Current situation of self - Care knowledge of the outpatients with type 2 diabetes mellitus having treatment at yen bai provincal hospital of endocrinology in 2018

Journal of military pharmaco-medicine n o 1-2020 139 CURRENT SITUATION OF SELF-CARE KNOWLEDGE OF THE OUTPATIENTS WITH TYPE 2 DIABETES MELLITUS HAVING TREATMENT AT YEN BAI PROVINCAL HOSPITAL OF ENDOCRINOLOGY IN 2018 Vu Thi Huong Nhai1; Vu Van Thanh2 SUMMARY Objectives: To describe the current situation of self-care knowledge of the outpatients with type 2 diabetes mellitus treated at Yenbai Provincial Hospital of Endocrinology in 2018. Subjects and methods: Cross-sectional descriptive study. Data were collected by directly interviewing 108 people with type 2 diabetes mellitus for outpatient examination and treatment at Yenbai Provincial Hospital of Endocrinology from January to April, 2018. Self-assessment questionnaires of diabetes self-care which were built based on the toolkit Diabetes Self-Care Knowledge Questionnaire - DSCKQ 30 and referred to the translation used in the study by Nguyen Vu Huyen Anh in Dienbien in 2016 with CVI effect index of 0.83; Cronbach’s alpha coefficient of 0.81 were used. Results: The rate of patients with self-care knowledge was 19.4%. The average knowledge score was 17.3 ± 3.6 in a total of 30 points. The lack of knowledge of the patients in the study mainly related to diet, self-monitoring of blood sugar and recognition of signs of hypoglycemia. Patients had better knowledge of physical activity, adherence to medication, detection and self-care of complications. Conclusion: Self-care knowledge of the outpatients with type 2 diabetes mellitus treated at in Yenbai Provincial Hospital of Endocrinology was limited: The rate of patients with adequate knowledge about self-care was 19.4%. * Keywords: Type 2 diabetes; Knowledge; Self-care. INTRODUCTION Diabetes is a chronic disease which does not widely spread and rapidly increase worldwide in the 21st century, in which type 2 diabetes mellitus predominantly accounted for 90% [8]. Type 2 diabetes mellitus is closely related to the patient's lifestyle, often triggering in the elderly, but now tends to rejuvenate with more and more children and adolescents catching it [12]. According to the report by the International Diabetes Federation (IDF) in 2017, there were about 425 million people with diabetes in the world, equivalent to every 11 adults there was one person suffering from this disease and more than 212 million people (50%) developed diabetes without being diagnosed [9]. 1. Yen Bai Medical College 2. Namdinh University of Nursing Corresponding author: Vu Van Thanh (vuthanhdhdd@gmail.com) Date received: 17/12/2019 Date accepted: 30/12/2019 Journal of military pharmaco-medicine n o 1-2020 140 Vietnam is one of the four countries in Southeast Asia with the highest incidence of diabetes of about 3.5 million adults (20 - 79 years old), but up to 54% are undiagnosed, 85% are only detected to have the disease when they have a dangerous complication [9]. Diabetes is a major burden for individuals, families and the whole society. One more person dies every 8 seconds and every 30 seconds a person is amputated because of diabetes [9]. Most countries have to spend 5 - 20% of total health expenditure on diabetes [9]. The lack of self-care knowledge leads to improper behavior, reduce treatment effectiveness, and contribute to increase complications, increase treatment costs, increase disability and death rates [11]. According to the report by Yenbai Provincial Hospital of Endocrinology, up to April 2018, in the whole province, there were 1,955 patients with type 2 diabetes mellitus who were being treated as outpatient at the hospital and the number of diabetic patients was increasing rapidly [2]. Yenbai is a mountainous province where many ethnic minorities live, the incidence of disease is not similar to the ones at the studied areas. Therefore, the aims of study were: To describe the current situation of self-care knowledge of the out patients with type 2 diabetes mellitus treated at Yenbai Provincial Hospital of Endocrinology in 2018. SUBJECTS AND METHODS 1. Subjects. * Inclusion criteria: Patients from 18 years old were diagnosed with type 2 diabetes mellitus within one year of the time of data collection; in outpatient treatment at Yenbai Provincial Hospital of Endocrinology for at least 1 month (there has been enough minimum experience to evaluate the questionnaire); capable of receiving and answering questions; agree to participate in the study. * Exclusion criteria: Patients with serious complications must go to an inpatient hospital. * Time and place of study: - Data collection time: from January to April 2018. - Research location: Outpatient Department, Yenbai Provincial Hospital of Endocrinology. 2. Methods. * Research design: Descriptive cross-sectional study. * Samples size: Convenient sample selection. Select all patients diagnosed with type 2 diabetes mellitus who are receiving outpatient treatment at Outpatient Department, Yenbai Provincial Hospital of Endocrinology to meet the sampling criteria, during the period from 01 - 2018 to 04 - 2018; the research team selected 108 people who agreed to participate in the study. * Data collection: - Data collection tool: The data collection toolkit is based on the Diabetes Self-Care Knowledge Questionnaire toolkit (DSCKQ 30) after obtaining the author's permission and referring to the translation used in Nguyen Vu Huyen Anh’s study at Dienbien in Journal of military pharmaco-medicine n o 1-2020 141 2016 [1]. The toolkit was examined, revised and evaluated by three experts in the field of endocrinology. Then