Worldwide Type 2 Diabetes Mellitus (T2DM) is a growing public health problem and
is closely linked to overweight and obesity. Many patients with T2DM in South Africa
are overweight or obese which has been associated with rapid urbanisation in South
Africans over the past 20 years. Urbanisation has resulted in a nutrition transition,
characterised by a transition from healthier traditional diets to a more Western
unhealthy diet and a sedentary lifestyle. Although it is a common assumption that
improvements in knowledge, attitude and practices would be the answer to the
diabetic epidemic, researchers agree that good knowledge of diabetes does not
always translate to behaviour change. The purpose of this study was thus to
determine current diabetes-related knowledge, attitude and practices (KAP) of adults
with T2DM in the Free State.
This research study was designed as a quantitative descriptive observational study.
The population included adult patients older than 18 years with T2DM visiting 12
community health centres and 10 primary health care clinics in the five districts in the
Free State. Within the selected facilities, convenience sampling took place until a
total of 255 adult participants had been included.
An adapted South African-Diabetes KAP questionnaire was used to gather
information about demographics and associated factors, quality of life, diabetesrelated
KAP and perceived care. Participants were also weighed and measured.
The questionnaire was piloted in a sample of 5 adult patients with T2DM in
Mangaung Metro district. Ethics approval was obtained from the Health Research
Ethics Committee, University of Free State.
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Two hundred and fifty five questionnaires were completed in 22 public health
facilities. The majority of participants were black African (92%, n= 235), which is a
reflection of the national distribution in South Africa where the majority of citizens are
black (80%). Only 8.6% of participants had completed high school and 10% were
illiterate. The median age of participants was 57 years,[range:19 to 84] and the
median age of diagnosis of T2DM was 48 years [range: 15 to 80].
An overwhelming 87% of participants were either overweight or obese. The majority
of the participants (67% of males and 98% of females) had a waist circumference
above the recommended cut-off points which is associated with an increased risk of
developing T2DM in both sexes. It was therefore not surprising that the majority
(61%; n=155) were diagnosed with T2DM following metabolic syndrome related
symptoms and another 11% (n=29) with other health related symptoms. This could
also explain the predominance of females (75%; n=193) was attributed to glucose
intolerance that is associated with higher visceral fat, which is more common in
South African women than in men.
Participants in the present study had poor knowledge of T2DM. Only half of the
participants knew the normal range of blood glucose, although almost 90% knew the
common signs of high blood glucose and two thirds were knowledgeable about
complications associated with diabetes. Participants were ignorant about food
groups, which is a concern considering that healthy eating is a pivotal aspect of
treatment.
The attitude of the participants toward their disease, in the present study was mostly
negative. The majority (81%, n=206) of participants felt that they would be a quite
different person if they did not have diabetes. A further 71% (n=181) felt that
diabetes was the worst thing that had ever happened to them, and 79% (n=201) felt
embarrassed about having diabetes.
Poor diabetes-management practices were reported by the majority of participants,
characterised by low levels of physical exercise and poor eating habits. Although the
majority (96%; n=245) of participants were knowledgeable about the benefits of
physical exercise, only 31% (n=78) reported exercising every day during the
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preceding week. The poor practices were also reflected in the high rates of
overweight and obesity that are closely associated with a lack of physical activity and
a sedentary lifestyle in general.
A statistically significant correlation was found between knowledge and attitudes,
indicating that better knowledge about diabetes could be associated with a more
positive attitude towards diabetes. Unfortunately this did not translate to improved
behaviour. Participants with a higher level of education obtained higher scores in
questions related to knowledge and attitude about diabetes, but not, interestingly, in
their practice scores.
Poor knowledge, a negative attitude and poor practices related to diabetes, were
observed in a high percentage of the participants included in this study. Barriers to
sustaining improved lifestyles and successful self-management activities should be
further researched since these could make a valuable contribution to improving the
health and quality of life of people with T2DM