EFFECTIVENESS OF INFORMATION BOOKLET ON DIABETES AMONG THE ADMITTED DIABETES CLIENTS IN BPKIHS Mehta RS*1, Karki P*2, Sharma SK*3 B.P. kiorala Institute of Health Sciences, NepalABSTRACT:Introduction: Diabetes is a major non-communicable Public health problem, rising prevalence of the diseasein the developing countries, which was rare before, is due to industrialization, socio-economicdevelopment, urbanization and changing life-style. As the disease cannot be cured, it is a lifelong and it can only be controlled, hence there is need for self-motivation and knowledge tomanage the disease. The Objectives of this study is to prepare an information booklet onDiabetes and to find out the effectiveness of it.Research Design and Methodology:It was single group pre-test post-test quasi-experimental research design, conducted among theadmitted diagnosed diabetes cases admitted in medical units of BPKIHS in 2005. Usingpurposive sampling technique 50 subjects were selected. After the pre-test, Information bookleton diabetes (In Nepali) was given to subjects along with explanation. After 3 days of pre-test,post-test was taken and the collected data was analyzed using SPSS-4 package.Results:It was found that 76% clients were suffering with NIDDM, 22% on OHA, 72% on insulin, and80% on diet therapy. About 80% subjects reported that they studied this type of booklet firsttime, and was easily understandable. Ninety percent subject reported that the booklet is veryhelpful, 10% mentioned it all right where as none of them reported not helpful, and 100%subjects mentioned that they refer others to study this booklet.This booklet will be very beneficial for diabetes clients attending diabetes clinic, MOPD andadmitted in medical units.*1 Mr. Ram Sharan Mehta (Corresponding Author), Asst. Professor, Medical surgical Nursingdepartment, College of Nursing. (Email: firstname.lastname@example.org) *2Prof. (Dr.) PrahladKarki, HOD, Department of medicine & Hospital Director. *3Dr. Sanjeev Kumar Sharma,Department of Medicine, B.P. kiorala Institute of Health Sciences, Nepal
Introduction: Diabetes Mellitus (DM) is a chronic disease caused by inherited and/or acquired deficiency inproduction of insulin by the pancreas. It is a syndrome caused by an imbalance between insulinsupply and demand, characterized by hyperglycemia and associated with abnormal carbohydrate,fat and protein metabolism. Insulin deficiency results in increased concentrations of glucose inthe blood, which intern damage many of the body’s systems, in particular the blood vessels andNerves1.As the number of people with diabetes grows worldwide the disease takes an ever-increasingproportion of national health care budget. Without primary prevention, the diabetes epidemicwill continue to grow. Even worse, diabetes is projected to become one of the world’s maindisablers and killers within the next twenty-five years. Immediate action is needed to stem thetide of diabetes and to introduce cost effective treatment strategies to reverse this trend2.DM is a chronic disease that affects approximately 14 million people and among those 14million, 7 million were un-diagnosed. Among older people (>65 years) 86% had type-II DM.Type-I DM approximately account for 10% and type-II 85-90% of all known cases of DM inUnited States2.There is rising prevalence of the disease in the developing countries, which was rare before, isdue to industrialization, Socio-economic development, and urbanization and changing life style3.Type-II DM is more prevalent than type-I DM and constitutes nearly 90% of cases among thediabetes2. The prevalence of diabetes increases with age. The prevalence2 of type-II DM infemale was relatively lower (5.57%) than males (6.73%).The high incidence (new cases) of type-II DM in Nepal was found due to lack of publicawareness regarding the problems and poor medical service in country. From 28th oct.1997, to27th Oct. 1998, in Medical OPD of B.P. Koirala Institute of Health Sciences, 1840 patients (1040M & 800 F) attended with DM1 .The investigators had conducted the study on “ socio-demographic and knowledge profile amongthe diabetes patients admitted in medical units” and found the urgent need of an informationalbooklet on Nepali. Hence the investigators had conducted this study. The Objectives of this studyis to prepare an information booklet on Diabetes and to find out the effectiveness of it.Research Design and