The purpose of this study is to determine the knowledge and attitudes on diabetes mellitus among Type II diabetes mellitus patients in Port Harcourt, Nigeria. Past studies showed below average understanding and mixed attitudes among diabetic patients regarding Type II diabetes mellitus. Knowledge of diabetes will be limited only to its causes. Specific objectives of the study will be: 1. describe respondents’ profile in terms of age, employment status, educational attainment, marital status; 2. determine the knowledge on diabetes mellitus in terms of causes, 3. establish the attitudes of the patients toward diabetes, 4. determine if there is a difference in the knowledge and attitudes when grouped according to age, employment status, educational attainment, and marital status.

Both in-patient and out-patient departments of hospitals within the jurisdiction will be the sampling sites. Therefore the researcher will closely coordinate with the hospital administrators and nurses in these wards.

This study will be non-experimental, cross-sectional, and correlational and the variables will be measured using self-administered survey questionnaires. Measures will be taken so that respondents will be treated ethically during the course of this investigation. The final output of this study will form the basis for enhancing and improving existing educational interventions and programmes for diabetes patients taking into account demographics.

Introduction

High glucose level, specifically, diabetes mellitus has taken its place as one of the key public health concerns in the 21st century that its escalating incidence is undermining health care systems the world over becoming increasingly burdensome to individuals with the disease and society in general. However, diabetes mellitus could be prevented on all fronts by adopting the primary, secondary, and tertiary lines of preventive strategies (Vinicor 1990).

The latest estimate from the International Diabetes Federation (2008) showed that by 2025, 380 million will be affected with one person dying every 10 seconds. In Africa, diabetes mellitus was rare at the start of the 20th century but as rapid industrialisation brought about lifestyle changes, the condition and its complications became ubiquitous. In Nigeria, diabetes prevalence is 2.2% which means that roughly 2.6 million Nigerians are diabetic (Oyegbade et al. 2007).

Diabetes, though not a communicable disease, could pose potential health risks for heart diseases, blindness, nerve disorders, kidney diseases, gangrene etc (Adetuyibi 1976; Alberti et al 1975; Hamstem & Steiner 1994; Amos et al 1997; Edward & Raffaele 1996 as cited in Nwafor and Owhoji 2001). Diabetes mellitus has two clinical forms- Type II or Insulin-dependent and Type II or Insulin-independent. The former is caused by autoimmune damage of the pancreatic beta cells resulting in absence of insulin production and secretion leading to absolute insulin deficiency in contrast to the latter which is the result of insulin resistance with relative insulin deficiency. In both classes, hyperglycaemia is a diagnostic clinical feature which is caused by genetics, environment, and behavior (LaMonte, Blair, and Church 1999).

Because of the poor health among Nigerians in recent years, the Federal Ministry of Health recommended the improvement of consumer’s awareness and community participation through designing communication programmes and capacity building, development of strategies to increase consumer’s knowledge and awareness of personal obligation to better health, their rights to quality care and information on health. Public education and awareness diabetes mellitus is essential especially among diabetic patients. Numerous researchers have found that knowledge among patients improved dietary compliance, insulin administration, and fasting blood glucose levels. Therefore, awareness leads to positive attitude and behavior which play a significant role in disease occurrence and control.

The proposed study will determine knowledge and attitudes on diabetes mellitus among Type II diabetes mellitus patients in Port Harcourt, Nigeria. It is important to provide the operational definitions of these variables. In the context of this study, knowledge will be defined as the level of awareness and understanding on diabetes mellitus in terms of causes and attitudes, the residents’ feelings towards diabetes, as well as preconceived ideas or notions about diabetes mellitus. In the context of diabetes prevention, patients should be adequate knowledge and positive attitudes towards the condition.

The research will be conducted in Port Harcourt, Nigeria because of its comparability with Western countries because of urbanisation, industrialisation, and “Westernisation” of lifestyle in the populace.

Aims

Primarily the aim of this study is to determine the knowledge and attitudes on diabetes among Type II diabetes mellitus patients in Port Harcourt, Nigeria.

Objectives

Specifically the study will address the following:

1. Describe respondents’ profile in terms of:

1.1. age

1.2. employment status

1.3. educational attainment

1.4 marital status

2. Determine the knowledge on diabetes mellitus in terms of causes

3. Establish the attitudes of the patients toward diabetes mellitus

4. Determine if there is a significant difference in the knowledge and attitudes when grouped according to:

4.1. age

4.2. employment status

4.3. educational attainment

4.4. marital status

Literature Review

From country to country, diabetes knowledge was below optimal. In India, Shah, Kamdar, and Shah (2009) found that less than half of diabetic patients knew about the condition’s pathophysiology and believed diabetes is curable. Among the complications, renal complication was noted to be least known among the patients. There was also preference of dietary modifications over exercises among the evaluated group. Mumtaz et al. (2009) showed little awareness of diabetes mellitus and its complications since only 13%, 21.7%, and 13.7%, 51.4% were aware that diabetes leads to cardiac, ophthalmological, and neurological complications, respectively. Okolie et al. (2009) showed that majority of diabetic patients have knowledge of signs, symptoms, and complications at 80.2%. Ironically, more than 75% had no knowledge of its causes while 88.5% and 74.5% reported no knowledge on how to avoid complications and prevent/control diabetes respectively. Furthermore, most respondents did not know about self-care practices in terms of testing urine and types of food to eat. They also stated to have not received any diabetes-related education/counseling. Among Thai respondents, diabetes is poorly understood because of erroneous background knowledge, expectations and misconceptions (Pongmesa, Li, & Wee 2009). A Nepalese study by Shreshtra and Nagra (2005) determined knowledge, attitude and practices regarding diabetes mellitus among the diabetic patients attending a diabetic education programme. The programme proved to be successful because majority had correct knowledge regarding diabetic diet, check their blood sugar regularly, and consult physicians frequently. Later, Upadhyay et al. (2008) noted low knowledge scores, poor attitudes and practices among diabetes patients in western Nepal which led the investigators to recommend educational interventions.

