Levels of Practice and Determinants of Diabetes Self-Care in Primary Health Care in Jeddah City, Saudi Arabia

Abstract

Objective To assess the level and determinants of practice in diabetes self-management at primary health care centers (PHCCs) and to analyze the association of self-management with the level of glycemic control. Method A cross-sectional study was conducted among patients with type 1 and type 2 diabetes, aged ≥ 17 years, and being followed at PHCCs in Jeddah, Saudi Arabia, from December 1, 2019, to December 30, 2019. A multistage cluster sampling technique was used to select 350 participants from five PHCCs. The level of practice in self-management was assessed using the Arabic version of the Summary of Diabetes Self-care Activities (SDSCA) questionnaire. The tool was administered as a face-to-face interview, followed by the collection of sociodemographic and relevant clinical data. In addition, blood was collected to measure fasting blood glucose (FBG) and HbA1c levels. The association of the overall SDSCA score with diabetes control was analyzed using linear regression and the receiver operator characteristics (ROC) curve. Multivariate binary logistic regression was carried out to analyze independent factors of inadequate practice. Result The overall mean (SD) SDSCA score was 3.13 (1.13)/7. Of the five dimensions of self-care, medication adherence yielded the highest score (mean=5.39 days per week), followed by diet (2.83) and blood glucose monitoring (2.78), while footcare had the lowest level of practice (2.26). The SDSCA score showed a negative correlation with the level of HbA1c, with a correlation coefficient r-squared =0.530 and regression coefficient B=-0.648 (p <0.001). ROC curve analysis showed that optimal glycemic control was associated with SDSCA score cutoff ≥3.5 with 82.0% sensitivity and 77.0% specificity, and the model showed that 38.0% of participants had adequate practice in self-management. Inadequate practice in diabetes self-management was independently associated with age >50 years (OR=2.00 [95%CI=1.02, 3.89]), rental accommodation (OR=0.42 [95%CI=0.23, 0.76]), independent job (OR=3.98 [95%CI=1.66, 9.57]), and longer duration of diabetes (≥8 years) (OR=4.25 [95%CI=1.82, 9.92]). Conclusion There are low levels of diabetes self-management among patients being followed at Jeddah PHCCs. This is associated with suboptimal glycemic control among the majority of the patients, indicating the importance of self-management to improve diabetes control. Patient health literacy and education for self-management should be considered the standard of care for diabetic patients in all PHCCs, with specific attention to subcategories of patients with the lowest levels of practice in self-management such as those with a longer duration of diabetes and the elderly.

Glycemic Control and Its Relationship with Diabetes Self-Care Behaviors Among Patients with Type 2 Diabetes in Northern Jordan: A Cross-Sectional Study

“…Others reported similar poor dietary adherence and foot care among patients with T2DM. 4 , 12 , 18 , 29 , 30 Interestingly, participants’ adherence to a specific diet was higher than that of a general diet, which others reported. 18 , 29 Consistently, Bawadi et al reported that diabetic patients in Jordan failed to achieve the recommended dietary guidelines for Arabs.…”

“…Most study participants reported unsatisfactory compliance to diabetes self-care behaviors, less than four days/week on average, consistent with the findings of previous Jordanian 16 , 18 , 29 and international studies. 11 , 12 , 21 , 30 , 31 In contrast, Qteishat & Ghananim (2015) reported high compliance to diabetes self-care activities using the same measurement tool. However, their study was conducted in different settings, in west-central Jordan, and with smaller sample size.…”

“… 51 The mean score for each subscale was calculated in this study according to the original SDSCA guidelines51 to permit comparability with other studies. 12 , 18 , 20 , 29 , 52 Then, by averaging subscales mean scores, the overall mean SDSCA-Arabic score also ranged between (0–7) days. Higher scores indicated better self-care behaviors.…”

“…29 Poor compliance to T2DM self-care behaviors was reported nationally, 16 , 18 , 29 and internationally. 11 , 12 , 21 , 30 , 31 ‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬ Self-management support is one of the six key elements of the chronic care model (CCM) to improve diabetes control in primary care settings. 32 The significance of self-care management corresponds with many studies’ findings, where greater adherence to each self-care behavior, including exercising, 8 , 10 , 11 , 18 , 33 dieting, 8 , 16 , 18 , 33 BST, 8 and medication adherence, 10 , 23 , 24 , 26 , 33 , 34 is a predictor of better glycemic control.‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬ However, several studies could not detect the contribution of self-care behaviors, 35 , 36 such as exercising, 23 , 24 , 26 diet care, 10 , 11 , 23 , 26 BST, 10 , 18 , 23 , 24 , 26 , 33 medication adherence, 18 and foot care, 10 , 11 , 18 , 26 , 33 in predicting glycemic control.…”

Self Care Application In Improving The Quality Of Care And Management Of Type 2 Diabetes Mellitus Clients

“…The ability of DM clients in managing good self-care can control blood sugar. Controlled blood sugar will reduce the risk of disease complications (AlQahtani et al, 2020;Helou et al, 2016).…”