Research

1. 1/31/2020 1
 BEKA ABERRA (MD, INTERNAL MEDICINE RESIDENT)
 ADVISOR(S): YARED ASMARE (MD, CONSULTANT INTERNIST, ASSISTANT
PROFESSOR)
GETACHEW TILAHUN (MPH, LECTURER) 1/31/2020
1

2. INTRODUCTION
STATEMENT OF THE PROBLEM
SIGNIFICANCE OF THE STUDY
LITERATURE REVIEW
OBJECTIVES
METHODOLOGY
REFERENCES
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3.  DM is the commonest of all metabolic diseases all over the world. There are three
main types of diabetes these are Type 1, Type 2 & Gestational diabetes.[1]
 Diabetes mellitus is a major and growing health problem affecting more than 425
million people worldwide, or 8.8% of adults 20-79 years, are estimated to have
diabetes. The number of people with diabetes increases to 451 million if the age is
expanded to 18-99 years. [1]
 About 79% live in low and middle income countries. If these trends continue, by
2045, 629 million of people 20-79 years or 693 million people 18-99 years.
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4.  The burden of diabetes is increasing in the worldwide including developing
countries like Ethiopia. International diabetic federation association 2017
reported Ethiopia to be ranked 1st in Africa with 2.6 million people with diabetes
and prevalence of 5.2 %, and estimated to reach 14.1 million people with IGT by
2045. [2]
 The management of diabetes mellitus (DM) largely depends on patients’ ability to
self-care in their daily lives, and therefore, patient education is always considered
an essential element of DM management. [3]
 Active patient participation in the management of the disease condition and self-
monitoring of the physiological processes is known as Self-Management Education
(SME). [4]
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5. • Obtaining information about the level of awareness about diabetes in a population
is the first step in formulating a prevention program for diabetes complications.[7,8]
• Studies have consistently shown that improved glycemic control reduces the rate
of complications and evidence suggests that patients, who are knowledgeable
about DM self-care, have better long term glycemic control.
• Diabetes education, with consequent improvement in knowledge, attitudes and
skills, leads to better control of the disease, and is widely accepted to be an
integral part of comprehensive diabetes care. [7,8]
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6.  Diabetes is a significant humanitarian and economic burden worldwide. [10]
 Behavior modification through interventional programs is essential to address the
burden of T2DM complication, and behaviors related to healthy eating habits,
physical exercise, regular blood glucose monitoring and medication adherence are
especially important, but knowledge relating to healthy eating habits, physical
activity, has been found to be insufficient, despite the fact that it is critical in the
management of patients with DM. [13,14]
 There needs to be an understanding of the level of knowledge, attitude and
practice of our patients with regards to diabetes and the associated factors, for
better control of their disease progression.
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7.  Because of the effect of education on the quality of life of patients, it is important
for health care workers to better their understanding of patients’ beliefs, thoughts
and feelings that may support or hamper self-management efforts,
 This Gaps need to be identified and addressed before embarking on behavioral
interventions that is necessary to manage DM.
 Finally, SPHMMC can use this result as a foundation for improving its services
for diabetic patients with regards to implementing a standardized diabetic
education program.
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8.  Proceeding from International studies to Local studies with regards to KAP of
diabetic patients was dismal.
 INDIA : Manipal Teaching hospital; 182 Patients; Knowledge score was 4.90±3.34;
attitude 2.03 ± 0.95 and practice 0.84±0.76, with maximum possible scores for
knowledge, attitude and practice patient being 18, 4 and 3 respectively. The KAP
scores of the patients were low. This suggests the need for educational
interventions to improve the knowledge, attitude and practices of the diabetes
patients.(15)
 PAKISTAN : Shaikh Zayed Hospital; 250 Patients; Among the study participants,
the levels of knowledge were low in 46%, medium in 39% and high in 63%. The
levels of attitude were also described accordingly as low 8%, medium 32% and
high 60%. The levels of practice of study subjects will be found to be low in 78%,
medium in 15% and high in 7%. (14)
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9.  MALAYSIA : There was a strong association between knowledge and attitude as
well as knowledge and practice (P<0.05). The mean (± standard deviation (SD)
knowledge score was 11.85 ± 2.45; attitude 3.36 ± 1.29 and practice 4.39 ± 1.36,
with the maximum possible scores for knowledge, attitude and practice being 14, 5
and 6 respectively. (16)
 IRAN : Golestan Hospital; 100 Patients; The overall mean (± SD) score of the
knowledge, attitude and practice of patients based on KAP questionnaire was in
medium level. (17)
 BANGLADESH : 202 Patients; Glycemic control was poor among 46.67% of
respondents and 62.38% patients never performed self-blood sugar test due to lack
of knowledge or lack of the feeling of necessity to do it. (19)
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10.  QATAR : Hamad Medical Corporation healthcare facilities; 300 Patients; Study
participants had variable knowledge of diabetes, its complications and risk
factors, and services available to diabetics. More comprehensive education and
awareness about diabetes is recommended for both patients and family members.
At the provider level, further improvement in patient counseling and promotion of
available services can be beneficial. (20)
 EGYPT : 3 family health centers in Dakahlia; The overall rate of adequate
knowledge regarding diabetes was only 52.3% among participants. Insulin-treated
patients had lowest knowledge, attitude, and practice toward diabetes. There is a
gap between patients' level of knowledge and their practice.(21)
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11.  NIGERIA : Adeoyo General Hospital; 200 Patients; Overall, 47 (26.9%) had a good
knowledge and attitude about diabetes.(6)
 SOUTH AFRICA :12 community health centers and 10 primary health care clinics
in the five districts in the Free State; 255 Patients; poor knowledge, a negative
attitude and poor practices related to diabetes, were observed in a high percentage
of the participants included in this study. (10)
 KENYA : Kenyatta National Hospital; 198 Patients; One hundred and thirty-four
patients (67.7%) had heard of the HbA1C test while 64 patients (32.3%) had never
heard of the test. Forty patients (20.2%) had at one point done the test while 158
(79.8%) had never done the test. .(22)
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12.  BALE : 605 non diabetic community members; About 52.5% of participants were
knowledgeable, 55.9% and 56.6% had good attitude and practice respectively.
Considerable limited knowledge, attitude and practices were seen. A great
emphasis on health education regarding symptoms and risk factors modification
for diabetes are necessary.(25)
 BAHIRDAR : FelegeHiwot hospital; 410 Patients; Half (49.8%) of them had good
knowledge and one hundred fifty-four (36.8%) participants had good practice on
diabetes, lower age was significantly associated with good knowledge and practice;
higher educational status was also associated with good knowledge and practice.
Increased duration of diabetic therapy was positively associated with good
knowledge and practice. Increased level of income was positively associated with
good practice. (12)
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13.  ADAMA : Adama Medical College Hospital; 116 Patients; LSM management of
diabetic; majority of the patients will be knowledgeable which accounts
90(77.59%), regarding attitude of the patients 95(81.89%) patients had positive
attitude and almost half of the patients 57(49.1%) had good practice. (23)
 GONDAR: University of Gondar Hospital ; 403 Patients; Of the total, 250 (62%)
had good knowledge, 271 (67.2%) had a good attitude, and 300 (74.4%) had good
practice towards glycemic control. In multivariate logistic regression, occupational
status and marital status were significantly associated with the knowledge of
participants towards glycemic control. Occupational status, educational status,
and marital status were significantly associated with attitude and practice
towards glycemic control. (24)
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14. 1/31/2020 14
Conceptual Framework (26)