Methodology: Single group pre-test post-test quasi-experimental research design was implemented to conductthe study. The study was conducted among the admitted diagnosed cases of diabetes in medicalunits of BPKIHS. The purposive sampling technique was used to select 50 subjects, who fulfillthe set criteria. The admitted patients willing to participate in the study was only selected. Thepatients, who were unable to read, their relatives were involved in teaching session andexplanation on information booklet was given to client and their educated relatives. The contentsof the Information booklet are: Introduction of Diabetes, Types of Diabetes, Causes of Diabetes,Signs & Symptoms of Diabetes, Treatment of Diabetes, Effect of Diabetes, Important
Information for Patients, Information about food, Information abut exercise, Foot care, Eye care,Hypoglycemia, Sugar test, Insulin Injection, Regular examinations, Ketoacidosis, Social life,Situations to contact doctor, Information about traveling, Information about OHA, Myths andFacts about DM and References for further information.Interview schedule was used to collect the data. The content validity of the tool was establishedby consulting with the experts from the field of nursing education, nursing research, physician,dietician and psychologist. The practicability of the tool was established by pre-testing the tool.By using interview schedule in pre-test details of identification data, along with Socio-demographic profile was obtained. After pre-test, information booklet was given to the clientwith proper information and explanation. A minimum after 3 days of pre-test, the post-test wastaken. The difference in knowledge was assessed. Verbal consent was obtained from theconcerned authority. Before pre-test informed verbal consent was obtained from each subject.The collected data was analyzed using SPSS-4 package and presented in tables and graphs.Results:Majority of the subjects were of age more than 40 years (Mean=54.35, SD=13.19, andRange=24-80 years), Male (68%), and Hindu (96%). About 37% subjects were uneducated, 40%from sunsari district, 56% were from villages and 98%were married. Majority of the subjects(84%) were Non-vegetarians. About 60% subjects were suffering with diabetes for more than 5years and majorities were of type-II i.e.76%.About 8% subject has family history (brother and sister) of diabetes and 18% had positiveparental history. Majority of the subjects (72%) were on insulin therapy.Majority of the subjects (80%) reported that they found this type of booklet first time, which iseasily understandable (80%), covered appropriate contents (90%), recommend others to study(100%), and evaluated the booklet useful (96%).The details of the results are depicted in table: I-V.Discussion:Diabetes is a major non-communicable public health problem increasing rabidly in developingcountries including Nepal. Disease can only control hence self-motivation & knowledge tomanage the disease is essential. Majority of subjects (76% were suffering with type – II DM,and duration of illness is prolong i.e. 1-26 yrs. (mean =8 yrs). Eighty Percent Subjects reportedthat they got the chance of getting information from this type of booklet is first time, and is veryuseful. Various studies (conducted by smith 7, funnel 8, Bruni9, and Pieffee 11) supported thefindings of this study. It generate scientific literature, Helpful for: doctors, nurses, students,diabetes clients and general public and also Aid in prevention & care of diabetes.
Recommendations: A similar study can be conducted among the diabetes clients in OPDsand in community will be more useful. Use of Videotapes and slide tapes for diabetes educationwill be more effective. One to one counseling, Skill training, and diabetes content sessions areeffective methods of diabetes education.Limitations of the study: The diagnosed diabetes client’s admitted in medical units during thedata collection period of 8 weeks were included in the study. Only 50 subjects were purposivelyselected for the study. Preparing booklet on Nepali language is difficult as many English termshave not exact Nepali Meaning. It was difficult to grade the facilities available with the subjectsand to recall the past events. It is also difficult to measure the quantitative form exactly.Measurement of individual differences found difficult to grade.References:1. Roman PG, Maitra S. A comparative study of oral glucose tolerance test and Glycated hemoglobin in high-risk patients for diabetes mellitus. INT.J. DIAB.DEV. Countries 2000; (1) 23-28.2. Mehta RS, Karki P, Sharma SK. Socio-demographic and knowledge profile among the diabetes clients admitted in medical units of BPKIHS. 