Perceived Impact Of Compliance To Diabetes Diet And Its Challenges Among Diabetic Patients In FMC Owo
Diabetes mellitus is a condition that results from the body’s ineffective use of insulin. Management of diabetes mellitus requires compliance to dietary regimen, lifestyle changes and drugs. The purpose of this study was to determine compliance to dietary recommendations among patients with diabetes mellitus attending Federal medical center Owo. Data was collected in the hospital using researcher administered questionnaires on a sample of 387 patients out of the targeted 403 selected randomly. About 10% of the respondents were followed to their homes in order to administer a 24-hour dietary recall. Dietary intake data was analyzed using nutrisurvey software. The rest of the quantitative data was analyzed using Statistical Package for Social Sciences (SPSS Version 21) computer software. Qualitative data from the key informant interviews and focused group discussions was studied and analyzed thematically using the common themes and based on objectives of the study. Mean age of the respondents was 58.5 years. Half (50.1%) of the respondents were farmers and 75.2% of the respondents had attained at least primary level education. The study recorded high level of knowledge on dietary recommendations in management of DM at 76.2%. There was a strong association between the level of knowledge on the recommended dietary practices in management of DM and level of formal education (P<0.001). Mean level of compliance to recommended dietary practices in management of DM as reported by respondents was 59.6% and using 24 hour recall it was 57.5%. The study found no association between compliance to recommended dietary practices in management of DM and sex (P=0.938), age (0.914), or level of formal education (0.779). The study accepted the null hypothesis that compliance to recommended dietary practices among patients with type 2 DM was not influenced by the level of knowledge on the recommendations (P=0.872). Respondents reported financial constraints (47%) as a major hindrance to compliance to recommended dietary practices. Some of the facilitators to compliance were adequate finances and government support to diabetes care. Other facilitators included availability of a variety of food as well as family support. Diabetes is expensive to manage and it is even more expensive with the complications that accompany prolonged undiagnosed DM or long standing poorly managed DM. There is therefore need for government, donors and other implementing partners to come up with ways that will ease the burden of diabetes mellitus care.
Table of Content
- 1.1 Background of the study
- 1.2 Statement of the problem
- 1.3 Objective of the study
- 1.4 Research questions
- 1.5 Hypothesis of the study
- 1.6 Significance of the study
- 1.7 Scope of the study
- 1.8 Limitation of the study
- 1.9 Definition of terms
- 1.10 Organizations of the study
Review of Literature
- 3.1 Research Design
- 3.2 Population of the study
- 3.3 Sample size determination
- 3.4 Sample size selection technique and procedure
- 3.5 Research Instrument and Administration
- 3.6 Method of data collection
- 3.7 Method of data analysis
- 3.8 Validity of the study
- 3.9 Reliability of the study
- 3.10 Ethical consideration
Data Presentation and Analysis
- 4.1 Data Presentation
- 4.2 Analysis of Data
- 4.3 Answering Research Questions
- 4.4 Interpretation of Result
Summary, Conclusion and Recommendation
- 5.1 Summary
- 5.2 Conclusion
- 5.3 Recommendation
1.1 Background to the Study
Diabetes mellitus is increasing rapidly. In 1980, prevalence of diabetes mellitus globally was 4.7% and has since risen to 8.5% in 2014 (WHO, 2017). Olokoba et al. (2012) estimated that the number of adults with diabetes in the world would rise from 135 million in 1995 to 300 million in the year 2025. Global mortality attributable to diabetes in 2000 was estimated at 2.9 million deaths, equivalent to 5.2% of all deaths (Roglic et al., 2005). The study also revealed that the mortalities were higher in 35–64 years old people with 6–27% of deaths attributable to diabetes. diabetes mellitus accounts for over 90% of diabetes in Sub-Saharan Africa (Hall et al., 2011 and mortality attributable to diabetes in 2010 was 6% (Mbanya et al., 2010). Christensen et al. (2009) recorded a 4.2% prevalence of DM in Nigeria; with a high prevalence being recorded in urban areas (12.2% in urban areas & 2.2% in rural areas). About 1% deaths were attributable to diabetes (WHO, 2014).