15. General
 To assess the level of knowledge, attitude and practice of diabetes mellitus and
associated factors among diabetic patients at Hospital.
Specific
 To determine level of knowledge regarding diabetes among diabetic people
 To determine attitude of diabetic patients towards diabetes mellitus
 To determine practice of diabetic people on diabetes mellitus
 To identify factors associated with knowledge of diabetes mellitus
 To identify factors associated with attitude of diabetes mellitus
 To identify factors associated with practice on diabetes mellitus
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16. Study Area / Period
 This study will be conducted at diabetic follow up clinic in SPHMMC. SPHMMC is one of the
two biggest specialized referral hospitals in Addis Ababa and in the country at large.
 The study will be conducted from March 1 to June 30, 2020.
Study Design
 A hospital based cross-sectional study design will be used for this study.
Source Population
 All adult patients visiting the diabetic clinic who are diagnosed to have diabetes and on
follow up.
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17. 1/31/2020 17
Study Population
 All adult diabetic patients having follow up during the study period who fulfill
the inclusion criteria.
Inclusion Criteria
 All diabetic patients aged ≥ 18 years and have been diabetic for the last one year
will be included in the study.
Exclusion Criteria
 Patients who will be severely ill, pregnant women [to exclude GDM] and not able
to communicate will be excluded from the study.

