Attitudes, Knowledge, and Perceptions of Patients Regarding Type-2 Diabetes in Jordan
ABSTRACT
Introduction: Poorly controlled Type 2 diabetes is considered a major public health problem and associated with adverse outcomes in Jordan. Good diabetes knowledge may facilitate adaptation of healthy behaviors and improve patients’ adherence to their diabetes management plans. Purpose: To gain an in-depth understanding of attitudes, perceptions and knowledge of patients which underpin their behaviors in Jordan. Methods: 8 focus groups with 38 patients with poorly controlled Type 2 diabetes were conducted. The focus group sessions were audio recorded and transcribed. Thematic analysis was employed to analyze the qualitative data. All transcripts were uploaded into the qualitative data analysis software pack NVivo. Results: Patients reported the different ways in which they were diagnosed with Type 2 diabetes. Most of the patients visited the health facility after experiencing signs and symptoms of diabetes, often for some time before seeking medical help. Stress and family history were perceived as causes of developing diabetes and reasons for poorly controlled diabetes. Fatalistic beliefs were shared when the patients were talking about the causes of diabetes, the reasons for developing diabetes and their inability to control their blood glucose levels. Patients also associated fatalistic attitudes with religious beliefs and the power of God as illness being in God’s hands. Patients’ responses also showed a poor understanding of the basic knowledge of diabetes. Conclusions: Effective health education programs need to be tailored to meet the individual needs of patients. Patients need to be provided with accurate information about medications, side effects and therapeutic effects. An educational program may rectify misconceptions among patients
Introduction: Poorly controlled Type 2 diabetes is considered a major public health problem and associated with adverse outcomes in Jordan. Good diabetes knowledge may facilitate adaptation of healthy behaviors and improve patients’ adherence to their diabetes management plans. Purpose: To gain an in-depth understanding of attitudes, perceptions and knowledge of patients which underpin their behaviors in Jordan. Methods: 8 focus groups with 38 patients with poorly controlled Type 2 diabetes were conducted. The focus group sessions were audio recorded and transcribed. Thematic analysis was employed to analyze the qualitative data. All transcripts were uploaded into the qualitative data analysis software pack NVivo. Results: Patients reported the different ways in which they were diagnosed with Type 2 diabetes. Most of the patients visited the health facility after experiencing signs and symptoms of diabetes, often for some time before seeking medical help. Stress and family history were perceived as causes of developing diabetes and reasons for poorly controlled diabetes. Fatalistic beliefs were shared when the patients were talking about the causes of diabetes, the reasons for developing diabetes and their inability to control their blood glucose levels. Patients also associated fatalistic attitudes with religious beliefs and the power of God as illness being in God’s hands. Patients’ responses also showed a poor understanding of the basic knowledge of diabetes. Conclusions: Effective health education programs need to be tailored to meet the individual needs of patients. Patients need to be provided with accurate information about medications, side effects and therapeutic effects. An educational program may rectify misconceptions among patients
Cite this paper
Al-Sahouri, A. , Merrell, J. and Snelgrove, S. (2019) Attitudes, Knowledge, and Perceptions of Patients Regarding Type-2 Diabetes in Jordan. Journal of Diabetes Mellitus, 9, 1-13. doi: 10.4236/jdm.2019.91001.
Al-Sahouri, A. , Merrell, J. and Snelgrove, S. (2019) Attitudes, Knowledge, and Perceptions of Patients Regarding Type-2 Diabetes in Jordan. Journal of Diabetes Mellitus, 9, 1-13. doi: 10.4236/jdm.2019.91001.
