Factors Affecting Diabetes Management

Factors Affecting Diabetes ManagementREVIEW OF LITERATUREThis chapter of review of literature helps focus on some of the recent literature related to diabetes. It helps throw light on the research articles relating to the knowledge, side and practices in diabetic patients. Further it also gives a sketch account of studies related to the predictors of selection approaches and the studies that are related to the sources that charm the wont of alternative approaches. The review is limited to the articles that were through with(p) between 1985-2014 of which some of them are valued and qualitative in nature. The databases through which the journals are referred include Pubmed, Springerlink, ScienceDirect, Sage, Wiley online library, Taylor Francis, Plos one, Mary Ann Liebert, Ameri good deal Diabetes Association, BioMedCentral (BMC) and Oxford Journals. This review helps in identifying the gaps that exist in the present literature.Knowledge, emplacement and Practices amongst Dia betic adults sensory faculty of diabetes and diabetes care is needed for successful disease management. Low take aim of awareness of diabetes and its complications among patients ensues in poor glycemic give in Indians with diabetes. Knowledge near diabetes mellitus, appropriate attitude and practices are vital to reduce the incidence and morbidity associated with it. Obtaining information about the train of awareness about diabetes in a population is the first stones throw in formulating a prevention program for diabetes (Mohan, Raj, Shanthirani, Datta, Unwin, Kapur, Mohan, 2005). A field of honor from Pakistan highlighted the fact that proper discipline and awareness program can change the attitude of the everyday regarding diabetes (Badrudin, Basit, Hydrie, Hakeem, 2002) as a large gap between knowledge and attitude among the diabetes patients was run aground (Sivagnanam, Namasivayam, Rajasekaran, Thirumalaikolundusubramanian, Ravindranath, 2002) and proper knowledge regarding various aspects of wellness information program can improve the knowledge of patients and change their attitude (Mehta, Karki, S defamea, 2006).In a find out that was conducted in Philippines to test the knowledge, attitude and practices among diabetic patients it was found that the overall knowledge score are poor, with a percentage mean score of barely 43%. The finding also reveal that only 1% of the 156 respondents believed that type 2 diabetes is a serious illness reflecting how most of the residents think of their condition as something to be taken lightly, this in turn had an effect on the participants practices where less than half of the respondents describe regular fol slump-up with their doctors (Ardea, Paz-Pacheco, Jimeno, Lantion-Ang, Paterno, Juban, 2010). Adequate knowledge has been associated with more adequate behavioural outcomes.In a cross-sectional nurture on knowledge, attitude and practices among diabetes patients about diabetes and its compli cations in Central Delhi, it was found that out of 170 patients 85.9% participants had the basic knowledge about the type of diabetes, about 87.6% of the participants revealed that they knew what they had to consume, while only 11.8% participants knew about normal blood lollipop levels. The maximum knowledge that the participants had were about the eye problems (48.82%) and kidney problems (40%) while very little knowledge was noted for diabetic coma and stroke that results from diabetes. It was also found that the participants hurt a positive attitude (72.65%) that was not reflected in their practices (Singh, Khobragade, Anil, 2013). An some other study done in Bijapur, Karnataka revealed the same results as the above where the positive attitude was about 60-90% among the participants and it was also found that 59.9% had poor knowledge and 24.8% had good knowledge about diabetes. Further the study focused on the practices of the respondents where they took extra care in chemise they were injured and 40.7% were exercised regularly (Raj Angadi, 2011).A study that was conducted among 238 diabetes patients in Saurashtra region, Gujarat, Shah, Kamdar and Shah (2009) found despite being diagnosed with diabetes for eight classs only 46% of them knew the pathophysiology of diabetes. The three main findings of the study revealed that low education about diabetes among the participants were because 40% of the participants belonged to the below poverty line, because of which they could not afford therapy or a minimum standard care. The second reason for having low knowledge was only 3% of the participants were being treated by an endocrinologist, the reason being