Le Roux, Maretha
English: 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, diabetes-related 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. 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 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.
Afrikaans: Tipe 2 diabetes mellitus (T2DM) is wêreldwyd 'n groeiende openbare gesondheidsprobleem en word gekoppel aan oormassa en vetsug. Talle pasiënte met T2DM in Suid-Afrika is oormassa of vetsugtig wat in studies met vinnige verstedeliking in Suid-Afrikaners oor die afgelope 20 jaar geassosieer word. Verstedeliking het gelei tot 'n verandering in eetgewoontes, wat gekenmerk word deur 'n verandering van `n tradisionele gesonder dieet, na `n meer Westerse ongesonde dieet en onaktiewe leefstyl. Alhoewel dit 'n algemene aanname sou wees dat verbetering in kennis, houding en praktyke die antwoord op die diabetes epidemie sou wees, is navorsers dit eens dat goeie kennis van diabetes nie altyd gedrag verander nie. Die doel van hierdie studie was dus om die huidige diabetes-verwante kennis, houding en praktyke (KHP) van volwassenes met T2DM in die Vrystaat te bepaal, en om te bepaal hoe dit verband hou met mekaar. Hierdie navorsingstudie is as 'n kwantitatiewe beskrywende waarneming studie ontwerp. Die populasie het volwasse pasiënte ouer as 18 jaar, met T2DM ingesluit. Twaalf gemeenskapgesondheidsorgsentrums en 10 primêre gesondheidsorg klinieke in die vyf distrikte in die Vrystaat is besoek. Binne die geselekteerde fasiliteite, het gerieflikheidsteekproefneming plaasgevind, totdat 'n totaal van 255 volwasse deelnemers ingesluit is. 'n Aangepaste Suid Afrikaanse-Diabetes KHP-vraelys is gebruik om inligting oor demografie en verwante faktore, lewenskwaliteit, diabetes-verwante KHP en waargeneemde sorg, in te samel. Deelnemers is ook geweeg en gemeet. `n Loodstudie is op 5 volwasse pasiënte met T2DM in Mangaung Metro-distrik gedoen. Etiese goedkeuring is van die Gesondheidswetenskappe Navorsingsetiekkomitee, Universiteit van die Vrystaat verkry. Twee honderd vyf en vyftig vraelyste is in 22 openbare gesondheidsfasiliteite voltooi. Die meerderheid van die deelnemers was swart (92%, n=235), wat 'n weerspieëling van die nasionale populasie-verspreiding in Suid-Afrika is, waar die meerderheid van die burgers swart is (80%). Slegs 8.6% van die deelnemers het hoërskoolopleiding ontvang en 10% was ongeletterd. Die mediaan ouderdom [reikwydte: 19 tot 84] van die deelnemers was 57 jaar en die mediaan ouderdom ten tye van diagnose van T2DM, was 48 jaar [reikwydte: 15 tot 80]. 'n Oorweldigende 87% van die deelnemers was oormassa of vetsugtig. Die meerderheid van die deelnemers (67% van die mans en 98% van vroue) het 'n middellyfomtrek bo die aanbevole afsnypunte gehad, wat verband hou met 'n verhoogde risiko van die ontwikkeling van T2DM in albei geslagte. Dit was dus nie verbasend dat die meerderheid deelnemers (61%; n=155) gediagnoseer is met T2DM nadat hulle metaboliese sindroom-verwante simptome gehad het en 'n verdere 11% (n=29) met ander gesondheids-verwante simptome gepresenteer het nie. Die meerderheid was vroue (75%; n=193) wat toegeskryf word aan glukose intoleransie wat geassosieer word met meer abdominale vet, wat meer algemeen in Suid-Afrikaanse vroue as mans voorkom. Deelnemers in die huidige studie het swak kennis van T2DM gehad. Slegs die helfte van die deelnemers het geweet wat die normale waarde vir bloedglukose vlakke is, alhoewel byna 90% geweet het wat die algemene tekens van hoë bloedglukose is, en twee derdes ingelig was aangaande die komplikasies wat verband hou met diabetes. Deelnemers was verder onkundig oor voedselgroepe, wat 'n rede tot kommer is, aangesien gesonde eetgewoontes 'n belangrike aspek van behandeling is. Die houding van die deelnemers jeens hulle siektetoestand in die huidige studie was meestal negatief. Die meerderheid (81% , n=206) van die deelnemers het gevoel dat hulle 'n heel ander mens sou gewees het as hulle nie diabetes gehad het nie. 'n Verdere 71% (n=181) was van mening dat diabetes die ergste ding is wat nog ooit met hulle gebeur het, en 79% (n=201) het skaam gevoel daaroor. Swak diabetes-hanterings praktyke was `n kenmerk in die meerderheid deelnemers en het hoofsaaklik ontoereikende fisiese oefening en swak eetgewoontes ingesluit. Hoewel die meerderheid (96%; n=245) van die deelnemers ingelig was oor die voordele van fisiese oefening, het slegs 31% (n=78) elke dag gedurende die vorige week geoefen. Swak praktyke is ook weerspieël in die hoë voorkoms van oormassa en vetsug wat nou verband hou met 'n gebrek aan fisiese aktiwiteit en 'n onaktiewe lewenstyl. In die huidige studie was daar 'n statisties beduidende korrelasie tussen diabetes-verwante kennis en houdings gevind, wat aandui dat 'n beter kennis oor diabetes geassosieer kan word met 'n meer positiewe houding teenoor die siekte. Ongelukkig het dit nie gelei tot verbeterde praktyke nie. Interessant genoeg, het deelnemers met 'n hoër vlak van opvoeding het beter gevaar in die vrae met betrekking tot kennis en houding oor diabetes, maar nie in hul praktyke nie. Diabetes-verwante KHP van die deelnemers in hierdie studie populasie was swak. Swak diabetes-verwante kennis, 'n negatiewe houding en swak praktyke, is waargeneem in 'n baie hoë persentasie van die deelnemers in hierdie studie. Hindernisse tot die handhawing van verbeterde lewenstyl en suksesvolle self- bestuursaktiwiteite moet verder nagevors word, aangesien dit `n waardevolle bydrae kan maak tot verbetering van gesondheid en lewenskwaliteit in pasiente met T2DM.