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Abstract
Background: Type 2 diabetes mellitus (T2DM) is currently a huge public health problem in Pakistan, and currently an estimated of 34.5 million adults are living with T2DM in Pakistan in 2024. Self-care is an integral part of diabetes management and prevention of complications but knowledge, attitude and practice (KAP) gaps exist as powerful barrier to self-care among patients in KPK. The number of patients suffering from T2DM is high in Tertiary care centers of Peshawar, however there is lack of proper KAP assessment in this area.
Methods: This study aimed at evaluating the knowledge, attitudes and self care practices of T2DM patients in tertiary care hospitals of Peshawar and then exploring association between KAP and socio-demographic, clinical and behavioral characteristics.Objective: To evaluate the knowledge, attitudes and self care practices of T2DM patients in tertiary care hospitals of Peshawar and to explore the associations of KAP scores with socio-demographic, clinical and behavioral factors.
Design: Descriptive cross sectional design was used. Convenience sampling was used to recruit a total of 220 T2DM patients from September to November in three tertiary care hospitals namely HMC, KTH and LRH, Peshawar. The socio-demographic and clinical profiling questions, Diabetes Knowledge Test Questionnaire (DKTQ, 12 items), Diabetic Health Belief Questionnaire (DHBQ, 16 items) and Summary of Diabetes Self-Care Activities (SDSCA, 17 items) were used to gather data. SPSS v.25 was used to analyze the data by descriptive statistics, chi-square test, Mann-Whitney U test, Kruskal-Wallis test, Spearman rank correlation test and binary logistic regression.
Results: The mean knowledge score was 6.80 ± 1.93 (56.67%) with 73.2% of the respondents showing satisfactory knowledge. The mean attitude score was 57.86 ± 7.74 out of 80 (65.41%), with 70.9% exhibiting a positive attitude. The mean self-care practice score was 83.49 ± 13.91 out of a total of 119 (65.18%) and 84.5% were considered to be demonstrating good self-care practice. There were significant associations between knowledge and education (p < .001), place of residence (p = .037), occupation (p = .027), age (Kruskal-Wallis H = 14.06, p = .003) and diabetes education attendance (p < .001). Attitude was significantly associated with age (p < .001), marital status (p < .001), education (p = .003), and occupation (p = .009). There was a significant association with self-care practice and occupation (p = .001) and attitude category (p = .036). Spearman correlation analysis showed that there were significant positive relationships between knowledge and attitude (r = .529, p < .001), knowledge and practice (r = .271, p < .001) and attitude and practice (r = .445, p < .001). Being a private employee (OR = 0.034, p < .001) was significantly associated with self-care practice level in the binary logistic regression.
Conclusion: Most of the T2DM patients had satisfactory knowledge, positive attitude and good self-care practices, but there are significant gaps especially in foot care, physical activities, dietary compliance and perceived barrier. The KAP levels were significantly influenced by education, occupation, age and attitude. The need is very urgent for targeted diabetes self-management education programs at these tertiary care centers to lower-educated, single, younger and occupationally vulnerable patient groups.