2004.3. Karki P, Barel N, Lamsel M, Rijals, Koner BC, Dhungel S, and Koirala S. prevalence of NIDDM in urban areas of Eastern Nepal: A hospital based study. South East Asia J Trop. MED. Public health .2000; 31 (1): 163-166.4. Bruni B, Barbero PL, carlimim etal. Principles, means and evaluation of a programme for diabetes education Ann. Osp. Maria. Vifforia torino. 1981 JAN-JUN; 24 (1-6); 43-74.5. Nova Nordisk Education Foundation Consensus guidelines – Minimum basic care for persons with DM. INT.J.DIAB. DEV. Countries 2000; 20 (1): 1-7.6. Kapur A, Jorgensen LN. Diabcare Asia study- comparative status of current Diabetes cares in Asia. Nova Nordisk diabetes update. 2001; 3-13.7. Smith DM, Norton JA, weinberger M, Mc Donald C2, Kat2 BP. Increasing prescribed office visits: A controlled trial in patients with diabetes mellitus. Med. Care. 1986, mar; 24 (3): 189-99.8. Funnel MM, Donnelly MB, anclerson RM, Johnson PD, Oh MS. Perceived effectiveness, cost, and availability of patient education methods and materials. Diabetes education 1992 MAR-APR; 18 (2): 139-45.9. Svoren BM, Butter D, Levine BS etal. Reducing acute adverse outcomes in youths with type- I diabetes: a randomized controlled trial. Evi. Based Nurs. 2004. APR. 7 (2): 42.10. Pietfe JD, weinberger M, creamer FB etal. Impact of automated calls with nurse follow-up on diabetes treatment outcomes in a department of veterans affairs health care system: a randomized controlled trial. Diabetes care. 2001 feb; 24 (2): 202-8.11. Berg AO. Screening for type-2 diabetes mellitus in adults: recommendations and rationale. American Journal of Nursing (AJN). Mar 2004, 104 (3): 83-89. 12. Christian medical association of India, New Delhi, health dialogues. Issue no. 37, April-June 2004. 13. Soundarya M, Asha A, Mohan V. roles of a Diabetes educator in the management of Diabetes. Ibt. J. DIAB. DEV. Countries. 2004, m4: 65-74.14. Susan L, Michael m, Venkat KM. Effectiveness of self-management training in type-2 Diabetes. Diabetes care. 2001;24(3):362-7.
Table – I Age and sex distribution of the subjects N=50S. N. Item/particular Percentage (%)1. Age group (In years): < 40 14 40-50 18 51-60 27 61-70 25 71-80 14 > 80 2 Mean 54.35 SD 13.19 Range 24-802. Sex Male 68 Female 32 Table – II Frequency of Admission and duration of the disease N=50S. N. Item / Particular Percentage (%)1. Frequency of admission 1st Time 52 2nd Time 22 3rd Time 18 >3 Time 8 Mean 2.10 SD 2.05 Range 1-122. Duration of disease (In years) <5 40 5-10 28 11-15 20 16-20 4 >20 8 Mean 8 SD 6.34 Range 1-26
Table – III Distribution Of Subjects According To The Known Risk Factors N=50 Percentage (%)S. N. Item /Particular1. Family history (brother/sister) of diabetes a. Present (yes) 8 b. No/ not sure 922. Parents with diabetes a. Present (yes) 18 b. No/ not sure 823. Birth of large baby (Wt.> 35kg) (only female Pt., N=16) a. Yes (H/O large baby) 6.25 b. No 62.5 c. Not sure 31.254. H/O using oral contraceptives (only female Pt., N=16) a. Yes 12.5 b. No/not used 87.55. History of having following Habits a. Tobacco chewing 50 b. Betel chewing 34 c. Guttca chewing 20 d. Smoking (Bidi/Hukka, cigarette etc) 60 e. Alcohol consumption 446. Life style a. Heavy physical worker (farmer/labor) 34 b. Office worker 16 c. Sedentary life style 40 d. Others 107. Obesity (H/W ratio) a. Present (yes) 28 b. Not present (no) 728. History of stress (eg. surgery/trauma/others etc) a. Present (yes) 28 b. Not present (no) 72
Table – IVDistribution Of Subjects According To The Treatment Or Therapies N=50S. N. Item /particular Treatment/therapies (%)1. Oral hypoglycemic agent (OHA) 222. Insulin 723. Diabetic diet 804. Weigh loss therapy 305. Quit smoking 506. Herbal /traditional remedy 10 Table – V Evaluation of the information booklet on diabetes N=50S. N. Item/particular Percentage (%)1. Studied this type of booklet earlier a. Yes (studied) 20 b. No (not studied) 802. Understanding level of this booklet a. Easily understandable 80 b. Understandable with little difficulty 20 c. Not understandable 03. Content covered a. Very appropriate 54 b. Appropriate 36 c. All right 10 d. Not appropriate 0