PSYCHOSOCIAL ASPECTS OF LIVING WITH DIABETES MELLITUS: BASIS FOR AN ENHANCED DIABETIC - PowerPoint Presentation

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PSYCHOSOCIAL ASPECTS OF LIVING WITH DIABETES MELLITUS: BASIS FOR AN ENHANCED DIABETIC PROGRAM OF PRIMARY HEALTH CARE IN DOHA, QATAR

KHALID ALI SHAMS, MDJOYCE J. ESPINOSA, RN, MN, MANLUZ L. ROVIRA, RNALI BADER ALBADER, MDABDULLA ALNAAMA, MDPERRY PAUL J. ESPINOSA, RN, PhD

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Background of the Study

Diabetes Mellitus (DM) is one of the major health and development challenges of the 21st century (International Diabetes Association, 2017)

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Globally, an estimated 422 million adults were living with diabetes mellitus in 2014, compared to 108 million in 1980.

It is expected to reach 438 million by the year 2030, with two-thirds of all diabetes cases occurring in low-to-middle income countries

(

International Diabetes Federation, 2017).

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The Middle East and North Africa (MENA) region, with the highest prevalence of Type I and II diabetes mellitus among adults aged 20-79 years in the world (11%), 48 percent of diabetes cases being

undiagnosed (International Diabetes Federation, 2013)

O

ut

of the ten

countries: Highest

DM prevalence worldwide (2013), several were MENA countries including Saudi Arabia (24%), Kuwait (23%) and Qatar (23

%).

(Christos

et al., 2014

)

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This situation has prompted the Ministry of Public Health (2017) in the State of Qatar to strengthen their strategies to ensure proper lifestyle advice, education, and counseling be available to diabetic patients and those at risk of developing type 2 diabetes, which in the long term will lead to a modification of risk factors, improving rates of diabetes prevalence and morbidity.

Promoting awareness of diabetes and its prevention throughout the population (

Qatar

Diabetes

Association, 2016).

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Earlier studies have found that patients with diabetes mellitus: H

igh risk of decreased psychological well-being (Gask, Macdonald, & Bower, 2011; Stuckey et al., 2014) Detrimental impact on well-being and psychological functioning (Brands et al., 2007) More likely to experience depression (Almeida, 2015)Psychological morbidity (Al-Madhaki & Al-Kuwari, 2017).

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Psychological and social problems are common among diabetic patients worldwide

(Peyrot, Rubin, Lauritzen, Snoek, Matthews, & Skovlund, 2005)Non-adherence to medications, poor quality of life, and lack of interest in managing disease resulting in poor glycemic control and long-term complications (Gupta, Bhadada, Shah, & Mattoo, 2016)Poor psychosocial outcome by 44.6% of the DM patients (DAWN Study, Nicolucci et al., 2013)

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Psychological and social issues are important concern in the overall health of patients with diabetes mellitus, however, in Qatar, this area is understudied.

Moreover, doctors, nurses, and other health care professionals should need to emphasize the psychological and social health aspects of patients with diabetes mellitus.

It is important therefore, to look into the psychological and social issues of patients with diabetes mellitus.

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Objective of the Study

To determine the psychological and social well-being of patients with diabetes mellitus in Doha, Qatar.

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METHODOLOGY

Research Design: Descriptive, cross-sectional

Respondents:

280

patients with type

II diabetes

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Al

Gharaffa (n = 81)Mugalina (n = 79)Al Sheehaniya (n = 120)

N

= 280

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Permission to conduct the study was also obtained from the Medical Directors of the 3 Health Centers.

Ethical Considerations

Ethical Board and Research Section of the Department of Clinical Affairs, Primary Health Care Corporation, Doha, Qatar (

PHCC/IEC/16/01/001)

B

ioethical

principles of the Declaration of Helsinki.

C

onsent letter was included as a part of the questionnaire which stated the purpose of the study.

