Effectiveness Health Education Program For Type Diabetes Mellitus Patients Attending Zagazig University Diabetes Clinic, Egypt
Effectiveness Health Education Program For Type Diabetes Mellitus Patients Attending Zagazig University Diabetes Clinic, Egypt
Effectiveness Health Education Program For Type Diabetes Mellitus Patients Attending Zagazig University Diabetes Clinic, Egypt
3 6 4, 2 070
ABSTRACT
Background: Diabetes mellitus is a major public
health problem. Objectives: To i) assess
kt~owledge, attitude, random blood sugar and
glycosylated hemoglobin (HbAlc) levels in type 2 diabetics, ii)
investigate the effect of different socio-demographic factors on
acquiring knowledge about diabetes, iii) assess the effectiveness of
health education on knowledge, attitude, blood sugar and HbAlc
levels in type 2 diabetics. Methods: This intervention study was carried
out on 122 randomly selected type 2 diabetics attending diabetes
outpatient clinic in Zagazig University, from January 2009 to April
2009. A questionnaire (pretest) was used to collect data on
socio-demographic characteristics, knowledge and attitude, then a blood
sample was taken for testing random blood sugar and HbAlc. Patients
were subjected to the first health education session where information
about diabetes was provided. In the second visit patients were informed
about the results of their investigations, and the remaining part of the
educational message was delivered. In the 3rd visit, patients were
subjected to the post test and blood samples were tested for random
blood sugar and HbAlc. Results: The majority of patients had
low levels of knowledge regarding different aspects of diabetes (Correct
answers ranged from 16.39% to 49.18%). Knowledge level was
significantly poor, among females, not educated, low social class, and
rural residence and of older age group. After implementation of the
educational message, a significant improvement was revealed in patients'
knowledge and attitude with lowering of their mean levels of blood
sugar and HbA lc. Conclusion and Recommendations: Health
education was an effective tool that implicated change in diabetic
patients' knowledge, attitude towards diabetes, random blood sugar and
HbAlc levels. Training of
Correspondixlg Author:
. Abdo
Dr. Naglaa M
Community Medicine Department
Faculty o f Medicine, Zagazig University, Egypt
E Mail: nanla abdo@hotmail.com
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INTRODUCTION
Diabetes mellitus is a major emerging clinical and public health
problem accounting currently for 5.2 % of all deaths world-wide.
According to WHO estimates (2007), 190 million people suffer from
diabetes world-wide and about 330 million ones are
expected to be diabetic by the year 2025.W
Egypt had been estimated to be the 9th country in the prevalence of
diabetes. Recent changes in physical activity and dietary patterns have
promoted the development of diabetes and if different preventive and
control activities are not adopted, by the year 2025, more than 9 million
Egyptians (13% of the population above 20 years old) will have
diabetes.(Z)
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Follow up Tools:
A printed follonr up sheet was used. One copy was given to the
patient and the other was kept with the researcher. It
includes the results of random blood sugar and the
HbAlc levels at the begirming of the study and at the
time of the 3rd visit.
Pilot study:
A pilot study was conducted to assess the feasibility and the
time needed to fill the questionnaire and to carry out health
education. It was conducted on 20 patients who attended
diabetes outpatient clinic. They were excluded from the main
study sample. Data obtained from the pilot study were
analyzed, and accordingly necessary modifications in the
questionnaire, health education message and the way of its
delivery were done. The time needed for filling the sheet was
about 10 minutes and the time needed for delivery of health
education message was about 120 minutes. Accordingly, the
llealth education message was delivered through two
sessions, each of about 6 0 minutes.
only for the purpose of research. Then the pre-test was filled by
the researcher.
2- Investigations:
A sample of venous blood was withdrawn from anticubital vein
using 3cc intermedica syringes and stored in tubes containing
Ethylene Diamine Tetra Acetic acid (EDTA) for measuring the
I-IbAlc and heparin for random blood sugar. The blood
samples were coded and sent to the laboratory for the estimation
of the blood glucose@) and HbA1C.m
A spoken message was delivered by the researcher in the form of
group discussjon. It included general knowledge
about diabetes symptoms with stress on symptoms of
hypoglycen-iic coma and how to deal with it. Also the
importance of adherence to treatment was emphasized. Then the
patient was given the printed pictured health education papers
and asked to attend any of the next educational sessions at
Thursday of each week to be informed about the results of their
laboratory tests.
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Statistical analysis
Data was coded, entered and analyzed by the SPSS program
version 12, using Mc-Nemar chi square test for analyzing paired
qualitative data.
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RESULTS
The highest percentage of the studied group were not working
(59.02 %), residing in rural area (66.39%), females
(63.11%), illiterate (58.20%) and of middle
social class (68.03%) Table (1). Their age ranged from 41 to 70
years with a median of 50 years (Table 1
).
Symptoms
l~~ni~. Hypoglycemia
l~voidin~ Hypoglycemia
l~ffect on eye
l~iabetic foot
(~iabetic foot prevention
Treatment of diabetes 60 49.18 79 64.75 P<O.01 @: McNerlzar
x
2
test
Table (3) shows the changes in the attitude of the studied group,
where a highly significant increase in the percentages of their
positive attitude regarding different aspects of diabetes after the
application of the health education message is noticed.
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Table (4) shows that patients who were males, of middle social class,
literate, working, residing urban areas and below 50 years of age were
significantly more likely to acquire adequate knowledge.
B
coefficient S
E OR(95%CI)
Gender
1 (Male) 0.75 0.30 2.14 (1.8-3.88) Social class (Middle) 0
I
.69 0.21
2.01 (1.3 1-3.07)
Education (Literule) 1 .45 0.66 1.47 (1.15-5.74) Residence
.44 0.39 1.24 (1.06-5.17) Work ( Working) 0 .85 0.22 1.33 (1.19- 4.71)
(Urbnrz) 1
Age (Meci'iiarz oge < 50) 1 .17 0.21 3.23 (2.1 1-4.95) Variables
n~ri//eri be/,11een brocke~s refer /o /lie refer-elice g rotip
Table (5): Means of Random Blood Glucose & Glycosylated
Hemoglobin Measurements in the Studied Group Before and
After Health Education
DiSCUSSION
Health education is a process that bridges .the gap between
health information and health practice. An important step in
planning health education intervention is to identify
predisposing factors like; knowledge, attitude, practice and
different socio-demographic characters of
patients.cl2) Health education is not an addition to treatment,
but it is one of the treatment tools that has a great effect on
enhancing the diabetic patients own abilities to carry out
self-care through providing adequate knowledge changing their
attitude, and empowering them with skills that are essential for
better control of the disease.(5)
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Regarding residence and the level of knowledge, those living in the
rural areas had sigruficantly lower level of knowledge compared with
those living in urban areas (Table 4). This finding is consistent with
Rafique et al. (2006) in Pakistan.(ls) It is mostly attributed to less
access to information among rural residents.
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