KNOWLEDGE-PRACTICE GAPS IN TYPE 2 DIABETES SELF-MANAGEMENT AMONG ADULTS ATTENDING A TERTIARY-CARE CLINIC IN RAWALPINDI, PAKISTAN: A CROSS-SECTIONAL STUDY

Abstract

Background: Type 2 diabetes mellitus (T2D) is a condition that is largely managed by the decisions made by patients and families on a daily basis. The burden of diabetes is very high in Pakistan and the evidence from the country and regions suggests that adherence to medication is generally better than lifestyle and preventive self-care. There is a need for granular evidence on how knowledge relates to routine practice for the design of feasible diabetes self-management education and support (DSMES). Objectives: To (1) evaluate participants' knowledge of T2D self-management; (2) document their views on recommended self-management behaviors; (3) document reported practices in medication use, hypoglycemia management, glucose monitoring, diet, physical activity, and foot care; and (4) identify barriers and domain-specific knowledge-practice gaps relevant to culturally appropriate clinic-based support. Methods: Descriptive cross-sectional study was carried out in a facility from August to October 2016. Systematic sampling was done to recruit clinic attendees with clinically diagnosed T2D. A target sample of 107 was determined based on an assumed 50% proportion, 95% confidence, 10% absolute precision and a 10% nonresponse allowance. The questionnaire was pilot tested and administered by the researchers and included questions on sociodemographic characteristics, medication use, hypoglycemia, blood glucose monitoring, diet, physical activity, and foot care. The data obtained from 105 respondents were analysed descriptively using SPSS 20. Results: The mean age of the participants was 49.89 years (SD = 12.36), 62.0% were female and 63.0% were uneducated. 100% of the participants were on diabetes medication. While 97.1% thought that glucose monitoring was important, 47.0% felt it should be done when they were feeling unwell, and 46.7% said they self-monitored. The majority (88.0%) had been given dietary advice, but only 20.0% reported a special diet, 92.2% reported that there was no special meal prepared at home and 63.0% used herbal supplements. 94.3% believed that physical activity was beneficial, and 36.2% indicated that they did not exercise. Knowledge of foot-care was high (97.1%) and adherence to recommendations was high (96.5%) with only 1.0% reporting regular foot inspection. Conclusions: Self-management knowledge was significantly higher than the performance of a number of specific behaviors, especially planned glucose monitoring, dietary adaptation, physical activity and daily foot inspection. Clinics providing DSMES should employ low literacy communication, behavioral goal setting, demonstration, family involvement, and structured follow-up, and not just information provision.

Keywords: type 2 diabetes mellitus, self-management, self-care, health literacy, diet, physical activity, foot care, Pakistan.