answer No. %

 

< 5 years 35 35

 

When you diagnosed with diabetes ? 5-9 years 30 30

 

10+years 35 35

 

< 5 years 58 58

When you start to take insulin therapy? 5-9 years 28 28

 

10+years 14 14

 

Accidentally 29 29

 

How your disease was diagnosed ?

 

71 71

 

After development of

 

symptoms

 

Do you consult regularly for your condition ? Yes 100 100

 

No 0 0

 

Private clinic 50 50

 

What health facility do you prefer ?

 

General hospital 25 25

 

Diabetic clinic 10 10

 

Health center 15 15

 

Do you give advices for newly diagnosed patients Yes 98 98

 

with diabetes in your family No 2 2

 

Have you received any nutritional advices Yes 100 100

 

regarding diabetes ? No 0 0

 

Yes 75 75

 

Do you follow these advices ?

 

No 25 25

 

Total 100 100

 

Table(3): showed that (44%) of studied patients do not have glucometer, and (43%) of them check their blood

 

glucose only when them fell ill, the majority of them (71.4%) were trained by pharmacist, (10.4%) of them trained by a

 

nurse, other diabetic patients act as source of training for (3.6%) of the participants.

 

Table 3: Practice of Blood Sugar Measurement

 

Question Answer No. %

 

No, I have no gluco meter 44 44

 

Do you check your blood glucose at you home?

 

Yes, Only when I fell ill 43 43

 

Yes, Regularly 13 13

 

Total 100 100

 

Doctor 3 5.4

 

Who trained you on measuring blood sugar?

 

Nurse 6 10.7

 

Pharmacists 40 71.4

Other diabetic patients 2 3.6

More than one source 5 8.9

 

Total 56 100

 

Table (4): showed that (59%) of diabetes patients uses other hypoglycemic medication with insulin, (43%) got

 

their insulin from private pharmacy hospitals considered as source of insulin for (41%) of patients, (90%) use insulin on

 

regular basis, (98%) of them keep their insulin in refrigerator, (66%) prefer the arm as a site of injecting insulin.

 

Regarding problems facing the participants (38%) of them faced no problem, (25%) faced redness and itching at

 

site of insulin injection, (40%) of them have no fear when they know need insulin therapy, (25%) of them fear of insulin

 

itself, while (18%) of them fear of pain and (17%) fear of hypoglycemia.

 

A Study to Assess the Attitude and Practice of Diabetic Patient towards Self-Administration of Insulin in Basra City, Iraq 69

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Table 4: Respondent's Practices and Attitudes toward Insulin Therapy

 

Question Answer No. %

 

Do you use other hypoglycemic medications with insulin? Yes 59 59

 

No 41 41

 

From where you get your insulin? Hospital 41 41

 

Health center 14 14

 

Private Pharmacy 43 43

Other sources 2 2

More than one source 5 8.9

When do you use your insulin therapy ? On regular basis 90 90

When I fell unwell 10 10

Where do you keep your insulin ? In refrigerator 98 98

On the shelf 2 2

At what site you prefer to inject yourself ? Arm 66 66

Thigh 25 25

Abdomen 9 9

What are the main problems you faced at the site of insulin No problem 38 38

injection? Redness and itching 25 25

Scar 23 23

More than one problem 14 14

What type of fears you faced when you knew you need No fear 40 40

insulin therapy? Fear of insulin itself 25 25

Fear of pain 18 18

Fear of hypoglycemia 17 17

 

Total 100 100

 

Only (50%) of participants check the expire date of insulin, all participants do change the site of injection

 

frequently, (97%) of them do not inject insulin on the scar or nevi, (55%) kept the insulin vial at room temperature at least

 

15 minute before been injected, (78%) wash their hands with soap and water before handling injection devices, (53%) of

 

them sterilized the site of injection, (92%) remove air bubbles from insulin syringe before injecting insulin. Only (20%) of

 

them use the insulin syringe for single injection, (4%) of them dispose the used insulin needles in a special container at

 

home, (97%) of them eat some food shortly after insulin injection as shown in table 5.

 

Table 5: Participant's Correct Practices Related to Self-Administration of Insulin (n=100)

 

Practices No. %

 

Checking the expire date of insulin 50 50

 

Changing the site of injections frequently 100 100

 

The site of injection should not be on scar or nevi 97 97

 

The insulin vial kept at room temperature at least for 15 minutes before injection 55 55

 

Washing hands with soap and water before handling injection devices 78 78

 

Sterilization of the site of injection 53 53

 

Removing air bubbles from the insulin syringe before injecting 92 92

 

Syringe should be used for one time only 20 20

 

Disposal of used insulin needles in a special container at home 4 4

 

Eating some food shortly after insulin injection 97 97

 

Comparing the rates of correct practices between males and females, it was found that except for practice of

 

Disposal of used insulin needles in a special container at home, the rate of correct practices among males was higher than

 

the rates among females for the majority of the items.

