INTRODUCTION:

Diabetes mellitus (DM), a chronic metabolic disorder, occurs mainly due to genetics and lifestyle factors such as obesity, poor diet, lack of physical activity, stress and urbanization. Also, at sometimes it is partly inherited and triggered by certain infections.(1,2) It is one of the fastest emerging threat to public health in almost all countries of the world.(3) According to International Diabetes Federation, it estimated that 50.8 million people suffered from this disease in 2010 and this number will rise up to 87.0 million by 2030.(4) DM is the most common disease in the developed countries. The increase in rates in the developing countries is mainly due to lifestyle changes, obesity and western-style diet.(5,6).

The planned teaching program, considered as the mailstone, helps in educating self management among patients with diabetes to prevent diabetes and complications associated. Studies conducted so far observed that people with diabetes have a poor knowledge regarding self-care behaviour of DM. (7-9) Hence, implementing self-care behavior among patients with DM is predicted to play a crucial role in its management.(8)

Diabetes self-care behavior such as blood glucose testing, medication administration and appropriate exercises and diet regimens should be implemented daily to increase the therapeutic patient outcomes. Home healthcare clinicians also plays an important role to impart slef-confidence in individuals with diabetes, achieve therapeutic goals and address diabetes-related complications.(10) The existing literature about self-care of DM only examined patients' routine health activities.However, the studies have not focused on relationship between patient’s outcome and decision making to signs and symptoms.

Altogether, considering above facts and figures, we strongly felt that the people with DM need more information on self-care behaviour. Therefore, the study was focused on to evaluate the effectiveness of PTP on knowledge regarding self-care behaviour among people suffering from DM in selected urban health centres of Belgaum.

MATERIALS AND METHODS:

Patients:

This study was conducted in three selected urban health centers of Belgaum using one group pretest-posttest design. A total of 45 adults aged between 40-70yrs including male and female were selected as study samples by using purposive sampling technique. Ethical clearance and formal authorization were obtained from the medical officers of Urban health center (UHC), Belgaum. The written consent was taken from the individuals before their participation in the study.

Study design and setting:

People suffering with DM and willing to participate in the study were included in the study. Whilst, people who were not present during the time of data collection were exempted from the study. In order toevaluate the knowledge of adults regarding self-care behaviour a structured interview schedule was developed by the investigator to collect the data from the respondents. The interview schedule consisted of two sections. Section-A consisted of 7 items related to demographic information of the respondents such as age, sex, religion, educational status, marital status, income per month and occupation. Section-B consisted of 40 multiple choice question items on knowledge regarding self-care behaviour of people suffering from diabetes with four options for each question. Each correct answer was assigned a score of ‘1’ and score ‘0’ for wrong answers. The total scores of Section-B was 40. The patients who get a score of above 22 were considered as ‘Good Knowledge’, scores of 18-22 were considered as ‘average knowledge’ and scored below 18 were considered as having ‘Poor knowledge’.

The structured interview schedule used to test the knowledge of the participants was presented before the members of the ethical committee of KLE University’s Institute of Nursing Sciences. The tool along with blue print was submitted to nine experts, three in the field of community medicine and six from community health nursing. The amendmentsrecommended by the experts were done before preparation of final draft. The tool was prepared both in English and kannada. The CVI (Content validity index) is mostly considered to have good content validity. The reliability of the tool consisting of knowledge questions for this study was tested by split half method using Karl Pearson’s 40 coefficient of correlation. The reliability computed for knowledge score was found to be 0.8. It is statistically significant and highly reliable.

Data Collection and analysis:

During pretest, questionnaire was given to each and every individual and asked to fill the form then and there. After pre-test, PTP was conducted to the selected patients. The post-test was conducted after seven days of the teaching program. The collected data was analyzed by using descriptive and the inferential statistics. Paired t-test was employed for comparison of knowledge before and after test. And chisquare test was used to find the association between pre-interventional knowledge and selected demographic variables.The difference between pretest and posttest knowledge scores was considered significant if the p-value is <0.05.

RESULTS:

The sociodemographic data of the patients are shown in the table 1. Majority of the patients were aged between 40 and 49 years with striking male predilection (75.40 %). Of total 45 patients, majority of them were Hindus (73.30 %), married (100 %), completed secondary education (40 %), self-employed (33.3 %) and drawn above 5000 per month (75.50 %).

