Assessing Patients’ Knowledge on Diabetes Self-care and the Clinical Outcome at Kenyatta National Hospital

Abstract

Diabetes is a chronic condition that is primarily self-manageable. Patients’ knowledge on diabetes self-care is key and has a great impact on their clinical outcome. Poor self-care knowledge causes poor glycemic control which leads to complications, a major cause of disability, reduced quality of life & death among diabetic patients. The main objectives of this descriptive cross sectional study was to assess patients’ knowledge on diabetes self-care and the clinical outcome among patients’ at KNH. A total of 127 respondents were selected and interviewed. Purposive sampling method was used for this study. A structured questionnaire was used to interview participants admitted in the medical wards. Participant’s data on clinical outcome was based on archived records of patients who were admitted and discharged earlier in the same unit between January and June, 2018. Data was analyzed using SPSS computer software version 20. Inferential statistical tests used include chi square and linear regression while statistical analysis outputs was presented with p-values and inform of absolute values & proportions. The study found out that on average respondents had moderate level of knowledge on self-care (55.9%). Of the total respondents, 95.6% (n=121) had good knowledge on the recommended diet. There was significant association between respondent’s age, marital status, level of knowledge and knowledge on diet (P < 0.05). Only 47% (n=60) of the respondents knew the correct range of normal blood sugar level. Only 31.4% (n=40) of the respondents had the correct knowledge on the frequency of eye examination. Respondents age had a significant influence on their knowledge on eye care (P = 0.031). About half of the respondents, 58.3% (n=68) had the correct knowledge on the recommended frequency of physical activity. The study found there was no association between respondents gender and knowledge on physical activity (p = 0.975). Half of the respondents 50% (n = 64) had the correct knowledge on feet examination. Respondent’s age, marital status, occupation and level of education had a significant influence on knowledge on physical activity (p < 0.05). On average respondents received three diabetic self-care counselling sessions. Respondents’ clinical outcome indicated average normal values; LDL (4.35mmol/l), HDL 2.60 mmol/l and TC (4.83mmol/l) on admission. Baseline HbA1c on average were high (9.94%).However there was a significant change in respondents LDL and HDL values (p < 0.05) on discharge. There was no significant change in respondents HbA1c values (p > 0.05) and the values were still high (8.7%) on discharge. Majority of the respondents had poor clinical outcome with 80% (n=102) having diabetes related complications and 7% (n=9) had died of related complications. In conclusion, respondents had moderate knowledge on self-care, however the clinical outcome was largely poor as marked by the high number of complications. Respondent’s demonstrated poor knowledge in areas where they had minimal exposure to counselling sessions; eye check-up, monitoring of sugar levels and physical activity. The researcher recommends that counselling on all aspects of diabetes self-care should be given same emphasis. There is need to increase exposure to counselling sessions and evaluating quality of content shared during counselling. Further studies are needed to establish contributing factors to the poor clinical outcome among diabetic patients