References
[1] IDF (2017) IDF Diabetes Atlas. 8th Edition. http://www.diabetesatlas.org [2] Al-Sarihin, K., Bani-Khaled, M., Haddad, F. and Althwabia, I. (2012) Diabetes Knowledge among Patients with Diabetes Mellitus at King Hussein Hospital. Journal of the Royal Medical Services, 19, 72-77. [3] Al-Khawaldeh, O., Al-Hassan, M. and Froelicher, E. (2012) Self-Efficacy, Self-Management, and Glycaemic Control in Adults with Type 2 Diabetes Mellitus. Journal of Diabetes and Its Complications, 26, 10-16. https://doi.org/10.1016/j.jdiacomp.2011.11.002 [4] Adwan, M. and Najjar, Y. (2013) The Relationship between Demographic Variables and Diabetes Self-Management in Diabetic Patients in Amman City/Jordan. Global Journal of Health Science, 5. https://doi.org/10.5539/gjhs.v5n2p213 [5] El-Qudah, J. (2016) Dietary Knowledge among Female Diabetic Patients in Amman, Jordan. Current Research in Nutrition and Food Science Journal, 4, 107-113. https://doi.org/10.12944/CRNFSJ.4.2.04 [6] Jarab, A., Mukattash, T., Al-Azayzih, A. and Khdour, M. (2018) A Focus Group Study of Patient’s Perspective and Experiences of Type 2 Diabetes and Its Management in Jordan. Saudi Pharmaceutical Journal, 26, 301-305. https://doi.org/10.1016/j.jsps.2018.01.013 [7] Naidoo, J. and Wills, J. (2009) Foundations of Health Promotion. 3rd Edition, Elsevier, Edinburgh. [8] Habashneh, R., Khader, Y., Hammad, M. and Almuradi, M. (2010) Knowledge and Awareness about Diabetes and Periodontal Health among Jordanians. Journal of Diabetes and Its Complications, 24, 409-414. https://doi.org/10.1016/j.jdiacomp.2009.06.001 [9] Albikawi, Z. and Abuadas, M. (2015) Diabetes Self-Care Management Behaviours among Jordanian Type Two Diabetes Patients. American International Journal of Contemporary Research, 5, 87-95. [10] American Diabetes Association (2013) Standards of Medical Care in Diabetes. Diabetes Care, 36, S11-S66. [11] Ajlouni, K., Khader, Y.S., Batieha, A., Ajlouni, H. and El-Khateeb, M. (2008) An Increase in Prevalence of Diabetes Mellitus in Jordan over 10 Years. Journal of Diabetes and Its Complications, 22, 317-324. https://doi.org/10.1016/j.jdiacomp.2007.01.004 [12] Morgan, D. and Krueger, R. (1998) The Focus Group Kit. Sage, London. [13] Nabolsi, M. and Carson, A. (2011) Spirituality, Illness and Personal Responsibility: The Experience of Jordanian Muslim Men with Coronary Artery Disease. Scandinavian Journal of Caring Sciences, 25, 716-724. https://doi.org/10.1111/j.1471-6712.2011.00882.x [14] Egede, L. and Ellis, C. (2009) Development and Psychometric Properties of the 12-Item Diabetes Fatalism Scale. Journal of General Internal Medicine, 25, 61-66. https://doi.org/10.1007/s11606-009-1168-5 [15] Sukkarieh-Haraty, O., Egede, L., Kharma, J. and Bassil, M. (2017) Predictors of Diabetes Fatalism among Arabs: A Cross-Sectional Study of Lebanese Adults with Type 2 Diabetes. Journal of Religion and Health, 57, 858-868. https://doi.org/10.1007/s10943-017-0430-0 [16] Albargawi, M., Snethen, J., Gannass, A. and Kelber, S. (2016) Perception of Persons with Type 2 Diabetes Mellitus in Saudi Arabia. International Journal of Nursing Sciences, 3, 39-44. https://doi.org/10.1016/j.ijnss.2016.02.007 [17] Jeragh-Alhaddad, F., Waheedi, M., Barber, N. and Brock, T. (2015) Barriers to Medication Taking among Kuwaiti Patients with Type 2 Diabetes: A Qualitative Study. Patient Preference and Adherence, 9, 1491-503. https://doi.org/10.2147/PPA.S86719 [18] Unger, J. (2012) Diabetes Management in Primary Care. 2nd Edition, Lippincott Williams and Wilkins, Philadelphia. [19] Rotter, J. (1966) Generalized Expectancies for Internal versus External Control of Reinforcement. Psychological Monographs: General and Applied, 80, 1-28. https://doi.org/10.1037/h0092976 [20] Bakkar, M., Haddad, M. and Gammoh, Y. (2017) Awareness of Diabetic Retinopathy among Patients with Type 2 Diabetes Mellitus in Jordan. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 10, 435-441. https://doi.org/10.2147/DMSO.S140841 [21] Al-Adsani, A., Moussa, M., Al-Jasem, L., Abdella, N. and Al-Hamad, N. (2009) The Level and Determinants of Diabetes Knowledge in Kuwaiti Adults with Type 2 Diabetes. Diabetes and Metabolism, 35, 121-128. https://doi.org/10.1016/j.diabet.2008.09.005 [22] Subhi, L., Kendall, P., Al-Shafaee, M. and Al-Adawi, S. (2016) Health Beliefs of People with Type 2 Diabetes in Primary Health Care in Muscat, Oman: A Qualitative Approach. International Journal of Clinical Nutrition & Dietetics, 2, 1-7. https://doi.org/10.15344/2456-8171/2016/106 [23] Alsunni, A., Albaker, W. and Badaro, A. (2014) Determinants of Misconceptions about Diabetes among Saudi Diabetic Patients Attending Diabetes Clinic at a Tertiary Care Hospital in Eastern Saudi Arabia. Journal of Family and Community Medicine, 21, 93. https://doi.org/10.4103/2230-8229.134764 [24] Hassan, H., Tohid, H., Amin, R., Bidin, M., Muthupalaniappen, L. and Omar, K. (2013) Factors Influencing Insulin Acceptance among Type 2 Diabetes Mellitus Patients in a Primary Care Clinic: A Qualitative Exploration. BMC Family Practice, 14, 164. [25] Al-Maskari, F., El-Sadig, M., Al-Kaabi, J., Afandi, B., Nagelkerke, N. and Yeatts, K. (2013) Knowledge, Attitude and Practices of Diabetic Patients in the United Arab Emirates. PLoS ONE, 8, e52857. https://doi.org/10.1371/journal.pone.0052857
[1] IDF (2017) IDF Diabetes Atlas. 8th Edition. http://www.diabetesatlas.org [2] Al-Sarihin, K., Bani-Khaled, M., Haddad, F. and Althwabia, I. (2012) Diabetes Knowledge among Patients with Diabetes Mellitus at King Hussein Hospital. Journal of the Royal Medical Services, 19, 72-77. [3] Al-Khawaldeh, O., Al-Hassan, M. and Froelicher, E. (2012) Self-Efficacy, Self-Management, and Glycaemic Control in Adults with Type 2 Diabetes Mellitus. Journal of Diabetes and Its Complications, 26, 10-16. https://doi.org/10.1016/j.jdiacomp.2011.11.002 [4] Adwan, M. and Najjar, Y. (2013) The Relationship between Demographic Variables and Diabetes Self-Management in Diabetic Patients in Amman City/Jordan. Global Journal of Health Science, 5. https://doi.org/10.5539/gjhs.v5n2p213 [5] El-Qudah, J. (2016) Dietary Knowledge among Female Diabetic Patients in Amman, Jordan. Current Research in Nutrition and Food Science Journal, 4, 107-113. https://doi.org/10.12944/CRNFSJ.4.2.04 [6] Jarab, A., Mukattash, T., Al-Azayzih, A. and Khdour, M. (2018) A Focus Group Study of Patient’s Perspective and Experiences of Type 2 Diabetes and Its Management in Jordan. Saudi Pharmaceutical Journal, 26, 301-305. https://doi.org/10.1016/j.jsps.2018.01.013 [7] Naidoo, J. and Wills, J. (2009) Foundations of Health Promotion. 