Study On The Knowledge,Attitude And Self-management Practice Of The Diabetes Patients In Shandong Province

BackgroundAs one kind of the chronic diseases,diabetes has been the third serious threat to public health after the cardiovascular disease and tumor.Its prevalence has been rising in recent years,resulting in serious loss of physical health,economic burden on patients.The diagnosis of diabetes means a life-long illness,and it can't be cured by the current medical therapy and technology completely.Therefore,the aim of the treatment is to control the blood sugar and prevent the complications.With the type 2 diabetes global guidelines issued by International Diabetes Federation in 2014,the guideline recommends that the medical systems of most countries and regions should implement the following services,including health education,blood glucose monitoring,lifestyle changes and drug.The disease control of diabetes is closely related with the daily life habits,so enriching patients' disease knowledge,enhancing their consciousness to adjust the way of life,and finally letting patients actively participate in self-management are the keys to prevent complications.At present,domestic researches on diabetes patients' self-management show that the blood sugar control is not ideal,and so the patient's self-management behavior is.At the same time,the existing research is limited to describe the status and influence factors of the patient's knowledge,attitude,self-management behavior and lack of systematic analysis of the three.Facing the challenges of diabetes prevention and control,we need to know the status quo of self-management of diabetic patients based on the"knowledge-attitude-practice" model and take corresponding interventions.ObjectivesThe purpose of this study is to investigate the status quo of the knowledge,attitude and self-management of the diabetes patients in the urban and rural areas,figure out the key subjects and contents of the low level of knowledge,attitude and practice in the interviewed patients,provide advice for improving the management and control strategies of diabetes,and a basis for the design of specific interventions at the next stage of the project.MethodsWe determine the urban of investigation,that is,Qingdao(Laoshan district,Jiaozhou city)in the eastern part of Shandong province,Weifang(Weicheng district,Zhucheng city)in the middle,Jinan(Zhangqiu district,Pingyin city)in the Midwest and Heze(Mudan District,Shanxian city)in the west according to the situation of public health work and the distribution of samples in those areas and economic development.Three streets(towns)were selected in each district(county),and then three communities(villages)were selected from each street(town).Then we conducted questionnaire survey among 35 diabetic patients who were included in management of public health in each community(village).The Epidata is used to establish a baseline database,Stata 14.0 and Excel 2016 are used to do the descriptive statistical analysis and inferential analysis;chi square test and multivariate analysis.Amos 17.0 is used to build the model between disease knowledge,attitude and practice of patients,and to verify whether this structural model is reasonable.Results(1)The patients' knowledge about disease is not ideal.The patients with "poor"knowledge level account for 55.77%of the total sample population.The knowledge rates for treatment of disease are higher,however the rates for the basic knowledge of diabetes including diabetes complications and symptoms are low.The knowledge for patients in urban is better than patients in rural areas;the knowledge level of young,high educational level,high income level and longer illness time patients are all higher(P<0.05).(2)The patient's overall attitude to the disease treatment is good.The proportion of the patients with good attitude to each treatment is more than 90%.Compared with other measures,the patients tend to ignore the importance of "receiving health education",and 9.98%of the patients think they are "general" or "unimportant".There was no significant difference in the treatment attitude between the urban patients and the rural patients.The results of multi factor analysis showed that the factors affecting the attitude were similar to those of the knowledge.The treatment attitude of the high education level,high income level,longer time of the illness and the married patients were better(P<0.05).(3)74.42%of the patients pay attention to diet control;the most selected of the non-attention diet control options is "not paying attention to total amount control",accounting for 9.93%.Among those who do not pay attention to diet control,nearly half of them say they just can't change the habits of many years;single factor analysis showed that whether in the urban or in rural areas,female patients is better than male in diet control(P<0.05).(4)The situation of exercise is not ideal,with 39.1%of the patients did not have regular exercise habit;among those with regular exercise habits,only 12.79%of them meet the guideline-recommended standard;exercise of patients in urban area is significantly better than that of the rural area,with the proportion of patients who meet the exercise standard two times of the rural patients,and the proportion of patients who have regular exercise habit in rural areas was significantly lower than that in urban areas.The main reason for no exercise is "unable to exercise due to the weak health","no more energy due to the intensified physical labor" and "no time for exercise";there is a difference in the choice of causes between urban and rural patients.Single factor analysis shows that in urban area,female patients do less exercise than male;in terms of the rate of reaching standard,the rates of young people and married patients are higher(P<0.05);there is no significant differences between various groups in rural areas in the above two aspects.(5)The vast majority of patients take going to the medical institutions as the main means of blood glucose test;less than 30%of the patients conduct the blood glucose self-monitoring at home;the proportion of patients who conduct self-monitoring(31.87%),the frequency of blood glucose self-monitoring(6.15 times per month)and the frequency of blood glucose test in medical institutions(1.37 times per month)in urban area are all higher than those in rural areas(19.71%,5.06 times per month,0.96 times per month),.Whether in urban or rural areas,male patients are better than female patients in self-monitoring;and the young group is better than the old group;in addition,in rural areas,the situation of married patients is better than that of the non-married population.In the aspect of basic public health services utilization,most patients have access to it and can reach the standard(87.06%)(6)Patients who don't taking any drugs for treating diabetes account for 13.80%,the main reason for not taking any drug is that "no need formedicine and consulting a doctor";among the patients who take medicine,only 38.46%of the patients whose drug adherence score is "good".The main cause for the low compliance is "forgetting to take drug unintentionally".In both urban and rural area,the medication adherence of the old patients is better than that of the young patients;in urban area,the adherence of non-married patients in urban area is better than that of the married group(P<0.05).(7)The path coefficient shows that the knowledge of the disease is significantly positively correlated with patients attitude,correlation coefficient between them is 0.27,namely diabetes disease knowledge degree is higher,the better attitude towards the treatment of patients;it also shows a significant positive correlation between the attitude and the self-management behavior treatment,the correlation coefficient between those two is 0.33,namely diabetes disease attitude degree is higher,the better self-management behavior of patients;the validation of the "knowledge-attitude-practice" model shows that the promotion of diabetes knowledge can significantly enhance the patient's treatment attitude and ultimately promote the improvement of self-management behavior.Conclusions and suggestionsThe knowledge level of diabetic patients is not ideal,and the treatment attitude of them is better.There are many improvements in patients' self-management behavior;The difficulty of changing many years of habit is the cause of poor diet control in most patients;the serious diet control problem is not to control total amount intaking,the key population is the male patient;"weak body","no time",and"no energy" are the main reasons for most patients who do not exercise,and most patients have regular exercise habits but do not reach the standard;the proportion of patients with self-monitoring of blood glucose is low,the key groups are female and elderly patients;most of the patients who did not take medicine have not consulted the medical staff,and the adherence of the patients is not good,the main problem is"forgetting to taking drug unintentionally" and the the key population is the low age group.Suggestions include:first,strengthening the health education for diabetics,while promoting the treatment of diabetes,we should strengthen the propaganda of the basic knowledge of diabetes and deepen the understanding of the patients with diabetes.;second,optimizing the health education method to correct the bad disease control habits of patients through different kinds of learning methods of the structured education.Taking the exercise treatment as an example,for patients who are physically weak,medical staff should emphasize the importance of the other treatment measures and improve the adherence;the patients with reasons including "lack of energy" or "lack of time" should be trained by structured education.For patients who didn't reach standard,medical staff should suggest to increase the intensity of exercise and set specific goals for them;third,medical workers should pay close attention to the key groups who are not ideal in self-management of diseases,find out problems and carry out health education in time.