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Knowledge and perceptions of diabetes in a semi-urban Omani population

Mohammed A Al Shafaee,¹ Sulaiman Al-Shukaili,¹ Syed Gauher A Rizvi,¹ Yahya Al Farsi,¹ Mushtaq A Khan,¹ Shyam S Ganguly,¹ Mustafa Afifi,² and Samir Al Adawi³

¹Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Oman

²Department of Non-Communicable Diseases, Ministry of Health (HQ), Oman

³Department of Behavioural Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Oman

Background

¹ Diabetes mellitus (DM) continues to be a major threat to global public health (Abegunde, Mathers, Adam, Ortegon & Strong, 2007; Hjelm, Mufunda, Nambozi & Kemp, 2003). More than 170 million people worldwide have diabetes, and this figure is projected to more than double by the year 2030, if current trends continue (Wild, Roglic, Green, Sicree & King, 2004). The global increase in diabetes is triggered by many factors, including the ageing population, unhealthy diet and sedentary lifestyle that increase the chances of obesity. In the industrialized countries of the West, diabetes is common among the elderly, in contrast with developing countries where diabetes most frequently affects those between the ages of 35 and 64 (Diabetes Action Now, 2004). In some countries, DM also frequently occurs among youth (Rosenbloom, Joe, Young & Winter, 1999).

² There is growing evidence that preventing and/or delaying diabetes is possible (Chiasson, 2007; Zinman, Harris, Gerstein, Young, Raboud, Neuman & Hanley, 2006). Increased physical activity, weight reduction, increasing public education and medication can decrease the rate of diabetes complications, even among high-risk groups. Basic lifestyle changes, such as a healthy diet that includes reducing sugar intake, are essential for the prevention and control of diabetes mellitus (Tuomilehto, Lindström, Eriksson, Valle, Hämäläinen, Ilanne-Parikka, Keinänen-Kiukaanniemi, Laakso, Louheranta, Rastas, Salminen & Uusitupa, 2001; Knowler, Barrett-Connor, Fowler, Hamman, Lachin, Walker & Nathan, 2002; American Diabetes Association and National Institute of Diabetes, 2002).

³ The prevalence of diabetes in the Sultanate of Oman in 2000, as revealed by the 2000 National Health Survey, was 11.6%, compared with 8.3% in 1991, which is an increase of 40% over a single decade (Diabetes Mellitus Management, 2003). Additional increases in diabetes prevalence are likely because of projected changes in overall population growth, changes in dietary habits, and increasing numbers of people who are overweight, obese, or less physically active. Higher prevalence rates of diabetes have been identified in more urbanized areas of the country (18%) in comparison with more rural areas (11%) (Al-Moosa, Allin, Jemiai, Al-Lawati & Mossialos, 2006).

⁴ Many medical problems are in fact more about changing individual and social attitudes and behaviors (Al-Adawi, 2006). Many health promotion strategies have had little success because of attitudes and lack of knowledge about medical problems (Hjelm, Bard, Nyberg & Apelqvist, 2003). Various recent studies conducted in many parts of the world suggest that there is a lack of public awareness and knowledge of several factors related to diabetes (Gunay, Ulusel, Velipasaoglu, Unal, Ucku & Ozgener, 2006; Angeles-Llerenas, Carbajal-Sánchez, Allen, Zamora-Muñoz & Lazcano-Ponce, 2005; Murugesan, Snehalatha, Shobhana, Roglic & Ramachandran, 2007). This study aims to evaluate the level of knowledge and overall perceptions of diabetes within the general population of Oman.

Methods

Study population

⁵ This study was carried out in two semi-urban villages. As part of the Village Health Care Course, provided by the College of Medicine and Health Sciences at Sultan Qaboos University, two villages Al Rumais and Al-Shuaiba, located 60 km and 80 km north of the University, were selected to carry out this study. These two semi-urban villages are next to the capital city of Muscat, Oman. The demographics of these two villages are similar to the Omani population (Al-Moosa et al, 2006). A total of 563 eligible adults were interviewed, with a response rate of 89.6%.

Measurement

⁶ The final survey instrument contained 24 items, subdivided into 5 sections. The first two sections included questions on participant demographics and medical history. The third section was for diabetic participants. The fourth section examined knowledge regarding diabetes definition, risk factors, signs and symptoms, and complications. The last section focused on the risk of developing diabetes, as well as the participant's knowledge regarding diabetes prevalence and prevention. The questionnaire was pre-tested and piloted with students and staff at the College of Medicine and Health Sciences at Sultan Qaboos University.

Results

⁷ A total of 563 individuals were surveyed. Overall, 86.1% of the subjects were below the age of 50 years and about 46% had studied up to high school or college levels.