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Research Instrument

Psychological Well-being (10-item, researcher-made- checklist)Social Well-being (10-item, researcher-made- checklist)Validated by 3 ExpertsReliability: Cronbach’s Alpha (.873 and .815)

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RESULTS

What is the profile of the respondents in terms of age, sex, civil status, educational attainment, work status, family monthly income, living arrangements, duration of diabetes, medications in use, presence of illnesses other than diabetes, and number of hospitalization related to diabetes?

Mean=53.63

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The psychological well-being of the respondents…

Items MeanSDInterpretation1. I am satisfied with myself.3.190.973Fair

2. I am living in a purposeful manner.

2.98

0.989

Fair

3. I feel nervous and restless about the complications of diabetes.

2.95

1.089

Fair

4.

I feel sense of helplessness about my future condition

2.92

1.091

Fair

5. I worry about my health.

2.83

0.804

Fair

6.

I feel worthless about my condition.

2.81

1.022

Fair

7. I feel lacking of self-confidence.

2.76

1.029

Fair

8.

I have been able to face up my problems.

2.73

1.067

Fair

9. It burdens me that I always have to think about my condition.

2.73

0.913

Fair

10.

I feel relaxed and free of tension.

2.37

0.858

Poor

Overall

2.82

0.983

Fair

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The social well-being of the respondents…

ItemsMeanSDInterpretation1. I feel that my family is concerned towards me.3.360.873Fair

2. I can open up freely about my condition to my family.

3.10

0.945

Fair

3. I have been finding easy to get on with other people.

3.10

0.886

Fair

4. I am capable of making decision about my treatment.

3.08

0.938

Fair

5. I have been able to enjoy my day-to-day activities.

3.08

0.925

Fair

6. I am feeling alone.

3.05

1.178

Fair

7. I have friends that support in managing diabetes.

2.83

0.908

Fair

8. I talk to other diabetes patients.

2.81

0.961

Fair

9. I feel unable to participate in civic activities.

2.76

1.000

Fair

10. I am keeping myself busy and occupied.

2.63

1.031

Fair

Overall

2.98

0.964

Fair

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Is there an association between profile of the respondents in terms of age, sex, civil status, educational attainment, work status, family monthly income, living arrangement, duration of diabetes, medications in use, presence of illnesses other than diabetes, and number of hospitalization related to diabetes and their psychological

well-being?ProfileGamma Valuep-valueInterpretationDecisionAge0.1380.211Not SignificantAccept HoEducational Attainment

-0.383

*0.000

Significant

Reject Ho

Family Monthly Income

0.131

0.169

Not Significant

Accept Ho

Duration of Diabetes

0.017

0.875

Not Significant

Accept Ho

No. of Hospitalization r/t DM

-0.205

0.323

Not Significant

Accept Ho

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Psychological AspectGoodFair Poor Total

Educational

Attainment

f

%

f

%

f

%

f

%

No Formal Schooling

2

3.39

36

61.02

21

35.59

59

100.0

Elementary

4

7.20

49

87.50

3

5.30

56

100.0

High School

4

4.21

78

82.10

13

13.69

95

100.0

College

6

8.57

62

88.57

2

2.86

70

100.0Total16

5.7122580.363913.93280100.0Gamma= -0.383 p=0.000

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Psychological Aspect

Living ArrangementsGood FairPoorTotalf%f%f%f

%

Alone

1

1.93

47

90.38

4

7.69

52

100.0

With Children

2

9.52

16

76.19

3

14.29

21

100.0

With Spouse

0

0.0

8

53.30746.715100.0With Relatives00.0450.00450.08100.0With Children & spouse9

5.81

128

82.58

18

11.61

155

100.0

With Friends

4

13.79

22

75.87

3

10.34

29

100.0

Total

16

5.71

225

80.35

39

13.94

280

100.0Cramer’s V= -0214 p=0.005

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Profile

Cramer’s V Valuep-ValueInterpretationDecisionSex0.1030.230Not SignificantAccept HoCivil Status0.0700.501Not SignificantAccept HoWork Status0.1080.364Not SignificantAccept Ho