 

And the differences was statistically higher among males regarding the followings, keeping the insulin vial at

 

room temperature at least for 15 minutes before injection (66.7%), Washing hands with soap and water before handling

 

70 Samira Muhammed Ebrahim, Utoor Talib Jassim & Doaa Mohammed Baji

 

Impact Factor (JCC): 2.9545 Index Copernicus Value (ICV): 3.0

 

injection devices (88.1%), Sterilization of the site of injection (66.7%), and Syringe been used for one time only (31%), as

 

shown in table 6.

 

Table 6: Participant's Correct Practices Related to Self-Administration of Insulin According to sex (n=100)

 

Correct Practices

 

Male Female Chi-

 

Square

 

P Value

 

No. % No. %

 

Checking the expire date of insulin 21 50 29 50 0.000 1.000

 

Changing the site of injections

 

frequently

 

42 100 58 100 - -

 

The site of injection should not be on

 

scar or nevi

 

42 100 55 94.8 2.240 0.135

 

The insulin vial kept at room

 

temperature at least for 15 minutes

 

before injection

 

28 66.7 27 46.6 3.982 0.046

 

Washing hands with soap and water

 

before handling injection devices

 

37 88.1 41 70.7 4.301 0.038

 

Sterilization of the site of injection 28 66.7 25 43.1 5.430 0.020

 

Removing air bubbles from the insulin

 

syringe before injecting

 

40 95.2 52 89.7 1.032 0.310

 

Syringe should be used for one time

 

only

 

13 31 7 12.1 5.425 0.020

 

Disposal of used insulin needles in a

 

special container at home

 

1 2.4 3 5.2 0.949 0.482

 

Eating some food shortly after insulin

 

injection

 

41 97.6 56 96.6 0.095 0.757

 

Table 7 showed that (19%)of the participants had poor level of correct practices regarding self-administration of

 

insulin, (27%) had fair level and (54%) had good practice level.

 

Table7: Score Level of Participant's Correct Practices Related to Self-Administration of Insulin

 

Score Level No. %

 

Poor (<50%) 19 19

 

Fair (50-69%) 27 27

 

Good (70% and over ) 54 54

 

Total 100 100

 

The level of correct practices related to self-administration of insulin was statistically lower for those who were receiving

 

insulin for more than 10 years than the other groups as shown in table 8.

 

Table 8: Score Level of Participant's Correct Practices Related to

 

Self-Administration of Insulin by the Duration of Insulin Therapy

 

Duration

 

Poor Fair Good Chi-

 

Square

 

P Value

 

No. % No. % No. %

 

< 5 years 11 19 15 25.9 32 55.2

 

5-9 years 1 3.6 8 28.6 19 67.9 14.416 0.006

 

10+years 7 50 4 28.6 3 21.4

 

Total 19 19 27 27 54 54

 

DISCUSSIONS

 

Living with diabetes is not easy, and achievement of glycaemic control requires from the patient to undertake

 

self-care behaviours with persistent ability to maintain attention and alertness over prolonged periods of time. The majority

 

of patients do not achieve glycaemic goals because of barriers related to insulin dose adjustment, self-monitoring of blood

 

A Study to Assess the Attitude and Practice of Diabetic Patient towards Self-Administration of Insulin in Basra City, Iraq 71

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glucose and fear of hypoglycaemia [9]

 

.

 

The prevalence of diabetes is higher in men than women, but there are more women with diabetes than men[10].

 

Results in this study showed that the majority of patients who self-insulin administration were females (58%), this study

 

was slightly similar to Bahrain's study were the female are (60.6%)[11]

. Regarding age the majority (54%) of them between

(25-49) years, this results was different from India's study were those aged less than 50 years represent (26%)[12], the

majority of participant of our study (90%) were married, this study was similar to Jordan study(91% ) were married [13].

In our study the majority (47%) had secondary school education, while in Kesihatan (46%) were also secondary school[14].

 

In this study (53%) had positive family history of diabetes, this was lower than what was found in cross sectional study on

 

403 diabetic patients, 202 Malaysian and 201 from the UAE, where more than three quarter of Malaysian respondents

 

(77.2%) were had a family history of diabetes compared to the UAE counterpart (64.7%)[ 15].

 

In this study (35%) of the participants had history of diabetic for less than 5 years, similar to the result of study

 

involving 59 diabetic patient in Kasturba Hospital in india[16], and lower than what was reported in a study of 199 diabetic

patient attending the outpatient clinics of Aga Khan University Hospital, Karachi, Pakistan [17].

