1.1 Introduction
Diabetes is a metabolic disorder of multiple etiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both (WHO, 2011). The prevalence of diabetes and its complications are major public health issues globally, regionally and locally. Notable complications and consequences of diabetes are stroke, blindness, amputation, death etc. Inadequate knowledge of diabetes, negative attitude and perception about diabetes is usually the root causes of diabetes complications and consequences. Developments in diabetes care and management have greatly evolved over the last several decades. Diabetes care has shifted from a treatment-oriented plan of care, to a proactive, prevention-based plan of care. The American Diabetes Association sets forth standards of medical care in diabetes each year. The most recent guidelines emphasize a comprehensive treatment plan with individualized diabetes education for each patient (American Diabetes Association, 2018).
As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitations of the Study and Definition of technical terms.
1.2 Background of Study
Diabetes is a disease whereby a human (or any other animal) has high sugar in the blood due to either insufficient insulin or when the produced insulin cannot be used by the body effectively (World Health Organization, 2016). Diabetes is a group of metabolic chronic diseases characterized by high sugar in the blood. There are basically three types of diabetes namely, type 1, type 2 and gestational diabetes (GD). Type 1 diabetes used to be called an insulin dependent, juvenile or childhood-onset diabetes. It is genetic in nature and it is usually diagnosed at childhood and adolescence but then it’s usually noted later in life. Current knowledge shows that type 1 diabetes is unpreventable (World Health Organization, 2016). Type 1 is usually uncommon as compared to type 2 (Chouhan & Shalini, 2006).
Type 2 diabetes occurs owing to the inability or unfitness of the body to effectively use the produced insulin. Type 2 is also be called non-insulin-dependent or adult- onset diabetes (World Health Organization, 2016). This type is usually caused by living a sedentary lifestyle. This is the commonest type of diabetes among adults worldwide and can be prevented or delayed (Sakane et al., 2011). Gestational diabetes occurs during pregnancy though a temporal condition; it can lead to type 2 diabetes in the long run and can also induce pregnancy and delivery complications (World Health Organization, 2016). In the US alone, gestational reported cases range from 2% to 10% in pregnancies. There is 35% to 60% probability of getting type 2 diabetes in women living with gestational diabetes (Facts & Diabetes, 2011).
Diabetes is a major and a serious public health issue not only in Nigeria but worldwide. Globally, in 2014,422 million had diabetes and the number rose to about 425 million people in 2017, it was projected that this will rise to about 629 million. In Africa an estimated number of over 16 million people suffer from diabetes, which is expected to increase up to around 41 million people by 2045 (International Diabetes Federation, 2017). This prevalence comes with some economic and health burden.
In 2017, 518,400 Nigerians were estimated to have the diabetes disease which is reported to be increasing daily and the prevalence rate was estimated to be 5%. Also diabetes related deaths in Nigeria (among ages 20-79 years) amounted to 9,778 (International Diabetes Federation, 2017).
Diabetes is one of the major causes of heart attacks, blindness, and lower limb amputation just to mention a few (Facts & Diabetes, 2011). Persistent high blood glucose, smoking, high cholesterol and excessive alcohol intake are some of the factors that can contribute to the risk of developing complications. Through adherence to medical treatment (taking medications as prescribed, to control their cholesterol and blood sugar) and diabetes care (regular checkup, regular exercise, healthy eating etc.), complications can be reduced drastically. Previous studies have shown that, socio-demographic and psychological factors are associated with diabetes education (Mogre et al., 2017).
Therefore, in Nigeria where the research was carried out, the activities that was conducted is to know the Impact of Education on Diabetes Control and Complication using Some Villages around Owerri Metropolis as a case study.
1.3 Statement of Problems
Investigation revealed that the prevalence of diabetes and its complications are major public health issues globally, regionally and locally. According to International Diabetes Federation (2017), in 2017, 518,400 Nigerians were estimated to have the diabetes disease and it is reported to be on the increase at 5% prevalence rate. According to the World Health Organization (2016), about 1.6 million people died due to diabetes globally in 2015 and in Nigeria diabetes related deaths (among ages 20-79 years) in 2017 was 9,778 (International Diabetes Federation, 2017). Most of the people who die are the adult group and usually, those with type 2 diabetes. The adult group is the active and working class who serve as the backbone for any country’s development as they are the main source of production.
