In this cross-sectional study, knowledge, attitudes, and practices of patients with T2DM with regard to their disease were assessed for the first time among Palestinian patients. Patients who took part in this study were recruited from different primary healthcare facilities in the West Bank of Palestine. In this study, more than half (52.2%) had good knowledge and 58.7% has positive attitudes with regard to their disease. On the other hand, only 36.4% had good practices. Findings of this study highlighted gaps in knowledge, attitudes, and practices with regard to T2DM among patients. In this study, correlations were established between knowledge, attitudes, and practices with the sociodemographic and clinical characteristics of the patients with T2DM. Additionally, knowledge, attitudes, and practices of patients who took part in this study correlated moderately. Findings of this study could be useful for policy makers, decision makers, healthcare providers, and patient advocacy groups who might need to design interventions to improve health outcomes of patients with T2DM.
In this study, the tool used to measure knowledge, attitudes, and practices was adopted from previous studies [24–26]. The tool was piloted for clarity and comprehension. Additional testing of stability of scores over a short period of time and internal consistency between the items included was performed. The test-retest method and Cronbach’s alpha ensured that the tool used in this study was reliable and internally consistent [28–32]. These measures might have added strength and rigor to methods used in this study. The data were collected using an interviewer administered questionnaire. Additionally, the interviewers in this study were final year MD candidates who were familiar with conducting interviews and taking patient history. This should have minimized occasions of mis- or lack of understanding associated with self-administered questionnaires [33].
Our findings indicated that almost half of the patients (52.2%) had good knowledge of T2DM and its associated complications. In a pilot study conducted in Sri Lanka, Hearth et al showed that 77% of patients with T2DM has moderate or above moderate knowledge of their disease [3]. Studies in different settings have reported variable level of knowledge among patients with T2DM in Mongolia, Sri Lanka, Bangladesh, India, Jordan, and Lebanon [34–40]. Not surprisingly, knowledge of T2DM was significantly higher among younger, male, never married, employed, educated, earning higher income, diagnosed with T2DM since less than 7 years ago, and having usual fasting plasma glucose level of less than 140 mg/dL. This could be explained simply because patients with higher education are expected to be more aware of their disease, its complications, and the ways to keep their blood glycemia under control. Additionally, it has been argued that younger patients are more interested in learning about their disease compared to older patients who could have other comorbidities and less interest in learning about their disease. Taken together, our findings might suggest that older and less educated patients need greater motivation and support from their healthcare providers and families. Our findings were consistent with those reported in some related studies that were conducted elsewhere. For example, Hearth et al showed that education was positively associated with higher knowledge of T2DM among patients in Sri Lanka [3]. Similarly, Karaoui et al showed that higher level of education was positively correlated with higher knowledge of T2DM among patients in Lebanon [36]. In Bangladesh, Fatema et al showed that male patients with T2DM had significantly higher knowledge of their disease compared to female patients [35].
Findings of this study showed that 58.7% of the patients had positive attitudes toward their disease. Our results were comparable to those reported by Belsti et al in Ethiopia in which [26]. However, in this study attitude scores were not significantly associated with educational level of the patients as was shown in Belsti’s study. Our findings showed significant association between attitude scores and higher income. Our findings were consistent with those reported among patients with T2DM in Bangladesh [35]. Probably, patients with higher income could have better access to healthcare services, ability to go to regular checkups, and practice physical activity compared to patients with less income [25].
Regarding practice, our study showed that 36.4% of the patients with T2DM had good practices with regard to their disease. In Ethiopia, less than half of patients with T2DM had good practices regarding T2DM and its complications [26]. Similarly, our findings were consistent with those reported in Sri Lanka and Lebanon [3, 36]. Our findings showed that younger, employed, educated, diagnosed since less than 7 years ago, and having controlled blood glycemia as indicated by fasting plasma glucose level, postprandial plasma glucose level, and HbA1c level were significantly associated with good practices. Our results were consistent with those reported in different settings in Mongolia, Sri Lanka, Bangladesh, and Lebanon [34–36].
Strengths And Limitations
Results of this study might be carefully interpreted taking into consideration the following strengths and limitations. First, this pilot study was the first to assess knowledge, attitudes, and practices of Palestinians with T2DM with regard to their disease. Second, this study was also to establish association between knowledge, attitudes, and practices with various sociodemographic and clinical characteristics of the patients. Third, the study tool used in this study was piloted and evaluated for reliability and internal consistency. Fourth, the study tool was administered by interviewers who were final year MD candidates who were familiar with interviewing patients and taking medical history. This should have reduced the occasions of mis- or lack of understanding that could be associated with self-administered questionnaires.
On the other hand, this study has a number of limitations. First, this study was a cross-sectional observational study. An interventional design should have permitted enhancing knowledge, improved positive attitudes, and promoted good practices among patients with T2DM with regard to their disease. Second, the sample size used in this study was relatively small. However, the sample size used in this study was comparable to those used in other studies [3, 36]. Third, a convenience sampling method was followed to recruit the sample needed for this study. It is noteworthy mentioning that the sample recruited was diversified by inclusion of patients from both genders, different educational levels, income levels, and geographic locations. Finally, the number of items relevant to knowledge, attitudes, and practices was relatively small. Despite the small number of items, we were able to expose the level of knowledge, attitudes, and practices of patients with T2DM with regard to their disease.