 

The difference rate of those who receive insulin therapy for the group of less than 5 years was higher than those

 

who had history of diabetes this could be explained by that some of the patient were previously of type 2 diabetes mellitus

 

and after period of time they became in need of insulin this agree with statement of American Diabetes Association the

 

injection of insulin may be needed by patients with type 2 diabetes for intermittent or continuous glycemic control [12].

 

In this study most of patient (71%) diagnose after developmental of symptoms, while in United Arab Emirates 69% were

 

diagnosed after developmental of symptoms[15].

 

In our study (44%) of patients do not have glucometer, this was higher than (31%) that was found among 100

 

diabetic patients visiting Diabetes Care Unit in Pakistan [18].

 

In present study (59%) of patients were on both insulin and oral hypoglycemic drugs, this results was different

 

from Jordan study just (18%) of them were on both insulin and oral hypoglycemic drugs [13]. The majority (66%) of

 

participant preferred arm as injection site followed by upper thighs, then the abdomen. Absorption is fastest with injection

 

in the abdomen, followed by the arms, thighs, and buttocks [19]. Redness and itching at site of insulin injection was reported

by (25%) by the patients, while in Finland (46%) had a redness at site of injection [20] ]. in our study (40%) of participant

 

faced no fear when they knew their need insulin therapy while the least fear was of hypoglycemia as reported by (17%) of

 

the patients while in Spain (53.3%) of the sample fear from hypoglycemia[21].

 

Regarding the percentage of procedures related to checking the expire dates of insulin, washing hands, removing

 

air bubbles from the syringe before injection were higher than what was found for the pre test and lower than that for the

 

post test after implementation individual planned teaching on self-administration of insulin for patients with diabetes

 

mellitus in Bangalore [22]

 

.

 

In the present study all participant changing the site of injections frequently, helping in reducing irritation,

 

bruising, and risk of infection, it is also critical for lipohypertrophy prevention, a complication reported in nearly 50% of

 

individuals using insulin who fail to rotate injection sites [23].

 

Manufacturers of disposable syringes and pen needles recommend that they only be used once. One potential

 

issue, which arises with reuse of syringes or needles, is the inability to guarantee sterility[24]. We identified a large

72 Samira Muhammed Ebrahim, Utoor Talib Jassim & Doaa Mohammed Baji

 

Impact Factor (JCC): 2.9545 Index Copernicus Value (ICV): 3.0

 

percentage of the participants reuse the disposable syringe, this unhealthy behavior need to be changed by education to

 

prevent complications. Proper disposal of used syringes and needles is important to the prevention of accidently injuries

 

from discarded needles, We identified a large percentage of patients who inappropriately disposed of used insulin needles

 

as only (4%) of the participants dispose the used insulin needles in a special container at home, much lower than the result

 

for convenience sample of 50 patients from two local independent pharmacies, a private endocrinology practice, and a

 

pharmacy services clinic in an ambulatory internal medicine clinic at an academic medical center in Richmond, Virginia

 

(44%) dispose the used insulin needles in a special container at home [25].

 

In present study (54%) of participant had good practice about insulin self-administration, (27%) fair and (19%)

 

poor level. These results were better than the result of study for the purpose of assessment of the practice regarding insulin

 

self-administration on sample of 60 diabetic patients in India revealed that (72%) of the subjects had poor practice; (28%)

 

of them had fair practice, and none of them had good practice[26]

. In our study the level of correct practices related to

 

self-administration of insulin was statistically lower for those who were receiving insulin for more than 10 years than the other group

 

this could be explained by that they consider insulin therapy as part of their routine activity that not need so much consideration.

 

CONCLUSIONS

 

· The patients in this study show variations in attitudes regarding their illness, insulin therapy and

 

self-administration of insulin.

 

· The level of correctly practicing self-administration of insulin was low

· The main defect in correctly practicing self-administration of insulin were in the aspect of reusing the syringe and

 

the disposal of used insulin needles in a special container at home.

 

· Except for the disposal of used insulin needles in a special container at home, the rate of correct practices

 

regarding self –administration of insulin among males was higher than the rates among females for the majority of

 

the items

 

· The level of correct practices related to self-administration of insulin was statistically lower for those who were receiving

 

insulin for more than 10 years than the other groups.

 

RECOMMENDATIONS

 

· Educating program can be conducted in the outpatient clinic and primary health care centers regarding insulin and

 

its administration. A booklet could be used with illustrations given to the patients including information covering

 

aspects of diabetes, insulin therapy and it's administration.

 

· There is need for future study on larger sample of patients to be able to generalize the results to the larger

 

population.

 

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74 Samira Muhammed Ebrahim, Utoor Talib Jassim & Doaa Mohammed Baji

 

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