18. The required sample size was calculated:
 49 % Proportion (P) of knowledge prevalence from similar study conducted in Bahir
Dare. [12] ; 95% Confidence Level; Marginal of error (d) = 5%; Non-response rate= 10%
 The formula for calculating the sample size (n) was: n= (Zα/2) 2 P x (1-P)/d2
 From the estimated, diabetic patients will be 1316 according to HMIS report.
 Since diabetic patients having follow up at SPHMMC is less than 10000 we use
reduction formula n/(1+n/N) = 297 + 29 (10 % Non-response rate) =*326
 Using systematic random sampling by taking every 4th patient after selection of
the first patient from the sampling frame.
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19. Dependent Variables
 Knowledge of diabetic patients regarding
Diabetes Mellitus
 Attitude of diabetic patients regarding
Diabetes Mellitus
 Practice of diabetic patients regarding
Diabetes Mellitus
Independent Variables
Socio-demographic variables
 Age
 Sex
 Income,
 Marital status,
 Educational level,
 Occupation,
 Duration of therapy
Health profile related variables of
diabetics Patients
 Type of medication used,
 Complications,
 Co-morbidity,
 Type of diabetic
 Laboratory tests
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20.  Primary data obtained by administering modified structured questionnaire to
patients. (27)
 Research Proposal DefenseResearch Proposal Draft[33].docx
 Prepared by reviewing different literatures and undertaking modifications for the
population being studied.
 Modified further after a pre-test; will be translated to local language
 Questionnaire will have five parts.
 The first part contained socio- demographic variables.
 The second/ third/ fourth part consist of knowledge, attitude and practice questions.
 The fifth part consist of clinical data and other laboratory tests which will be retrieved
from medical records.
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21.  A scoring system was developed for each knowledge attitude and practice
questions.
 The knowledge part of the questionnaire has 10 general questions on diabetes
with the maximum of 30 correct responses. The attitude and practical part of the
questionnaire have 11 and 10 questions based on diabetes self-care, with a
maximum of 11 and10 correct responses respectively. Each correct answer will be
given a score of one and each wrong answer will be given a score of zero.
 Data will be collected by the researcher and data collectors.
 Data collectors will be trained about the contents of the interview and to collect
the data in a compassionate and accurate manner.
 Each paper will be checked for completeness.
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22.  Data will be entered and cleaned using EPi-info version 3.5.3 statistical software
and then transferred to SPSS version 21 Statistical software for further analysis.
 Frequencies and cross tabulations will be used to summarize descriptive statistics
of the data and tables and graphs will be used for data presentation.
 Bivariate logistic regression analysis will be used to check variables association
with dependent variable individually. Variables found to have association with the
dependent variable (p-value up to 0.2) will then be entered in to multiple logistic
regression models for further analysis and Hosmer and Lemeshow’s goodness-of-
fit test will be done and variables having P- value of less than 0.05 will be
considered as significantly associated with the dependent variable.
 The degree of association between dependent and independent variables will be
expressed by using odds ratio with 95% confidence interval.
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23.  Always: Monitoring blood glucose every day or 3 times per week.
 Frequently: Monitoring blood glucose 2 days per week.
 Good knowledge: when patients respond the mean or above the mean score on knowledge questions.
 Good practice: when patients respond the mean or above the mean score on practice questions.
 Good glycemic control: when HbA1-c results become less than 6.5%.
 Negative attitude: when patients respond below the mean score on attitude questions.
 Not at all: Monitoring blood glucose not regularly.
 Occasional: Monitoring blood glucose once or 3 times per month.
 Poor knowledge: when patients respond below the mean score on knowledge questions.
 Positive attitude: when patients respond the mean or above the mean score on attitude questions.
 Poor practice: when patients respond below the mean score on practice questions.
 Poor glycemic control: when HbA1-c results become greater than or equal to 6.5%.
 Some times: Monitoring blood glucose every 2 weeks.
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24. ETHICAL CONSIDERATION
 Permission will be obtained from SPHMMC research office and institutional
review board.
 Informed written consent will be obtained from each participant after careful
clarification of the aim and significance of the study.
 Every participant will be given chance to deliberate on their rights to participate,
refuse, or withdraw at any time they wish to do so.
 To ensure confidentiality, the name of respondents will not be written in the
questionnaires.
DISSEMINATION OF RESULTS
 The result of this study will be presented on scientific conferences. The study
result will be shared with stakeholders. The manuscript will also be sent to local
and international journals for possible publication.
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25. 1/31/2020 25
Activity Responsible
Person
Month
July Aug Sep Dec Jan Feb Mar Apr May Jun Jul Aug Sep
Prepare research proposal investigator
Proposal approval and
ethical clearance
Research office
Collect data Investigator and
data collectors
Compile and assure
completeness of data
Investigator
Data analysis and
interpretation
Investigators
Write and submit report Investigators
Paper evaluation by
concerned bodies
Research office
Present results Investigators

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