investigate more than 30 patients who satisfied the sampling criteria to correct the toolkit. The result of the toolkit had a CVI of 0.83; Cronbach's alpha coefficient was 0.81; consisted of 2 parts with the following contents: + Part I: General information, including information on demographic characteristics such as age, gender, ethnicity, education level, family history... + Part II: Self-care knowledge consists of 30 sentences divided into 3 areas: Lifestyle changes (18 questions); comply with self-care practice (8 questions) and the consequences of not controlling blood glucose levels (4 questions). - Scale and evaluation: Each correct answer is 1 point. Each incorrect answer or not knowing the answer is 0 point. The maximum total score is 30 points. The total score is presented as a percentage (%). Self-care knowledge will be divided into 2 levels: + Knowledge gained: When reaching 21 points or more in a total of 30 points (correct answer ≥ 70% of the total score). + Knowledge does not gained: When correct answer < 70% of the total score. - Steps to collect data: + Step 1: Training for 3 collaborators are 3 lecturers of the Nursing Department, Yenbai Medical College about the purpose, content, and method of investigation. + Step 2: Conducting surveys and assessing the self-care knowledge of the research objectives by direct interview method through the prepared questionnaires while the patients wait for the test results with time about 25 to 30 minutes. * Statistical analysis: Data were cleaned, entered and analyzed using SPSS 18.0 software. Use appropriate algorithms to describe values that are appropriate for each variable. RESULTS AND DISCUSSION 1. General characteristics of the subjects. Among 108 research subjects of type 2 diabetes mellitus, aged from 19 to 86 years old, the average age was 59.4 ± 12.2. Most study subjects were in the age of 60 or older, accounting for 51.8%. This result was similar to Nguyen Thi Thu Thao’s findings with the average age of the study subjects being 57.1 ± 12.8 [5]. In our study, the percentage of women (61.1%) was higher than men (38.9%). The majority of research subjects were Kinh people, accounting for 75%, the rest was ethnic minorities; in which, Dao people accounted for 11.1%. This was entirely consistent with the proportion of ethnic groups in Yenbai province according to the results of the Yenbai population and housing census in 2009 [3]. The research subjects mainly live in rural areas, accounting for 64.8%. Research subjects with lower secondary education accounted for the highest percentage (30.6%) and 9.3% of them were illiterate. Thus, people with type 2 diabetes mellitus made up a high rate. The main occupation of the research objectives is farmers, accounting for 37.0% and retirement accounts for 36.1%. Journal of military pharmaco-medicine n o 1-2020 142 2. Situation of self-care knowledge of type 2 diabetes mellitus. Table 1: The self-care knowledge points (n = 108). The average points (X ± SD) The lowest points (min) The highest points (max) Total points Total knowledge points 17.3 ± 3.6 8 25 30 The self-care knowledge points of the study subjects ranged from 8 to 25 points. The average point was 17.3 ± 3.6 on the total of 30 points. The proportion of patients with self-care knowledge was low, accounting for 19.4%. This result was lower than Nguyen Vu Huyen Anh’s finding in Dienbien in 2016 with 37.4% having standard knowledge [1]. This difference may be due to: the rate of illiterate research subjects in our study was high (9.3%) and the people mainly live in rural areas, accounting for 64.8%, higher than Nguyen Vu Huyen Anh's research; therefore, it can greatly influence the ability to access self-care knowledge for type 2 diabetes mellitus patients. According to the study by Adibe et al, the longer time the patients are ill, the higher level of self-care knowledge they have [6]. In our study, only those with type 2 diabetes mellitus who were diagnosed with the disease within 1 year were selected and in the study by Nguyen Vu Huyen Anh, the proportion of study subjects with the time ≤ 1 year made up only 11.7% in which mainly 60% of people who had been infected for 1 - 5 years, so they had a better knowledge of self-care [1]. Although Nguyen Vu Huyen Anh’s research results in Dienbien was higher than ours, but in general, the proportion of patients participating in both studies with self-care knowledge was still low. Dienbien is a mountainous province which has many similarities with Yenbai province where many ethnic minorities live, hence, access to health care knowledge is limited. Currently, we only found the research by Nguyen Vu Huyen Anh on the assessment of the self-care knowledge of type 2 diabetes mellitus patients published in Vietnam, so we had not compared the knowledge level of other areas in the country like the delta area... Figure 1: The level of general knowledge about self-care of research subjects. Journal of military pharmaco-medicine n o 1-2020 143 The rate of patients with self-care knowledge was low, accounting for 19.4%. The proportion of patients with self-care knowledge was not high, accounting for 80.6%. For foreign studies, there was a significant difference in the level of knowledge with our research results. According to Jackson's study, out of 303 research subjects, 241 people correctly answered from 70% or more, accounting for 79.5% and only 20.5% had self-care knowledge meeting the standard [11]. Our results were also lower than Dinesh et al’s findings, 24% of patients had good knowledge, 59% had average knowledge and 17% had poor knowledge [7]. This may be due to differences in