Meaning of diabetes and symptoms

⁸ Three hundred and twenty subjects (56.8%) reported that they were aware of the meaning of the condition called diabetes. However, when asked to define it, only 262 subjects (46.5%) were able to give at least a basic definition.

Rates of awareness regarding important diabetes risk

⁹ About 59.9% perceived high consumption of dietary sugar as an important risk factor for developing diabetes. Only 29.5%, 20.8% and 16.9% perceived obesity, physical inactivity and positive family history, respectively, as risk factors for diabetes.

Awareness of diabetes as a serious condition

¹⁰ Only 55.1% of the sample knew that diabetes is a condition that, if uncontrolled, can produce lifelong complications affecting different organs of the body. Visual problems were identified as complications by 24.3% of the subjects, followed by heart disease (20.4%), kidney disease (17.9%), and stroke (9.4%).

Preventing Diabetes

¹¹ 63.1% reported that diabetes can be prevented by modifying dietary habits, and 42.3% felt that diabetes can be prevented by increasing physical activity; however, only 17.9% felt that avoiding obesity and reducing weight play important roles in the prevention of diabetes. Approximately 78.9% of the study sample perceived diabetes as a preventable condition.

Discussion

¹² Oman has been successful in reducing the rate of communicable diseases and increasing the standard of life among its people. Rapid cultural changes and social advances since 1970 have led to a wide range of non-communicable diseases. High prevalence rates for diabetes (11.6%) and obesity (20.5%) exist in the Omani population (Al-Lawati, Mohammed, Al-Hinai & Jousilahti, 2003). Health promotion is seen as an essential component of any strategy aimed at diabetes control and prevention.

¹³ In this study, we surveyed a semi-urban population of Oman regarding its level of knowledge and overall perceptions of diabetes. The data are somewhat discouraging. Over half of the subjects (53.5%) were unable to provide even a rudimentary definition of diabetes, though they might be aware of its existence or have some idea about its symptoms. The failure to define diabetes and recognize its symptoms may reflect the general public's significant lack of knowledge about diabetes. This is likely to have negative consequences, in terms of trying to control and prevent diabetes.

¹⁴ It is widely understood that excessive sugar intake is a risk factor for incident diabetes mellitus (Johnson, Segal, Sautin, Nakagawa, Feig, Kang, Gersch, Benner & Sánchez-Lozada, 2007). Recent affluence in Oman has resulted in significant changes in dietary habits, which includes an increased likelihood of excessive sugar intake. Approximately 60% of those surveyed perceived high consumption of dietary sugar as an important risk factor for developing diabetes. However, studies have consistently shown that there is a mismatch between one's attitudes and behaviors (Hjelm, Bard, Nyberg & Apelqvist, 2007). Therefore, it is not yet known if knowledge of the harmful effects of excessive sugar intake will cause Omanis to reduce their excessive sugar intake.

¹⁵ The present study shows that one's level of education has a direct influence on one's level of knowledge regarding the definition, symptoms, risk factors and complications of, and preventative measures against diabetes. This suggests that knowledge about diabetes is beneficial for health education. In addition to education, a family history of diabetes also appears to influence one's level of knowledge and perceptions of diabetes. Individuals with a positive family history of a disease may develop a personal sense of vulnerability which may increase their awareness, as was revealed in the present study (Walter, Emery, Braithwaite & Marteau, 2004).

Conclusion

¹⁶ The central objectives in this research were (1) to evaluate general population knowledge and perceptions of diabetes, and (2) to determine the relationships that exist between the various components of knowledge and socio-demographic background in a semi-urban community in Oman. This study has shown that significant numbers of Omanis lack the knowledge and perceptions required to prevent and control the increasing prevalence of diabetes in Oman. On the bright side, the study shows that health education is essential as it could be a powerful tool for those developing strategies to fight diabetes and other similar diseases.

Abridged References

Abegunde D., Mathers C., Adam T., Ortegon M. & Strong K. (2007). The burden and costs of chronic diseases in low-income and middle-income countries. Lancet, 370,1929– 1938. doi: 10.1016/S0140-6736(07)61696-1.

Diabetes Action Now. An Initiative of the World Health Organization and the International Diabetes Federation. WHO library cataloguing-in-publication data. Geneva, WHO; 2004.

Hjelm K., Mufunda E., Nambozi G., Kemp J. (2003). Preparing nurses to face the pandemic of diabetes mellitus: a literature review. J Adv Nurs, 41, 424–434. doi: 10.1046/j.1365- 2648.2003.02548.x

Rosenbloom A., Joe J., Young R., Winter W. (1999). Emerging epidemic of type 2 diabetes in youth. Diabetes Care, 22, 345–354. doi: 10.2337/diacare.22.2.345.

Wild S., Roglic G., Green A., Sicree R., King H. (2004). Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care, 27, 1047–1053. doi: 10.2337/diacare.27.5.1047.

All the references are available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2517595/