Bridging the gap between health education and lifestyle practices in Maltese diabetic adults : identifying target groups and areas

Abstract

This study was carried out among type 1 and type 2 adult diabetic patients attending Mater Dei, Mosta and Floriana diabetes clinics. It measures diabetes knowledge, diabetes-related distress and self-care, the relationship between these three parameters and factors influencing them. The study was carried out between October 2008 and February 2009. The study population was obtained through a sequential sample of 356 patients, 257 from Mater Dei Hospital, 39 from Floriana Health Centre and 60 from Mosta Health Centre. Patients were recruited on the day of their follow-up visit at one of the clinics, informed consent was obtained and details were extracted from the patient file. Patients were contacted at a later date to carry out a telephone interview. Of those eligible to participate, 313 responded, giving a response rate of 89.7%. The questionnaire administered collected Socio-demographic data and diabetes-related data. In addition, it contained three validated tools, namely the Michigan Diabetes Research Centre's Diabetes Knowledge Test to assess knowledge about Diabetes, the Joslin Diabetes Centre's Problem Areas in Diabetes questionnaire assessing diabetes-specific emotional distress, and the Self-Care Inventory - revised developed by the University of Miami to assess the patients' perceived level of self-care. The study has been approved by the University of Malta Research Ethics Committee, the data controllers of Mater Dei Hospital and Primary Health Care and the Head of Department of the Mater Dei Diabetes Clinic. Results revealed the mean diabetes knowledge score to be 50.23%. Diabetes-related distress was generally low (mean score 26.6%). Adherence to self-care was generally good (mean score 66.6%). Diabetes knowledge correlated positively with the

self-care score, but not with diabetes-related distress. Although diabetes-related distress was found to correlate negatively with the diet and positively with the hypoglycaemia care and general prevention self-care sub-scores, there was no correlation with the total self-care score. While most results were in agreement with international studies, important factors influencing these three aspects of diabetes were identified. Age was found to be significantly associated with diabetes knowledge, as well as diabetes-related distress, while gender, body mass index and a family history of diabetes also influenced the latter factor. On the other hand, self-care was found to have a significant relation with the level of education and the type of diabetic medication one was taking. These results allow for the inception of recommendations for action, including self-care training programmes geared towards at risk groups, such as the elderly and those with poor education, providing psychological support to vulnerable patient groups, and increasing the importance given to self-care in the patient's management, both on a personal level and during interactions with healthcare professionals.