Results in terms of attitudes varied from author to author. Diabetic patients felt there is a need to train health professionals (Anderson et al.1993). Cord and Brandenburg (1995) showed that most patients regarded diabetes as a serious disease and expressed anger and frustration. Despite these strong emotions, they believed diabetes made them healthier and happier. Gagliardino, Gonzales, and Caporale (2007) proved that patients value strict glycaemic control and the disease’s psychosocial impact. Johnson and Whetstone (2005) revealed that patients were influenced by need for special training and autonomy suggesting that educational and supportive interventions should promote patient autonomy. In Etsuko et al (2001) patients were concerned about diabetes complications and hoped to change their lifestyles in order to prevent complications. In the analysis of Khattaba et al. (2010), the patients had negative attitudes toward diabetes. On the average, Olgun (2006) noted a negative attitude towards diabetes among all patients in Turkey. Similarly, Wongwiwatthananukit and Lohavisavapanich (2003) indicated that majority of patients had negative attitudes towards diabetes.

Literature did not seem to agree on the results on the factors affecting diabetes knowledge. Aljoudi and Taha (2009) revealed that age is important predictors of knowledge. In the multiple linear regression analysis by Pongmesa, Li, and Wee (2009) on demographic profiles, older age was significantly associated with knowledge of diabetes. However, in Yung et al. (1998), diabetes mellitus knowledge declined with old age. Among the Costa Rican patients, Firestone et al. (2004) found younger patients were more knowledgeable about their condition. In Hassan, Zia, and Maracy (2004), males showed better understanding of diabetes compared to their female counterpart. On the other hand, Ford et al. (2000) gender did not influence knowledge of patients about diabetes. Alnaif and Alghanim (2009) showed no significant difference in the amount of knowledge possessed about diabetes mellitus by employment status. This is due to the same frequency of obtaining knowledge from public health centers. Educational status was found to be positively associated with knowledge of diabetes in a study conducted at the Aga Khan University Hospital Karachi (Jabar et al. 2001 as cited in Nisar et al. 2008). Nisar et al. (2008) reported that educated people were more aware about the disease but as regards risk assessment scale, being male, living in urban communities and even educated were prone towards diabetes, possibly due to dietary habits and life style. Education is particularly a challenge for health professionals especially those with low education. Health authorities should therefore develop an easy diabetes mellitus education campaign, suitable for elementary level. Understanding insulin most especially does not only help understand disease pathogenesis, but also help deliver the treatment (Ratanasuwan et al. 2005). He and Wharrad (2007) found that housewives got the lowest scores in knowledge.

According to Fitzgerald, Anderson, and Davis (1995), attitudes towards diabetes differed between male and female patients. Wongwiwatthananukit et al. (2004) observed that attitudes of diabetes patients were influenced by higher educational attainment, gender and marital status.

Methodology

The study will follow a non-experimental, cross-sectional, and correlational approach using survey questionnaires designed to measure knowledge and attitudes of Type II diabetes mellitus patients on diabetes mellitus. This is the appropriate method since the principal objective is to test whether knowledge and beliefs of diabetic patients are influenced by selected demographic characteristics. Since it will entail surveys using standardized tests, permission will first be sought from the authors. If consent for use of such tests will not be given in due time, the researcher will develop the data collection tool which will be reviewed independently by an expert panel consisting of diabetologists and diabetes nurse consultants. After face-validity, the self-constructed questionnaire will be tested for reliability. Another problem is the translation of the questionnaire. Because it could potentially introduce bias into the data, back translations will be done by nurses competent in the language. There might be instances that the respondents might not be able to answer the instruments completely. To minimise this problem, the investigator will check the accomplished instruments.

Research Design

The study will follow a non-experimental, cross-sectional and correlational approach using survey questionnaires measuring knowledge and attitudes on diabetes. All Type II diabetes mellitus patients will be identified from hospitals in Port Harcourt both in the in-patient and out-patient departments. In both departments, the researcher will identify potential respondents with the assistance of the ward nurses. Before data collection will commence, permission will be sought from the university and hospital administrators through correspondence. Once permission to conduct the study is granted, the researcher will closely coordinate with both wards in the hospitals considered. Questions will be entertained should the respondent have difficulty understanding the items in the questionnaire.

Inclusion/exclusion criteria

In choosing the prospective respondents who are patients with Type II diabetes mellitus, they must satisfy the following criteria: 1. at least 18 years old; 2. non-pregnant; 3. diagnosed with Type II diabetes mellitus for at least one year; and 4. speaks and understands either English or Pidgin. Patients who could not answer the questionnaire independently, have poor vision, diagnosed with mental illness, and pregnant will not be considered in the proposed study.

Ethical Consideration

So that respondents better understand the study rationale, both information sheet and consent form will either be in English or Pidgrin. Respondents will be asked to sign the written consent forms which included information that their responses will be treated with utmost confidentiality. The investigator will be the only person to examine the subjects’ medical records from either in-patient or outpatient clinics.

Expected Outcomes

It is hoped that by identifying the factors influencing knowledge and attitudes on diabetes among Type II diabetes patients, existing health education programmes would be further enhanced taking into consideration the demographic factors.