Knowledge, Attitude and Practice of Type 2 Diabetic Patients (T2DM) with Chronic Kidney Disease (CKD) At Sigatoka Hospital in 2018

Introduction: Type 2 Diabetes Mellitus (T2DM) is one of the 4 major non-communicable diseases (NCD) that is contributing to the NCD crisis globally while Chronic Kidney Disease (CKD), which affects 1 in 7 adults, is the 9th leading cause of death worldwide. In Fiji, T2DM and CKD are 1st and 4th respectively for most causes of disabilities, deaths and premature deaths. Having adequate knowledge, attitude and practice (KAP) about T2DM and CKD can lead to a reduction in burden of disease. As little information is available in Fiji, this study aims to identify the level of KAP and its determinants in T2DM patients with CKD at Sigatoka Sub-divisional Hospital (SSH) in 2018.
Method: A quantitative, cross-sectional study was done from 1st July, 2018 to 31st August, 2018 using self-structured questionnaire to 225 patients. The inclusion criteria were confirmed T2DM patients (Fiji citizens) with CKD who were attending Special Outpatient Department (SOPD) at SSH with age of 30 years or above. The exclusion criteria included patients without T2DM, CKD from other causes or having mental instability. The questionnaire had 2 sections whereby the 1st section contained 7 questions on demographic information while the 2nd section was subdivided into 3 parts – each part had questions related to each aspect of KAP. For the knowledge component, each item was given a score of ―2‖ for a correct answer, ―1‖ for ―do not know‖ and ―0‖ for incorrect response. Hence, the total scoring range for this section of 15 questions was 0 – 30 for each participant. Those with a score of 0-15 were considered as ―low level of knowledge‖, 16-22 as ―medium level of knowledge‖ and 23 and over as ―high level of knowledge‖. Similarly, for the attitude component, each item was given a score of ―2‖ for a positive attitude, ―1‖ for ―neutral‖ and ―0‖ for negative attitude. Hence, the total scoring range for this section of 15 questions was 0 – 30 for each participant. Those with a score of 0-15 were
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considered as ―low level of attitude‖, 16 - 22 as ―medium level of attitude‖ and 23 and over as ―high level of attitude‖. For the practice component, each item was given a score of ―1‖ for a positive practice and ―0‖ for negative practice. Hence, the total scoring range for this section of 10 questions was 0 – 10 for each participant. Those with a score of less than 5 were considered as ―low level of practice‖ and 5 or over as ―high level of practice‖. The data was analyzed using Statistical Package for the Social Sciences (SSPS) Version 25. Independent t-test and ANOVA was used to test differences between demographic variable and practice score while non-parametric tests were used for knowledge and attitude. Spearman correlation and multiple linear regressions were also done. All the tests were set at 5% level of significance.
Results: The mean age was 58.6 years (SD=9.99), 48.9% were males, 48.9% were I-Taukei, 48% had secondary level education, 38% were employed, 80.4% were married and 67.1% had average monthly income of <$400. The mean level of knowledge was high - 23.3 (SD±3.25) with 61.8% of participants having high knowledge. Similarly, the mean level of attitude was high - 23.1 (SD±2.73) with 63.6% of participants having high attitude. On that same note, the mean level of practice was also high – 7.1 (SD±2.04) with 88.4% of participants having high practice. High level of knowledge was seen in those with university level education (p<0.001), unemployed (p=0.05) and high average monthly income (p=0.03). Age category of 61-70 years had 0.53 points lower attitude score (p=0.05) compared to other age categories while age category of >70 years had 1.78 points lower attitude score (p=0.01) compared to other age categories. Fijians of Indian Descent (FID) had lower attitude (p=0.002) but higher practice (p=0.001). A weak positive correlation was seen between knowledge and attitude (p=0.002) and knowledge and practice (p=0.025).
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Conclusion: T2DM patients with CKD at SSH in 2018 have high level of KAP. Those with higher level of education, unemployed and high monthly income had higher knowledge while FID had low attitude but high practice and the higher age category had lower attitude. The study had identified high risk groups for low KAP which can become the focus of future public health intervention. Future large scale studies at SSH can provide data on other relevant determinants of KAP which could have been missed by this study which had a relatively small sample size.