Gujarat having very less number of endocrinologists with not even one in the Government hospital making it difficult for the poor to afford the private institutions. Third and the most important factor was the low level of education where only 10% of them were graduates and 37% of the participants were co mpletely literate. The study also shows the attitude towards diabetes among the participants where it was found that the participants believed that they are completely responsible for their throw health indicating that if motivated and given education about diabetes they would make necessary changes in their lifestyle.A Cross-sectional study that used the knowledge, attitude and practice (KAP) questionnaire among the out patients in Nepal revealed that the knowledge, attitude and practice level of the participants were low (Gul, 2010 Upadhyay, Palaian, Shankar, Mishra, Pokhara, 2008). Supporting this study another recent study involving young (31-40 years) diabetic Saudi women also reported poor KAP scores (Saadia, Rushdi, Alsheha, Saeed, Rajab, 2010). Another study done in Malaysia reported that diabetic patients in a primary care centre had good knowledge and better attitude towards the care of their get disease (Ranjini, Subashini, Ling HM, 2003). Some research articles reveal ed that diabetic patients possess adequate knowledge and have positive attitude towards their condition and that there is no coincidence between the KAP and actual control of Diabetes Mellitus (Ng, Chan, Lian, Chuah, Noora, 2012).A study that was conducted by Kheir, Greer, Yousif, Geed and Okkah (2011) evaluated the knowledge, attitude, practice (KAP) and psychological status of adult Qatari patients with type 2 diabetes mellitus to study the routine of these factors on the ability of the patients to manage their diabetes and to achieve desirable health outcomes. It was found that there were significant differences in the attitude and knowledge between educational levels. The study concluded that providing education and other support programs to diabetics could be more effective if the KAP of the patients are understood before conducting such programs.A study which was done in United Arab Emirates to find out the KAP in diabetic patients revealed poor knowledge among the partic ipants. It was found that the majority of patients (72%) had a negative attitude towards having diabetes. However, only 6% expressed a negative attitude towards the importance of DM care. The results also showed marginally significant associations between the practice score and level of education, marital status, mode of diagnosis, while of disease, insulin use and frequency of seeing diabetes educator (Al-Maskari El-Sadig, Al-Kaabi, Afandi, Nagelkerke, Yeatts, 2013). Another research indicated that although the knowledge levels(56.14% of the respondents scored 100% in knowledge related questions) among our study participants are high, the levels of attitudes (17.5% scored above 50%) and practice (15.78% scored 100%) are lower than desirable (Saadia, Rushdi, Alsheha, Saeed, Rajab, 2010).Predictors of Alternative ApproachesVarious predictors have been found to play a role in an individuals behaviour to get hold of in alternative approaches. The studies below throws light on the recent research that has been done in this area. The demographic factor was not found to be a significant predictor of CAM usage which included age ( Nilsson, Trehn, Asplund, 2001 Singh, Raidoo, Harries, 2004). A study conducted by Mehrotra, Bajaj and Kumar (2004) shows that age was not significantly associated (p0.1) with usage of complementary and alternative euphony. Whereas, on the contrary age was related to the usage of alternative approaches (Chang, Wallis, Tiralongo, 2007 Ogbera, Dada, Adeleye, Jewo, 2010). Adding to this, research conducted by Hasan, Ahmed, Bukhari and Loon (2009) indicated that variables such as age groups (above 50 years ), those in the 25-44 year age group (Metcalfe, Williams, Mc Chesney, Patten, Jett, 2010), middle age (Bishop, Lewith, 2010 Ernst, 2000 Pirotta, Cohen, Kotsirilos, Farish, 2000) that is 4660 years (Lee, Charn, Chew, Ng, 2004) contributed to the usage of complementary and alternative medicates. Findings from the 2007 National Hea lth Interview keep up women reveal that middle age men reported to use complementary and alternative care for more than younger or older individuals. Higher levels of education were associated with higher rates of use. Prevalence rates of use for each type of complementary and alternative medicine significantly increased with an individuals income (Upchurch, Rainisch, 2013). concord to Singh et al. (2004) level