Living Arrangement

-0.214

*0.005

Significant

Reject Ho

Medication in Use

0.054

0.805

Not Significant

Accept

Ho

Illnesses Other than

Diabetes

-0.190

*0.010

Significant

Reject

Ho

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Psychological AspectIllnesses Other than Diabetesf%f%f

%

f

%

None

4

3.31

103

85.12

14

11.57

121

100.0

Hypertension

7

7.00

77

77.00

16

16.00

100

100.0

Hyperlipidemia

2

9.521571.43419.0521100.0Both312.501770.83416.6724

100.0

Others

0

0.0

13

92.90

1

7.10

14

100.0

Total

16

5.71

225

80.35

39

13.94

280

100.0

Cramer’s V=

-0.190 p= 0.010

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Is there an association between profile of the respondents in terms of age, sex, civil status, educational attainment, work status, family monthly income, living arrangement, duration of diabetes, medications in use, presence of illnesses other than diabetes, and number of hospitalization related to diabetes and their

social well-being?ProfileGamma Valuep-ValueInterpretationDecisionAge-0.0970.332Not SignificantAccept HoEducational Attainment-0.034

0.679

Not Significant

Accept Ho

Family

Monthly Income

0.146

0.138

Not Significant

Accept Ho

Duration of Diabetes

-0.046

0.642

Not Significant

Accept Ho

Number of Hospitalization Related to Diabetes

0.0132

0.461

Not Significant

Accept

Ho

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Profile

Cramer’s V Valuep-ValueInterpretationDecisionSex0.0880.339Not SignificantAccept HoCivil Status0.0720.479Not SignificantAccept HoWork Status0.1370.103

Not Significant

Accept

Ho

Living Arrangement

0.172

0.083

Not Significant

Accept

Ho

Medications in Use

0.082

0.438

Not Significant

Accept

Ho

Illnesses Other Than Diabetes

-0.214

*0.005

Significant

Reject

Ho

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Social Aspect

Illness Other than DiabetesGood FairPoorTotalf%f

%

f

%

f

%

None

20

16.53

87

71.9

14

11.57

121

100.0

Hypertension

10

10.0

81

81.0

9

9.0

100

100.0

Hyperlipidemia29.521571.42419.0621100.0Both416.671562.5520.8324

100.0

Others

1

7.14

10

71.43

3

21.43

14

100.0

Total

37

13.2

208

74.3

35

12.5

280

100.0

Cramer’s V = -0.214

p-0.005

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Conclusions

This study sheds light the importance of addressing the psychological and social well-being of patients living with diabetes mellitus in Doha, Qatar. The results suggest that self-satisfaction and living purposefully despite the illness, and the support of family members are the factors that could increase the likelihood of positive psychological state and better social well-being.

Higher level of education and living with spouse, children, and friends are associated with lesser tendency of having poor psychological

health.

Respondents

with no illnesses other than diabetes were more likely to develop good psychological and social functioning as well.

Overall, patients with diabetes mellitus still have the ability to maintain positive psychological health and social functioning.

 

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Recommendations

Doctors and nurses should continuously and effectively counsel diabetic patients that would maintain and improve patients’ satisfaction and therapeutic outcomes through appropriate psychological and social interventions such as problem-solving and coping skills, relaxation techniques and stress management, motivational interviewing, and empowerment-based

programs.

To

effectively counsel the patients with diabetes, doctors and nurses should receive appropriate training associated with teaching and counseling techniques.

To

those patients with poor literacy and poor numeracy skills, diabetes education should be strengthened through interactive modules and should be culturally flexible for diabetic patients of different origin and backgrounds.

 

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Thank you for your attention!

AcknowledgementResearch Section of the Department of Clinical Affairs, Primary Health Care Corporation, Doha, Qatar (PHCC/IEC/16/01/001)Dr. Khalid

Joyce

Luz