Effective management of diabetes mellitus requires that patients learn and practice new and complex behaviors like blood glucose monitoring, taking medications (some self-injecting), keeping track of meal times, diet and exercise, besides dealing with their routine work, social and family life (Kapur et al., 2008). Compliance to these new practices is important. Dietary modification is one of the major aspects in management of diabetes mellitus (Ministry of Public Health and Sanitation, 2010). A patient should consume high-fiber foods, low glycemic index (GI) with caloric restrictions. This includes consuming more fruits and vegetables, nuts and whole grains, and choosing unsaturated vegetable oil as opposed to saturated animal based fats. World Health Organization (WHO) recommends 30g fiber intake in a day for good health while higher fiber content is recommended for diabetic patients (Joshi, et.al., 1991). A diet plan for patients with DM also includes avoiding alcohol and limiting consumption of snacks that are high in fat, sugar or salt. These snacks may include potato chips, cakes, biscuits, soda and among others (American Diabetes Association, 2015). Portion sizes as well as meal times should also be observed. The diet plan is normally individualized. Management of DM also involves lifestyle modifications and adherence to medication. Delamater (2006) in his study on improving adherence noted that diabetes mellitus care regimen is complex; however, there are patients with good diabetes self-care behaviors who always manage to attain excellent glycemic control.
Compliance to recommended lifestyle changes improves glucose levels, and leads to decreased blood pressure and corrects lipid abnormalities which are factors associated with complications of diabetes (Ganiyu et al., 2013). The same study also reported 63% rate of adherence to dietary regimen. Patient’s knowledge on diabetes mellitus is vital in proper management of DM. Patients with adequate understanding and knowledge of their medication have better gycemic control (McPherson et al., 2008). However studies have shown that knowledge is not always translated into practice. A study by Saleh et al. (2012) reported high levels of nutritional knowledge on management of DM but adherence to these guidelines was very low; for instance, only a third of the respondents partially followed the rules of measuring food before eating. This study therefore set out to determine the perceived impact of compliance to diabetes diet and its challenges among diabetic patients in FMC Owo.
1.2 Statement of the Problem
Diabetes is a condition causing a metabolic disorder that leads to chronic hyperglycaemia. There are two types of diabetes. Type 1 is when the beta cells in pancreas stop the insulin secretion and occurs when there is resistance to the action of insulin. The World Health Organisation´s definition of diabetes is fasting glucose over 7.0 mmol/l or whole blood over 6.8 mmol/lI. In long term untreated diabetes can lead to retinopathy and blindness, neuropathy that can cause renal failure, foot ulcers or worse, amputation. If diabetes is not medicated correctly it can lead to ketoacidosis or a nonketotic hyperosmolar state that in worst case can lead to coma or death (World Health Organization, 1999). Diabetes Mellitus (DM) relies heavily on proper management which includes hypoglycemic drugs/insulin injections and lifestyle changes. Diabetes complications are common and they are the major causes of morbidity and mortality among patients with DM. Managing diabetes complications is almost triple the annual cost of managing diabetes (Bate & Jerums, 2003). Compliance to diabetic regimen (diet, exercise, drugs and other self-care) prevents/ delays the onset of diabetes complications (Bate & Jerums, 2003). Compliance to dietary recommendations also improves glucose levels, reduces obesity and leads to decreased BP and other complications of DM (Ganiyu et al., 2013). Compliance to dietary regimen in management of DM in Nigeria was 63% (Ganiyu, 2013). Patients attending hospitals in FMC Owo recorded high DM complications and frequent hospitalization attributable to poor management of DM. However there was limited literature on perceived impact of compliance to diabetes diet and its challenges among diabetic patients in FMC owo.
1.3 Objectives of the study
The objective of the study is to establish the perceived impact of compliance to diabetes diet and its challenges among diabetic patients in FMC owo.
Specifically, the Objectives are;
- To establish the level of knowledge of the recommended dietary practices in management of DM among diabetic patients attending FMC owo.
- To establish the level of compliance to recommended dietary practices among patients with DM attending FMC owo.
- To establish factors that influence compliance to recommended dietary practices among patients with DM attending FMC owo.
1.4 Research Questions
The study will provide answer to the following research questions;
- What is the level of knowledge of the recommended dietary practices in management of DM among diabetic patients attending FMC owo?
- What is the level of compliance to recommended dietary practices among patients with DM attending FMC owo?
- Which factors influence compliance to recommended dietary practices among patients with DM attending FMC owo?
1.5 Hypothesis of the Study
H0: Compliance to recommended dietary practices among patients with DM is not influenced by the level of knowledge on the dietary recommendations.