Table 1: Sociodemographic variables

Socio demographic variables	n (%)
Age (years)
40-49	20 (44.45)
50-59	10 (22.22)
60-70	15 (33.33)
Sex
Male	34 (75.60)
Female	11 (24.40)
Religion
Hindu	33 (73.30)
Christian	4 (8.90)
Muslim	8 (17.80)
Others	0
Marital status
Married	45 (100)
Single	0
Widow	0
Divorced	0
Educational status
Illiterate	3 (6.60)
Primary	12 (26.70)
Secondary	18 (40)
Preuniversity	12 (26.70)
Graduate	0
Income per month
Above 5000	34 (75.60)
3001-5000	6 (13.30)
1001-3000	5 (11.10)
Less than 1000	4 (8.90)
Occupation
Coolie	14 (31.10)
Unemployed	2 (4.40)
Self-employed	15 (33.30)
Professional	14 (31.10)

The pretest and posttest knowledge scores of the patients in different items of structured knowledge questionnaire is shown in Table 2. Among different items, maximum 60 % of the patients gained knowledge regarding exercises followed by diet, predisposing factors, sign and symptoms of DM, drugs, skin care and foot care, regular check-up and complications and day-to-day practices

Table 2: Pretest and posttest comparison of knowledge scores of patients in different items of structured knowledge questionnaire.

Items	Total scores	Pretest	Post test	Gain in knowledge
Diabetes mellitus Predisposing factors, Signs & symptoms	270	40.4 %	97.8 %	57.4 %
Diet	135	37.04 %	95.6 %	58.6 %
Drugs	270	35.6 %	93.3 %	57.7 %
Exercise	90	32.2 %	92.2 %	60%
Skin care, foot care	90	43.3 %	90 %	46.7 %
Regular checkup& complications	225	54.7 %	93.8 %	39.1 %
Practices	720	54.3 %	76.9 %	22.6 %

Table 3: Frequency and percentage distribution of knowledge score of self-care behaviour of people suffering with diabetes mellitus.

Knowledge score	Pretest score	Posttest score
Good	0	45 (100)
Average	41 (91.10)	0
Poor	4 (8.90)	0

f=frequency

The pre-test and post-test knowledge scores of self-care behaviour of people suffering with DM is shown in Table 3. Among 45 patients, majority of the patients (91.10%) had average knowledge in the pre-test. Whereas, in the posttest all the patients (100%) gained good knowledge. The mean difference between pre-test and post-test knowledge scores was found to be 14±83. And the calucated paired t-test value (51.5) was greater than tabulated value (1.96). Moreover, the difference observed was statistically significant (p<0.05) (Table 4)

DISCUSSION:

DM, a chronic illness, requires ongoing medical care and continuing patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetic-care needs multifactorial risk reduction strategies beyond the glycemic control. (11) Therefore, this promoted us to initiate a PTP on knowledge regarding self-care behaviour of people suffering from DM.

The sociodemographic data pooled from all the diabetic patients is comparable to the other published reports. (12-14). Knowledge in patients with DM was assessed using variables such as predisposing factors, signs and symptoms of DM, diet, drugs, exercise, skin care, foot care, practices, regular check-up and complications. The variables assessed in this study is consistent with the study done by Santosh et al. (15) In this, patient’s knowledge was assessed using aspects such as diet, exercise, leisure, foot care and medications followed.

The present showed that most of the patients had average knowledge in pretest whereas the posttest score showed all the patients had good knowledge regarding self-management of DM. The findings were alike the study conducted by Das et al.(16) In this study, among 30 diabetic patients in pre-test 36.7% diabetic patients had below average knowledge, 50% had average knowledge and 13.3% had good knowledge, whereas post-test score showed that 83.4% had good knowledge after administration of PTP and only 3.3% had poor knowledge regarding self-management of DM. Other similar studies conducted also reported gain in knowledge of people about disease and self-care behaviour among diabetic patients after administering structured teaching programme.(8,9,17)

The results revealed that the calculated chi square values were less than the tabulated chi square values of all the demographic variables. Furthermore, the present showed no significant association between the pretest knowledge scores with the demographic variable. Likewise, a study done by Zagade et.al (18) to determine effectiveness of self instructional module on prevention of micro and macrovasclar complications among diabetic patients revealed no association between sociodemographic variables and pre-interventional knowledge or pre-test scores.