of education and income (Mehrotra et al., 2004) were shown not to bias the usage of completing and alternative medicine on the other hand in contrast to their findings education level (Bishop, Lewith, 2010 Ernst, 2000 Foltz et al., 2005 Harris, Rees, 2000 Hasan, Ahmed, Bukhari, Loon, 2009 McFarland, Bigelow, Zani, Newsom, Kaplan, 2002 Metcalfe et al., 2010 Millar, 2001 Nilsson et al., 2001 Ogbera et al., 2010 Park, 2005 Wiles, Rosenberg, 2001) and Income (Foltz et al., 2005 Hasan et al., 2009 MacLennan, Myers, Taylor, 2006 Metcalfe et al., 2010 Park, 2005., Singh e t al., 2004, Thomas, Nicholl, Coleman, 2001 Wiles, Rosenberg, 2001) was found to influence the CAM usage. Research evidence also reveals that sex (Singh et al., 2004) predicts the usage of alternative therapies. Women were more apparent to have used CAM services than men (Aziz, Tey, 2008 Bishop, Lewith, 2010 Ernst, 2000 Lim, Sadarangani, Chan, Heng, 2005 McFarland et al., 2002 Metcalfe et al., 2010 Millar et al., 2001 Nilsson et al., 2001 Park, 2004 Roth, Kobayashi, 2008 Vincent, Eric, Jean, Sui VL, Sian, 2007 Wiles, Rosenberg, 2001). The other predictors that were identified were the marital status (Singh et al., 2004), individuals who were currently not married or in a common law relationship (Metcalfe et al., 2010), medicine use, duration of diabetes, period of complications and self-monitoring of blood glucose (Chang et al., 2007) and factors relating to an individuals health status (Bishop, Lewith, 2010).In a health survey which was conducted in England the first ind ependent predictors of 12 month Complementary and alternative medicine use were the presence of anxiety or depression, perceived low levels of social support, having a healthy diet, being female, and income that is above the national bonny (Hunt et al., 2010).Factors that influence Alternative ApproachesPeople resort to alternative approached due to a number of reasons, it is important from both academic and applied perspectives to understand why such substantial numbers of people use CAM. In a study that was conducted among the Indian community in Chadsworth, South Africa, Singh et al. (2004) found that people chose Alternative medicine/ approaches because it was a natural and safe form of medical care (23.4%), secondly because modern medicine carried a risk of unwanted side effects or they had experienced side effects themselves (15.6%). They also found that more than half (51.9%) of people who use Alternative therapy did so upon advice from someone they knew or because they came across an ad in the local press. Similar results were found by Hasan et al. (2009) where friends were the main source of influence (32.5%) on patients with chronic diseases to use Complementary and Alternative Medicine, followed by health professionals (25.9%), family members (20.2%) advertisement (15.8%) and old folks or culture beliefs (4.4%). Family history (Hasan et al., 2009 Lee, Charn, Chew, Ng, 2004), poor perceived health, being recommended by social contacts who are close, holding on to powerful traditional health beliefs and the perceived satisfaction with care influence the use of alternative methods (Lee et al., 2004)The way an individual perceives the illness/health influences the usage of Complementary and alternative medicine (Bishop et al., 2007 Hasan et al., 2009 Nilsson et al., 2001). People chose different treatment options depending on their perceptions of the kind, duration, cause and validity of their illness and the order in which they resort to these dif ferent options is dependent on the perceptions of illness. scholarship of oneself in poor health leads to usage of alternative approaches (Bausell, Lee, Berman, 2001 Pirotta et al., 2000). Individuals perceptions about effectiveness or the outcome of the treatment option and the perceived harm from treatment options also plays an important role in deciding the form of treatment/management (Rao, 2006).The various other reasons why people cogency be attracted to and use complementary and alternative medicines are because they hold beliefs that are congruent with Complementary and alternative medicine which include beliefs related to the amount of personal control/autonomy over their health (Bishop et al., 2007 Pal, 2002). Hence pro-beliefs about complementary and alternative approaches play a major role in influencing an individual to use them. ineffectuality (Menniti-Ippolito, Gargiulo, Bologna, Forcella, Raschetti, 2002 Sirois, 2008), having side-effects or dissatisfaction (Men niti-Ippolito et al., 2002) with allopathic/conventional medicine has led to people looking at other alternatives methods (Pal, 2002 