Knowledge and attitude about diabetes self-care of older adults in primary health care

Borba, Anna Karla de Oliveira Tito; Arruda, Ilma Kruze Grande; Marques, Ana Paula de Oliveira; Leal, Márcia Carréra Campos; Diniz, Alcides da Silva

doi:10.1590/1413-81232018241.35052016

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Article • Ciênc. saúde colet. 24 (1) • Jan 2019 • https://doi.org/10.1590/1413-81232018241.35052016 copy

Knowledge and attitude about diabetes self-care of older adults in primary health care

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This study aimed to assess the knowledge about diabetes, the attitude for self-care and associated factors through a cross-sectional study, the baseline of a randomized clinical trial with elderly diabetic in primary health care in Recife, Northeastern Brazil. We used the Diabetes Knowledge Scale (DKN-A) and Diabetes Attitudes Questionnaire (ATT-19). Of the 202 elderly, 77.7% had insufficient knowledge of the disease, especially for ketonuria, food replacement and were unaware of the causes and care of hypoglycemia. As for attitude, 85.6% had a negative psychological adjustment for diabetes. The logistic regression model showed that living alone was a protective factor (OR = 0.24; 95% CI 0.09-0.65; OR = 0.22; 95% CI 0.07 to 0.71), and low education, a risk factor (OR = 7.78; 95% CI 3.36-18.01; OR = 13.05; 95% CI 4.63-36.82) for the insufficient knowledge and the negative attitude for self-care, respectively. The findings reinforce the need for interdisciplinary educational actions that include socioeconomic, psycho-emotional and educational aspects in diabetes management to maintain elderly autonomy and functionality.

Key words
Diabetes Mellitus; Elderly; Knowledge; attitudes; practice; Primary Health Care

Questions (n = 15)	Correct answers n (%)	Errors n(%)	Did not reply n(%)
1. Blood sugar is high in uncontrolled diabetes	136(67.3)	23(11.4)	43(21.3)
2. Poor diabetes control may result in a greater likelihood of complications later	110(54.5)	32(15.9)	60(29.7)
3. The normal blood glucose range is 70-110 mg / dL	135(66.8)	21(10.4)	46(22.8)
4. Butter is mainly composed of fat	121(59.9)	19(9.5)	62(30.7)
5. Rice is mainly composed of carbohydrates	67(33.2)	51(25.3)	84(41.6)
6. The presence of ketones in urine is a bad sign	40(19.8)	25(12.4)	137(67.8)
7. Changes in the lungs are not usually associated with diabetes	64(31.7)	64(31.7)	74(36.6)
8. If someone taking insulin has a high blood sugar or urine, as well as the presence of ketones, he/she should keep the same amount of insulin and the same diet, and have a blood and urine test	71(35.1)	65(32.2)	66(32.7)
9. If someone with diabetes is taking insulin and gets sick or cannot eat the prescribed diet he/she should use oral hypoglycemic for diabetes instead of insulin	7(3.5)	79(39.1)	116(57.4)
10. If hypoglycemia is starting, one should eat or drink something sweet immediately	78(38.6)	36(17.8)	88(43.6)
11. Someone with diabetes can eat as much lettuce and watercress as he/she wants	95(47.0)	65(32.2)	42(20.8)
12. Hypoglycemia is caused by excess insulin	23(11.4)	73(36.1)	106(52.5)
13. 1 kg corresponds to a unit weight and is equal to 1,000 grams	54(26.7)	49(24.3)	99(49.0)
14. 1 French bread equals 4 cream crackers; 1 egg is equal to 1 serving of ground meat	19(9.4)	89(44.1)	94(46.5)
15. Replacement of French bread with 4 cream crackers or 2 medium cheese breads	2(1.0)	157(77.7)	43(21.3)