CONCLUSION:

The current illustrated that people don’t have adequate knowledge regarding self-care behaviour for DM. However, after the execution of PTP, knowledge of people on self-care behaviour for DM was increased to high score. This evidently demonstrates that PTP plays a crucial role in implementing knowledge regarding self-care behavior among people suffering from DM.

ACKNOWLEDGEMENTS:

Both the authors have contributed equally in the development of manuscript.

REFERENCES:

1. Riserus U, Willett WC, Hu FB. Dietary fats and prevention of type 2 diabetes. Progress in lipid research. 2009; 48(1):44-51.

2. Melmed S, Polonsky SK, Larsen R, Kronenberg MH. William's textbook of endocrinology. Philadelphia: Elsevier Saunders; 2011.

3. House W. Follow-up to the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. 2013.

4. Patil RS, Gothankar JS. Prevalence of type-2 diabetes mellitus and associated risk factors in an urban slum of Pune City, India. world. 2013; 1:6.

5. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes estimates for the year 2000 and projections for 2030. Diabetes care. 2004; 27(5):1047-53.

6. Vijayakumar G, Arun R, Kutty V. High prevalence of type 2 diabetes mellitus and other metabolic disorders in rural Central Kerala. J Assoc Physicians India. 2009; 57:563-7.

7. Sruthy V. Effect of Structured Teaching Programme on Knowledge and Practice Regarding Foot Care among Chronic Diabetic Patients. Int J Sci Res. 2013; 5(8):837-41.

8. Milenkoviæ T, Gavriloviæ S, Percan V, Petrovski G. Influence of diabetic education on patient well-being and metabolic control. Diabetologia Croatica. 2004; 33:3.

9. Shaini G, Venkatesan L, Ben A. Effectiveness of structured teaching on home care management of diabetes mellitus. Nursing Journal of India. 2007; 98(9):197.

10. Hunt CW, Grant JS, Palmer JJ, Steadman L. Facilitators of Diabetes Self-Management Among Rural Individuals. Home Healthcare Now. 2014; 32(3):154-66.

11. American Diabetes Association. Standards of medical care in diabetes—2013. Diabetes care. 2013; 36(Supplement 1): S11-S66.

12. Thomas S, Mohite VR. Effectiveness of Self Instructional Module on the Knowledge Regarding Diabetic Diet among Diabetic Patients. International Journal of Science and Research. 2014; 3(6):672-678.

13. Babu RL, Mali N, Shinde M. Effectiveness of Planned Teaching Programme on Knowledge Regarding Non-Curative Care of Terminally ILL Cancer Patients among Care Takers. International Journal of Science and Research. 2014; 3(4):198-205.

14. Jaisy TJ. Effectiveness of planned teaching programme on self-care for patients with diabetes mellitus in selected community at Mangalore. Mangalore: Fr. Muller College of Nursing; 2005.

15. Santosh I. A study to assess the effectiveness of Structured Teaching Programme on knowledge regarding self care activities among patients with diabetes mellitus in a selected PHC at Tumkur. IOSR Journal of Nursing and Health Science. 2015; 4(3):01-8.

16. Dorwin D, Nilesh M. Assess the effectiveness of structured teaching programme in terms of knowledge regarding diabetic foot care among diabetic patients in selected hospital, Indore. Int J Adv Sci Res. 2016; 1(10):20-1.

17. Kaur H. Effectiveness of structured teaching programme regarding self care management in relation to prevention of complications among diabetics. Asian Journal of Nursing Education and Research. 2014; 4(3):279.

18. Zagade T, Patil A. Effectiveness of Self Instructional Module on Knowledge Regarding Prevention of Microvascular and Macrovasclar Complications among Patients with Diabetes Mellitus. International Journal of Science and Research. 2014; 3(5):902-908.

Received on 04.03.2019 Modified on 21.04.2019

Int. J. Nur. Edu. and Research. 2019; 7(3):399-402.

DOI: 10.5958/2454-2660.2019.00090.5