Satisfaction and compliance to recommended management practices among type 2 diabetes patients in Morogoro Municipality, Tanzania
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Date
2024-05
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Sokoine University of Agriculture
Abstract
The prevalence of type 2 diabetes mellitus has been increasing
primarily due to the rising of risk factors such as sedentary lifestyles and
unhealthy eating habits, resulting to overweight and obesity. Diabetes-
related complications are the major causes of morbidity and mortality
among people with type 2 diabetes mellitus. Changes in lifestyles and
dietary patterns are essential for the management of type 2 diabetes
mellitus, including regular physical exercises, smoking cessation,
weight management, and diet control, which help to mitigate the long-
term effects of diabetes. Patient counseling has been identified as an
important means to enhance patients' knowledge about risk factors,
lifestyle modifications, and diabetes-related complications, which can
influence adherence to recommended management practices. Little is
known on counselling practices, satisfaction of diabetes related health
care services received and adherence to recommended prevention and
management practices among type 2 diabetes patients. Thus, the
present study aimed to evaluate counseling practices, challenges and
satisfaction with the services provided among type 2 diabetes patients.
It also assessed compliance to recommended management practices
for prevention and management of the disease related complications in
selected health facilities in Morogoro Municipality, Tanzania. A hospital-
based cross-sectional study was conducted from February to May 2023
among 140 patients, including those diagnosed with type 2 diabetes for
at least 3 months and receiving healthcare services in selected diabetes
clinics. Two health facilities with diabetes clinics which are Sabasaba
Health Centre and Morogoro Regional Referral Hospital, were
purposively selected to represent public health facilities with diabetes
clinics. Data were collected through face-to-face interviews using a
structured questionnaire that included patients' characteristics.
Additionally, a previously validated Summary of Diabetes Self-care
Activities questionnaire was used to assess patients' compliance with
recommended prevention and management practices, and a Diabetes
Clinic Satisfaction Questionnaire was used to assess services
satisfaction. Data were analysed using Statistical Package for Service
Solutions, version 25. Descriptive statistics and appropriate significance
tests such as mean, frequencies, percent and standard deviations (SD) were obtained. Multivariable logistic regression analysis was employed
to identify factors influencing services satisfaction and those that are
associated with compliance with recommended prevention and
management practices. The study commenced after receiving ethical
approval from National Health Research Committee of the National
Institute for Medical Research. Permission to conduct this study was
also sought from the President's Office Regional Authority and Local
Government, as well as the respective regional, district, and health
facility authorities. The mean age of the respondents was 59±12 years,
with 65% (n=91) being females, and 62% (n=87) having completed
primary-level education. Almost all respondents 96% (n=135)
acknowledged receiving advice on medication and healthy diet. Advice
on adopting a healthy lifestyle was not mandatory, with approximately
one in four respondents never having received counseling on either
alcohol intake or tobacco use. Nearly half of the respondents (49%,
n=68) expressed satisfaction with the services offered. There was a
significant association between patient satisfaction and the duration of
living with type 2 diabetes mellitus (AOR 2.2, 95% CI: 1.1-4.4), marital
status (AOR 2.1, 95% CI: 1.2-4.8), and waiting time to receive services
in the healthy facility (AOR 0.76, 95% CI: 0.6-0.9). Diabetes services
were mostly limited to large patient-load and shortage of trained
healthcare providers, private space and time, as well as lack of
guidelines and protocol for counseling. Findings also revealed that
among the 140 patients, 91.4% (n=128) exhibited poor or unsatisfactory
self-care practices, with an overall mean of 3.81±2.08 days per week for
diabetes management. Self-care practices with good or satisfactory
performance included non-smoking, not drinking alcohol, and using
prescribed medication, while unsatisfactory performance was observed
on the practices of self-monitoring of blood glucose and physical
activity. Multiple regression analysis indicated that having co-morbidities
(AOR 4.5, 95% CI: 1.14-18.02) and being employed (AOR 4.4, 95% CI:
1.25-15.44) were independently predictive of adherence to self-care
practices. Generally, this study shows moderate satisfaction with
counseling practices and services, as well as poor compliance to
recommended prevention for complications and management practices.
Self-monitoring of blood glucose, physical exercise, and dietary
practices were the least practiced aspects, which could potentially increase the risk of complications among patients with type 2 diabetes.
The government through the Ministry of Health and other stakeholders
should ensure the formulation of clear protocol and guidelines for
counseling and diabetes prevention and management. It is further
suggested that recommended practices should be integrated into
existing healthcare systems to ensure that they become a routine part
of care.
Description
MSc Dissertation
Keywords
management practices, diabetes patient, Morogoro Municipality, Tanzania