T2D (Type 2 Diabetes) is one of the major growing health problem. Write about the self-management of disease its prevalence and how it can be controlled by preventive measures life style. Diabetes prevalence is becoming a fast epidemic with people affected approximately going to double in next decade, especially in developing countries. The reasons are increased ageing that might be a factor in addition to already existing burden. Till date, no sure cure been identified for T2D. But, various treatment modalities like modification in the lifestyle, management of obesity, use of oral hypoglycemic agents and metformin (insulin sensitizer) reduced the resistance to insulin.18 Novel drugs are also being developed to manage the T2D. However, education and self-care practices has remain an important key factor to control this increasing burden and these factors should be tailored to improve the life quality of individuals with T2D. Hence, the present study was designed to assess the self-care behavior of T2D patients in Hossana, SNNPR, Ethiopia to assess the management strategies being adopted by them to control the disease burden.
In the present study, approximately 119 (43.1%) patients practiced the recommended self-care practices which is lower than the study conducted in Gondar, Ethiopia (48.14%).18 Similarly, the outcome of practicing the self-care practices in Hossana was lower than data from Palestine 48%,19 Bangalore, India 50.5%,20 Ardabil, Iran and Puducherry,21 India 63.6%.22 However, the data generated to adopt self-care practices for T2D management is higher than other regional studies conducted in Ethiopia such as Dire Dawa and Harari hospitals.16 Also, it is much higher than study conducted in Tawam and Al-Ain hospital, UAE 15.3%.23 The likely reason behind this may the difference source population, age group included in the study and socio-economic conditions of the people.
Education plays an important role in the management of communicable, non-communicable and chronic diseases. The present study also revealed that individuals educated (minimum up to high school) were more adhered to better diabetic self-care activities when compared to others illiterate. Similarly, various other studies from Addis Ababa,24 Bahir Dar,25 Ghana26 and South Gondar27 also reported that education is more important in management of chronic diseases like T2D. The literacy rate of Ethiopia was 51.77% only in 2017 which is still poor and might be because of huge gap of education in urban and rural areas, big and small cities. Hence, the most probable reason towards poor adherence to diabetes self-care activities might be that participants with higher education do have knowledge about disease management, better informed or understand and practice the acceptable standards of self-care activities than non-educated participants.
Although, knowledge alone is not sufficient to change behavior of any individual, instead the attitude plays an important role. But, knowledge is more important to explain behavior changes in a patient to manage the diseases with efficiency. Findings from the present study showed that knowledge of the respondents about diabetes was high accounting 230 people (83.3%); however, majority of them did not follow the recommended self-care practices. Though, knowledge is an essential factor for change in behavior or attitude of any individual, but, this change in behavior by its own alone also depends on individual circumstances. This is similar to the study conducted in Nigeria, where immense knowledge was reported in study participants about diabetic signs and symptoms, but, despite of this all they were lacking in adoption of self-care practices.28 Another study from Addis Ababa, Ethiopia also showed that knowledge about diabetes had no significant statistical association with glycemic control.24 This may be associated to factors such as high perceived barriers of self-care, less perceived severity of the disease and its complications, infrequent cues to action, low income and educational status. In one of the studies from Bengaluru, India, only 24.25% individuals had good knowledge for self-care practices, whereas foot care was the most neglected area observed.29 In Nigeria, negative attitude towards the disease condition was observed to be significantly associated with knowledge.30
Economy too plays a major role in self-care behavior practices. Findings from the present study indicates that patients with high income were two fold more likely to practice self-care than low income patients. Similarly, data generated from Jimma University and Nigeria corroborates that self-care behavior also depends on the monthly income of the patients.31 Individuals with high income can frequently visit the health facility for follow-ups and stick to the treatment too. The present study showed that patients with more perceived barrier were less likely to practice self-care than those with less perceived barrier. This is in line with the findings from Harari which indicated that people who had less perceived barrier to self-care were better to perform self-care than moderate perceived barrier. On contrary, one of the studies from Jordan showed that increased perceived barriers to adherence was significantly associated to poor control of diabetes.32
The present study revealed that patients with high perceived susceptibility to diabetic complications will self-practice two fold more when compared to low perceived susceptibility. On contrary, study from Jordan revealed that individuals with high perceived susceptibility to diabetic complications were less likely perform their self-care practice than those with less perceived susceptibility. The possible reason for this difference might be the findings are in line with the constructs of the HBM assumption; where patients who had high perceived susceptibility the disease complication were more adherent to self-care.33