1.6 Significance of the Study
Results of this study will add value to the policy makers in their work of developing policies and guidelines on dietary management of diabetes mellitus as well as compliance to recommended dietary practices. The study will also benefit in understanding some of the challenges patients with DM face that hinder compliance to recommended dietary practices in management of DM. The stakeholders will now have a chance to use the evidence to prioritize strategies that would eliminate the barriers to compliance. Health facility workers will also use the results to develop key messages that will improve on compliance to recommended practices. Results of the study will benefit diabetes community since the challenges they face on diet in management of diabetes mellitus will be documented and different actors can now take up different roles to address them.
1.7 Scope of the Study
The study on the perceived impact of compliance to diabetes diet and its challenges among diabetic patients. It will be carried out in Federal Medical Center OWO ondo state.
1.8 Limitation of the Study
Like in every human endeavour, the researchers encountered slight constraints while carrying out the study. Insufficient funds tend to impede the efficiency of the researcher in sourcing for the relevant materials, literature, or information and in the process of data collection (internet, questionnaire, and interview), which is why the researcher resorted to a moderate choice of sample size. More so, the researcher will simultaneously engage in this study with other academic work. As a result, the amount of time spent on research will be reduced.
1.9 Operational Definition of Terms
Was the extent to which patients adopted the recommended dietary practices in management of diabetes mellitus.
Recommended Dietary Practices:
Was the meal composition, meal frequency and meal timings in management of DM
Meal composition referred to the choice of food by groups, for instance; cereals, tubers and roots, meats and pulses, vegetables, fruits and oils, among others. It also referred to the portion sizes of each food type in household measures and in grams.
Frequency of Meals:
Frequency of meals in diabetes management was considered to be the number of meals a patient should/ actually consumes in a day. Main meals and snacks were regarded as individual meals.
Referred to consuming meals at almost exact time in a day e.g. taking breakfast at 7, most of the days 24 Hour
Is a structured interview aimed to capture detailed information on all foods and beverages consumed by respondent in the past 24 hours
1.10 Organizations of the Study
The chapter one consist of the introductory part of the study which includes the study background, the statement of the research problem, the study objective and scope of the study.
The second chapter is a critical review of other literatures relevant to the study and its objectives including the theoretical framework for the study. While the third chapter is methods of data collection, sampling and data analysis used in conducting the study. The fourth chapter centres around the research findings including an analysis of how it relates to previous findings. The fifth chapter consists of the summary of findings, conclusion and recommendations base on the study objectives.
Conclusion and Recommendations
5.1 Summary of the Study
Good nutrition is important in management of DM. Patients acquire correct information on the recommended dietary practices from the health workers. While knowledge level was relatively high at 76.2%, compliance level was only 59.6%. Main hindrances cited by respondents were heavy resource burden of the condition; financial constraints and forgetfulness as a result of the many components involved in management of DM. ANOVA test indicated that level of formal education was a major factor that determined the level of knowledge on recommended dietary practices in management of DM. While compliance level was not significantly different among different levels of formal education, the absolute means indicated that the more educated respondents had higher compliance level over the less educated. Younger respondents also recorded higher level of knowledge on recommended dietary practices. There is need to do more research on the factors that hinder or facilitate compliance to recommended dietary practices
- There was a relatively good knowledge (76.16%) among patients on dietary recommendations in management of DM. Older patients had lower level of education on recommended dietary practices. Consequently, knowledge on need to carry candy as a first aid when one is hypoglycemic was low. In addition, knowledge on the need for patients with DM to keep the times one consume their meals (meal timings) as well as consume snacks in between main meals in order to reduce incidences of hypoglycemia was low. Level of formal education of patients with DM influenced strongly the assimilation of information provided by health care providers. Age was also strongly associated with how much a patient was able to grasp information and remember. Continuous education on recommended dietary practices was noted as important.
- Compliance to recommended dietary practices was 59.6%. Unlike the level of knowledge which was influenced by various demographic characteristics like age and level of formal education, compliance was not influenced by any of the assessed demographic factors. While the level of knowledge was high at 76.2%, this was found not to directly translate to compliance to recommended dietary practices in management of DM.
- Compliance to recommended practices was not influenced by level of knowledge on recommended dietary practices in management of DM. Support by those related/ living with the patients was reported as one of the strong facilitator towards compliance. Management of DM was reported to be resource intense; financially and time wise. It was therefore sometimes difficult for patients to balance all aspects of recommendations.
There is need for comprehensive education at the health facility on management of DM, including those aspects that are often neglected for instance the need to observe meal times, need to carry candy at all times and also take snacks in between main meals for better blood glucose control.
There is also a need to review and educate patients on a regular basis in order to reinforce the information and promote compliance.
The Federal government, state governments and donors are encouraged to come up with a way of reducing cost of diabetes care.
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