Family Psychosocial and Facility Related Determinants of Adherence to Home Management of Type 1 Diabetes Mellitus Among Children at Kenyatta National Hospital

Abstract

Background: Type 1 diabetes mellitus (T1DM) is a chronic disease and is the most common type of endocrine disorder in children with a global incidence of 3%-6.2% yearly. Home management which includes administration of insulin as per the prescription, blood glucose monitoring at least 4 times a day, dietary regulation and physical activity is the recommended care. However, poor adherence to home management of children with T1DM remains a challenge and has contributed to increased mortality in children. Objective: This study established the adherence and family psychosocial and facility related determinants of adherence to home management of type 1 diabetes mellitus among children at Kenyatta National Hospital (KNH). Methodology: This was a descriptive cross-sectional study carried out at KNH pediatric diabetes clinic among caregivers of children with type 1 diabetes mellitus. The sample size was 91 caregivers recruited through simple random sampling. Data was collected using a structured interviewer administered questionnaire. Review and approval for the protocol was provided by University of Nairobi-Kenyatta National Hospital (UoN-KNH) research and ethics committee. Permission was sought from the KNH administration to implement the study in the facility. Study participants provided informed consent to participate. Data was analyzed using SPSS V28 and presented in tables, pie charts and graphs. Descriptive and inferential statistics were applied in data analysis. Demographic characteristics were presented as frequencies and percentages while overall adherence was determined through model analyses by combining the individual elements of adherence. Family psychosocial and facility related determinants to adherence were determined using multivariate logistic regression analysis at 95% confidence interval (CI). Results: From this study results show that only (39.6%) of the children were deemed adherent to T1DM home management. The family psychosocial factors established to have a statistical significant and positive association with adherence to T1DM home management included, perceived helpfulness of the treatment (p = 0.016) and affordability of necessary resources and treatment by the family (p = 0.000). The facility-related factors established to have a statistical significant and positive association with adherence to T1DM home management included, support from the health care workers (p = 0.011), treatment availability in the health facility (p = 0.000) and appropriate health education offered to the caregivers (p = 0.004). Conclusion: Based on the findings of the study, the level of adherence to type 1 diabetes mellitus home management among most of the surveyed children attending diabetes clinics at KNH was sub-optimal particularly in domains of diet, physical exercise and blood glucose monitoring. The key determinant factors of adherence in T1DM clients include a mix of both family psychosocial and facility factors Recommendations: The low level of adherence calls for concerted efforts and sensitization of caretakers and health workers on T1DM management that include individualized health education talks be given to caregivers and children. Strengthening home visits approach for the families of children with T1DM.