Variable		Insufficient knowledge (< 8 points)
Variable		N (%)	n	%	p-value^* * Pearson's Chi-Square test p-value for proportions’ heterogeneity;
Gender
	Male	54(26.7)	42	77.8	0.991
	Female	148(73.3)	115	77.7
Age (years)
	60-69	132(65.3)	95	72.0	0.007
	≥ 70	70(34.7)	62	88.6
Marital status
	Married/common-law marriage	93(46.0)	74	79.6	0.423
	Single/divorced	44(21.8)	31	70.5
	Widower	65(32.2)	52	80.0
Household scheme
	Living alone	33(16.3)	20	60.6	0.010
	Living with someone	169(83.7)	137	81.1
Schooling (years)
	≤ 8	162(80.2)	140	86.4	<0.001
	> 8	40(19.8)	17	42.5
Economic class
	B	35(17.3)	21	60.0	0.003
	C	107(53.0)	82	76.6
	D and E	60(29.7)	54	90.0
DM diagnosis time
	Less than 10	102(50.5)	80	78.4	0.283
	10 \|- 20	60(29.7)	43	71.7
	20 and over	40(19.8)	34	85.0
DM complications
	Yes	160(79.2)	127	79.4	0.271
	No	42(20.8)	30	71.4
Tobacco use
	Yes	15(7.4)	13	86.7	0.529^ Fisher's Exact Test;
	No	187(92.6)	144	77.0
BMI
	No overweight	99(49.0)	78	78.8	0.721
	Overweight^* ***** BMI >27kg/m2.	103(51.0)	79	76.7
Glycated hemoglobin
	≤ 7%	155(78.7)	117	75.5	0.158
	> 7%	42(21.3)	36	85.7
Attitude for self-care
	Positive	173(85.6)	144	83.2	<0.001
	Negative	29(14.4)	13	44.8

Variables		Crude model			Adjusted model^* * Model adjusted for the variables: economic class, time of diagnosis of diabetes mellitus, complications of diabetes mellitus, glycated hemoglobin and attitude for self-care;
Variables		OR	(CI 95%)	p-value^ Pearson's Chi-Square Test.	OR	(CI 95%)	p-value
Age (years)
	60-69	0,33	(0,13 – 0,80)	0,007	0,33	(0,12 – 0,88)	0,027
	≥ 70	1,00	-		1,00	-
Household scheme
	Living alone	0,36	(0,15 – 0,86)	0,00	0,24	(0,09 – 0,65)	0,005
	Living with someone	1,00	-		1,00	-
Schooling (years)
	≤ 8	8,61	3,73 – 20,10	<0,001	7,78	(3,36 – 18,01)	< 0,001
	> 8	1,00	-		1,00	-

Variable		Negative attitude for self-care (< 70 points)
Variable		n(%)	n	%	p-value*
Gender
	Male	54(26.7)	43	79.6	0.141
	Female	148(73.3)	130	87.8
Age (years)
	60-69	132(65.3)	111	84.1	0.387
	≥ 70	70(34.7)	62	88.6
Marital status
	Married/common-law marriage	93(46.0)	82	88.2	0.074
	Single/divorced	44(21.8)	33	75.0
	Widower	65(32.2)	58	89.2
Household scheme
	Living alone	33(16.3)	23	69.7	0.011**
	Living with someone	169(83.7)	150	88.8
Schooling (years)
	≤ 8	162(80.2)	150	92.6	<0.001
	> 8	40(19.8)	23	57.5
Economic class
	B	35(17.3)	26	74.3	0.037
	C	107(53.0)	91	85.0
	D and E	60(29.7)	56	93.3
DM diagnosis time
	Less than 10	102(50.5)	88	86.3	0.210
	10 \|- 20	60(29.7)	48	80.0
	20 and over	40(19.8)	37	92.5
DM complications
	Yes	160(79.2)	134	83.8	0.134
	No	42(20.8)	39	92.9
Tobacco use
	Yes	15(7.4)	10	66.7	0.046**
	No	187(92.6)	163	87.2
BMI
	No overweight	99(49.0)	81	81.8	0.128
	Overweight***	103(51.0)	92	89.3
Glycated hemoglobin
	≤ 7%	155(78.7)	126	81.3	0.002
	> 7%	42(21.3)	42	100.0

Variables		Crude model			Adjusted model*
Variables		OR	(IC 95%)	p-valor**	OR	(IC 95%)	p-valor
Gender
	Male	0.54	(0.22 – 1.34)	0.141	0.32	(0.11 – 0.90)	0.030
	Female	1.00	-		1.00	-
Household scheme
	Living alone	0.29	(0.11 – 0.77)	0.011***	0.22	(0.07 – 0.71)	0.011
	Living with someone	1.00	-		1.00	-
Schooling (years)
	≤ 8	9.24	(3.62 – 23.93)	< 0.001	13.05	(4.63 – 36.82)	< 0.001
	> 8	1.00	-		1.00	-
Complications
	Yes	0.40	(0.09 – 1.48^a)	0.134	0.19	(0.04 – 0.87)	0.032
	No	1.00	-		1.00	-

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[1] Collaborations

AKOT Borba: design, implementation of the research, data analysis and interpretation, elaboration and critical review of the paper; IKG Arruda: design, data analysis and interpretation, and critical review of the paper; MCC Leal: design, research planning and critical review of the paper; AS Diniz: research planning and critical review of the paper; APO Marques: design, research planning, data analysis and interpretation, elaboration and critical review of the paper.