location, time and demographic characteristics of the study subjects. Table 2: The proportion of research subjects with correct knowledge about physical activity, diet, prevention of complications, and blood sugar self-monitoring (n = 108). Content The number of subjects Rate (%) Physical activity The relationship between frequency of blood glucose level monitoring and physical activity 78 72.2 Understanding the frequency of physical activity 101 93.5 Understanding the intensity of physical activity 47 43.5 Diet Should have a snack before going to bed 26 24.1 Classify food according to blood sugar index 59 54.6 Fulfill the schedule of meals 58 53.7 Prevention of complications Need to take care of the feet carefully 90 83.3 Should use soft socks, have good elasticity 77 71.3 Daily dental care is essential 93 86.1 Self-monitoring of blood sugar Only health workers can check blood glucose and blood pressure for patients 24 22.2 Frequency of self-monitoring of blood glucose 29 26.9 According to the recommendation of the American Diabetes Association (2017) and the Guidelines for Diet for Diabetes of the Ministry of Health (2015), the diet plays a very important and indispensable role in controlling diabetes. In our study, the knowledge of patients' diets was limited. The proportion of respondents who knew that they should have a meal before going to bed only accounted for 24.4%; Journal of military pharmaco-medicine n o 1-2020 144 54.6% of the respondents knew to classify food by blood glucose index and 53.7% knew that they needed to keep their meals on schedule, not to skip meals even when they did not want to eat. This result was consistent with the study by Vu Thi Tuyet Mai at Kiengiang General Hospital in 2014 up to 70.2% of type 2 diabetes mellitus patients had inadequate knowledge of the diet of patients; 26.7% of patients knew that there should be extra meals and 62.6% of patients knew not to skip meals [4]. Knowledge of self-monitoring of blood glucose of research subjects was very limited. Only 22.2% knew that not only health workers but they themselves can check blood glucose, blood pressure as well, and 26.9% knew the frequency of self-monitoring of blood glucose. During the interview process, most of the study subjects did not practice self-monitoring of blood glucose at home. Some of the reasons were due to lack of knowledge about self-monitoring of blood glucose. They supposed that in-home self-monitoring was not as correct as measured at health facilities. Another reason was linked to the economic burden, patients cannot afford to pay for blood glucose test strips, insurance did not cover the cost of self-monitoring blood glucose while these patients had low-income. In order to overcome this situation, it is necessary for health workers to strengthen counseling, encouragement and guidance for compliance so that patients can practice self-monitoring of blood glucose at home. Table 3: The proportion of research subjects with correct knowledge about medication compliance (n = 108). Content The number of subjects Rate (%) The use of diabetes medication does not need to be maintained for a lifetime 92 85.2 When you feel well, you do not need to take diabetes medicine 93 86.1 Drinking alcohol while taking diabetes mellitus drugs is a serious problem 82 75.9 Diet and exercise are not as important as diabetes medications 68 63.0 When you feel well, there is no need for periodic health checkups 104 96.3 Most of the research subjects had the right knowledge about drug compliance. Through the process of direct interview, all patients participating in the study experienced tremor, restless, confused and sweating expressions, but only 24.1% knew it was a sign of hypoglycemia which was equivalent to the results in the Adibe’s study (26.9%), but higher than Nguyen Vu Huyen Anh’s, which was 17.5% [1, 6]. Thus, the proportion of research subjects who had correct knowledge about the consequences of uncontrolled blood glucose levels was very low; therefore, health workers need regular counseling for patients with knowledge to help identify and detect complications early in order to be treated timely. Journal of military pharmaco-medicine n o 1-2020 145 * The proportion of research subjects with correct knowledge about the consequences of uncontrolled blood glucose level (n = 108): Symptoms of neurological complications appear only in the feet: 53 people (49.1%); signs of hypoglycemia: 26 people (24.1%); high blood glucose levels can cause eye complications: 100 people (92.6%); high blood glucose levels can cause cardiovascular and kidney complications: 92 people (5.2%). CONCLUSION The self-care knowledge of type 2 diabetes mellitus patients treated at the Yenbai Provincial Hospital of Endocrinology in 2018 was still limited: the rate of patients with standard self-care knowledge was at 19.4%. The average knowledge score was 17.3 ± 3.6 out of 30 points; the lowest was 8 points and the highest was 25 points. The lack of knowledge of patients in the study mainly relates to diet, self-monitoring of blood glucose and recognition of signs of hypoglycemia (24.1%). REFERENCES 1. Nguyen Vu Huyen Anh. Assessing self-care knowledge of type 2 diabetes mellitus patients in Dienbien Provincial General Hospital. Master's Thesis in Nursing. Namdinh University of Nursing. 2016. 2. Yenbai Provincial Hospital of Endocrinology. Report on the implementation of tasks in the first 6 months of 2017. Yen Bai. 2017, October. 3. Electronic Portal of Yenbai province. Yenbai ethnic groups. At the website Yen-Bai.aspx?l=CacdantocYenBai, accessed on 28/5/2018. 2016. 4. 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