3rd Edition, Elsevier, Edinburgh. [8] Habashneh, R., Khader, Y., Hammad, M. and Almuradi, M. (2010) Knowledge and Awareness about Diabetes and Periodontal Health among Jordanians. Journal of Diabetes and Its Complications, 24, 409-414. https://doi.org/10.1016/j.jdiacomp.2009.06.001 [9] Albikawi, Z. and Abuadas, M. (2015) Diabetes Self-Care Management Behaviours among Jordanian Type Two Diabetes Patients. American International Journal of Contemporary Research, 5, 87-95. [10] American Diabetes Association (2013) Standards of Medical Care in Diabetes. Diabetes Care, 36, S11-S66. [11] Ajlouni, K., Khader, Y.S., Batieha, A., Ajlouni, H. and El-Khateeb, M. (2008) An Increase in Prevalence of Diabetes Mellitus in Jordan over 10 Years. Journal of Diabetes and Its Complications, 22, 317-324. https://doi.org/10.1016/j.jdiacomp.2007.01.004 [12] Morgan, D. and Krueger, R. (1998) The Focus Group Kit. Sage, London. [13] Nabolsi, M. and Carson, A. (2011) Spirituality, Illness and Personal Responsibility: The Experience of Jordanian Muslim Men with Coronary Artery Disease. Scandinavian Journal of Caring Sciences, 25, 716-724. https://doi.org/10.1111/j.1471-6712.2011.00882.x [14] Egede, L. and Ellis, C. (2009) Development and Psychometric Properties of the 12-Item Diabetes Fatalism Scale. Journal of General Internal Medicine, 25, 61-66. https://doi.org/10.1007/s11606-009-1168-5 [15] Sukkarieh-Haraty, O., Egede, L., Kharma, J. and Bassil, M. (2017) Predictors of Diabetes Fatalism among Arabs: A Cross-Sectional Study of Lebanese Adults with Type 2 Diabetes. Journal of Religion and Health, 57, 858-868. https://doi.org/10.1007/s10943-017-0430-0 [16] Albargawi, M., Snethen, J., Gannass, A. and Kelber, S. (2016) Perception of Persons with Type 2 Diabetes Mellitus in Saudi Arabia. International Journal of Nursing Sciences, 3, 39-44. https://doi.org/10.1016/j.ijnss.2016.02.007 [17] Jeragh-Alhaddad, F., Waheedi, M., Barber, N. and Brock, T. (2015) Barriers to Medication Taking among Kuwaiti Patients with Type 2 Diabetes: A Qualitative Study. Patient Preference and Adherence, 9, 1491-503. https://doi.org/10.2147/PPA.S86719 [18] Unger, J. (2012) Diabetes Management in Primary Care. 2nd Edition, Lippincott Williams and Wilkins, Philadelphia. [19] Rotter, J. (1966) Generalized Expectancies for Internal versus External Control of Reinforcement. Psychological Monographs: General and Applied, 80, 1-28. https://doi.org/10.1037/h0092976 [20] Bakkar, M., Haddad, M. and Gammoh, Y. (2017) Awareness of Diabetic Retinopathy among Patients with Type 2 Diabetes Mellitus in Jordan. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 10, 435-441. https://doi.org/10.2147/DMSO.S140841 [21] Al-Adsani, A., Moussa, M., Al-Jasem, L., Abdella, N. and Al-Hamad, N. (2009) The Level and Determinants of Diabetes Knowledge in Kuwaiti Adults with Type 2 Diabetes. Diabetes and Metabolism, 35, 121-128. https://doi.org/10.1016/j.diabet.2008.09.005 [22] Subhi, L., Kendall, P., Al-Shafaee, M. and Al-Adawi, S. (2016) Health Beliefs of People with Type 2 Diabetes in Primary Health Care in Muscat, Oman: A Qualitative Approach. International Journal of Clinical Nutrition & Dietetics, 2, 1-7. https://doi.org/10.15344/2456-8171/2016/106 [23] Alsunni, A., Albaker, W. and Badaro, A. (2014) Determinants of Misconceptions about Diabetes among Saudi Diabetic Patients Attending Diabetes Clinic at a Tertiary Care Hospital in Eastern Saudi Arabia. Journal of Family and Community Medicine, 21, 93. https://doi.org/10.4103/2230-8229.134764 [24] Hassan, H., Tohid, H., Amin, R., Bidin, M., Muthupalaniappen, L. and Omar, K. (2013) Factors Influencing Insulin Acceptance among Type 2 Diabetes Mellitus Patients in a Primary Care Clinic: A Qualitative Exploration. BMC Family Practice, 14, 164. [25] Al-Maskari, F., El-Sadig, M., Al-Kaabi, J., Afandi, B., Nagelkerke, N. and Yeatts, K. (2013) Knowledge, Attitude and Practices of Diabetic Patients in the United Arab Emirates. PLoS ONE, 8, e52857. https://doi.org/10.1371/journal.pone.0052857