So, when the active group is being killed by the diabetes disease, there will be low productivity and can lead to underdevelopment (high indebted poor country). If effective measures are not put in place to reduce the complications (blindness, stroke, amputation etc.) and consequences (death, loss of job etc.), social selection can set in and its consequences may be costly. Previous studies have shown that, diabetes care providers give little support for diabetes patients’ self-management and also, diabetes care are not provided close to the patients (Mwangome et al., 2017).
Much concentration is given to the biomedical (much reliance on drugs/medication) aspect of diabetes healthcare services than the education and awareness factors (knowledge, attitude and belief). However, existing evidence have shown that, knowledge, attitude and belief are related to diabetes care (Ahmed et al., 2015), (Services, 2014). Therefore, there is the need to ensure effective measures such as diabetes care education for both care providers and patients (self-care).
Hence, this research work seeks to determine the level of diabetes education through knowledge, attitudes and beliefs among persons with diabetes and to find out whether it is associated with their diabetes care.
1.4 Aim and Objectives of Study
The aim of the study is to investigate the Impact of Education on Diabetes Control and Complication using Some Villages around Owerri Metropolis as a case study. In achieving this aim, the following specific objectives were laid out as follows:
- To determine diabetes patients’ knowledge about diabetes and how it affects their diabetes care;
- To examine the attitudes of diabetic individuals and how it affects diabetes care;
- To determine how the beliefs of individuals living with diabetes affects diabetes care; and
- To find out how diabetes complication can be controlled among individuals residing in the area under study.
1.5 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- Do diabetes patients’ beliefs affect diabetes cares among individuals living with diabetes?
- Do the attitudes of individuals living with diabetes affect diabetes care?
- Does knowledge about diabetes affect diabetes care among individuals living with diabetes?
- How can diabetes complication be controlled among individuals residing in the area under study?
1.6 Research Hypothesis
In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.
Hypothesis One
- H0: There will be negative relationship between attitudes of diabetes patients and diabetes care
- H1: There will be positive relationship between attitudes of diabetes patients and diabetes care
Hypothesis Two
- H0: Diabetes patients’ knowledge on diabetes will not significantly affect their diabetes care.
- H1: Diabetes patients’ knowledge on diabetes will significantly affect their diabetes care.
Hypothesis Three
- H0: Diabetes patients’ belief will negatively affect their diabetes care.
- H1: Diabetes patients’ belief will positively affect their diabetes care.
1.7 Significance of Study
The findings will inform persons living with diabetes, public health experts, diabetes care providers and policy makers, on the development and improvement on existing policies, treatments (care/management) and interventions. There is no much research on assessing patient’s knowledge, attitude and belief about diabetes and its association with diabetes care. As such, this study seeks to examine the knowledge, attitude and belief of persons living with diabetes and self-care among diabetes patients in the area under study.
Health is holistic and as such the psychosocial and demographic determinants needs to be ensured. Knowing diabetes patients’ knowledge, belief and attitude towards diabetes and diabetes care will help in reducing the prevalence, complications and burden of diabetes globally and locally.
This study will be of immense benefit to other researchers who intend to know more on this study and can also be used by non-researchers to build more on their research work. This study contributes to knowledge and could serve as a guide for other study.
1.8 Scope of Study
The scope of the research is focused on the Impact of Education on Diabetes Control and Complication using Some Villages around Owerri Metropolis as a case study.
1.9 Limitations of the Study
During the course of this study, many things militated against its completion, some of which are:
- Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
- Establishment Policies: Establishment policies posed a serious limitation as most staffs are not ready to release information needed for this project work. There were lots of information needed from the staffs of this establishment to enhance the study which took them time to release or they did not release at all for security purposes, hence the scope was reduced.
- Research material: availability of research material is a major setback to the scope of the study.
- Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
- Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
1.10 Definition of Terms
Diabetes: Diabetes is a group of metabolic diseases or a chronic disease characterized by high sugar in the blood.
Knowledge: A factual information that a person knows or skills required to perform an act acquired through education, training or via experience.