Rao, 2006). It was also found that people value natural treatments/ holistic approaches (Sirois, 2008) which are non-toxic and hold postmodern belief systems where the participants believe that psychological and lifestyle factors are important in the development of illness (Bishop et al., 2007). Individuals who are more likely to select healthy lifestyle choices are also likely to engage proactively in other self-care (Sirois, 2008) behaviours which includes the usage of complementary and alternative approaches (Hunt et al., 2010, Nahin et al., 2007).Research evidence also shows that live plays an important role in determining which different alternatives to choose for treating an illness (Pal, 2002 Rao, 2006). Studies have also focused on how general philosophies of life predict the usage of alternative approaches. Alternative therapies are attractiv e because they are seen as more compatible with patients values, world-view, spiritual/religious philosophy or beliefs regarding the nature and meaning of health and illness (Bishop et al., 2007 Pal, 2002 Weaver, Flannelly, Stone, Dossey, 2002).Further research has suggested that people use alternative approaches because they suffer from chronic conditions (Al-Windi, 2004 Astin, Pelletier, Marie, Haskell, 2000 Bausell et al., 2001 Menniti-Ippolito et al., 2002) which might not have been treated by conventional medicine effectively or satisfactorily or also use them as they experience psychological distress as a result of the life threatening disease and would try anything that would reduce or might offer a cure for such a condition (Bishop, Lewith, 2010 Ernst, 2000 Nilsson et al., 2001) to preserve their own health status (Furnham, Vincent, 2000, Goldstein, 2000). Mehrotra, Bajaj and Kumar (2004) found that out of 493 participants 290 (86.8%) resort to complementary and alterna tive medicine because they desire for the maximum and early benefit. Several specific chronic disorders such as arthritis (95%) other musculoskeletal disorders (95%) and stroke (95%) were significantly associated with CAM use (Lee et al., 2004).In a research that was conducted with type 2 diabetes it was found that complementary and alternative medicine use was influenced by peoples beliefs, experience and their positive attitude towards the alternative approach, history of its use, having stronger health beliefs about diabetes, longer duration of diabetes, the outcome of complementary and alternative medicine in treating diabetes. It also associates the use to the persons behaviour (such as a higher degree of self-care activities by the individual) towards disease management rather than their demographic characteristics (Chang, Wallis Tiralongo, 2012). It was also found that diabetic patients used complementary and alternative approaches to improve their general well-being rather than treating diabetes itself (Arcury, 2006 Bell, 2006 Lind, Lafferty, Grembowski, Diehr, 2006).Summary of the reviewThe review of literature highlights the level of knowledge, attitude and practices among diabetic patients indicating the importance of knowledge which affects the individuals attitude and practices regarding management of their lifestyle and diet. Further the research evidence has also revealed a number of demographic factors that might have an effect in the usage of alternative approaches such as age, education level, socio-economic status (income) and marital status. A large number of reasons were found to influence people to use alternative approaches such as dissatisfaction or ineffectiveness of allopathic medication friends and family members, advertisements that the individual encounters, individuals attitude, holistic and cultural beliefs, cause, severity and duration and ones perception of the illness, the cost of the treatment and having a chronic disease. The studies that have been done so far focus on the knowledge, attitude and practices in relation to managing the illness specifically with respect to diet and lifestyle modifications and it also shows the predictors and influencers of usage of complementary and alternative approaches. However, not much of research has been done integrating knowledge, attitude and practices with the usage of alternative approaches in Indian Context. Since India is a diverse country having high cultural diversity it is important to understand the influence it has on the level of knowledge, attitude and practices of the population with respect to the usage of the various other approaches that people indulge in other than allopathic medication so as to understand and provide the country with a culturally acceptable diabetes education programme.