ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE TOWARD DIABETIC PATIENTS IN RIYADH CITY, 2016

Mohammed obaid AlAnazi, Mashael Belal Alrubaian , Abdullah Khalaf Almutairi , Abduldaim Fahad AlKhraiji, Ahmad Omar Bogari ,Musaad Ajban Alhurayyis ,Narjis abdulraziq Bakkar, Maab Abdulsalam Emam , Manar Abdulsalam Emam , Mohammed Mubarak Al-Masabi and Fadhilah Hussain Alshafei. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History

Background:-Diabetes mellitus (DM) is a global public health problem [1] . he prevalence of diabetes mellitus is increasing and the number of persons with the disease will double by 2025 [2] . The management of diabetes mellitus (DM) largely depends on patients' ability to self-care in their daily lives, and therefore, patient education is always considered an essential element of DM management. Studies have consistently shown that improved glycemic control reduces the rate of complications and evidence suggests that patients, who are knowledgeable about DM self-care, have better long term glycemic control [3-4-5] . Although the prevalence of DM is high among populations in the Middle East and Gulf countries, patients often lack the knowledge and skills to self-manage their condition [6-7-8-9]. During the past three decades, the population of the Kingdom of Saudi Arabia has undergone tremendous changes in lifestyle, primarily leading to decreased physical activity and unhealthy eating habits. These changes have had a considerable negative impact on the health of the society. Indeed, this lifestyle transformation is thought to be responsible for the epidemic of non communicable diseases and their complications in the country [10][11] , Our Study Was Designed To Examine Health Beliefs And Assessment Level OF Awareness Toward Diabetic among Population In Saudi Arabia, Riyadh city And Applies The Health Belief Model To Determine Barriers.
Rationale:-Diabetes mellitus (DM) is a global public health problem [1] . he prevalence of diabetes mellitus is increasing and the number of persons with the disease will double by 2025 [2] . The management of diabetes mellitus (DM) largely depends on patients' ability to self-care in their daily lives, and therefore, patient education is always considered an essential element of DM management. Studies have consistently shown that improved glycemic control reduces the rate of complications and evidence suggests that patients, who are knowledgeable about DM self-care, have better long term glycemic control [3-4-5] . Although the prevalence of DM is high among populations in the Middle East and Gulf countries, patients often lack the knowledge and skills to self-manage their condition [6-7-8-9].
Objectives:-General objectives:-To assess the level of awareness, Attitude And Practice toward diabetes in Riyadh city to identify barriers.

Specific objective:
The goal of this study was to examine community health beliefs regarding diabetes and their perceptions related to it and evaluate the role of demographic factors in shaping beliefs about diabetes and assess possible associations between demographic characteristics with the preventive behavior of interest.

Methods:-
Study design: cross sectional study.

Setting and data collection:
This survey analysis was conducted among community population in Riyadh city. A preformed self-administered questionnaire was distributed among the community population.
Sample:-Subjects will be chosen according to geographical and sex distribution. Sample size was calculated based on website calculator [11] ,taking the total size of Riyadh population (4,087,000) [13] , confidence level (95%) and margin error (5%) to be 285. additional 20 % was added to cover the missing data . The total sample obtained was 360.

Study population:-
The study population included were both male and female in Riyadh city.

Study tool:-
Pre-formed Self-administered questionnaire that requires information about: 1-Socio-demographic data: age, nationality, gender, education level, income, marital status, and employment status. 2-Risk Factors Associated with diabetes-clinical manifestation of diabetes-incidence and prognosis of diabetes. 3-Beliefs about diabetes assessment including 8 questions. A score of 1 was given right answer and 0 otherwise.
For each subject, a maximum score of 8 was calculated. A scoring system was applied to measure the respondents' beliefs about diabetes. The awareness level was categorized into 3 levels indicated by weak (0-2), average (3)(4)(5) and good (6)(7)(8). 4-Knowledge about prevention behavior assessment including one question "Do you believe that psychological pressure is one of the diabetes factors?". A score of 1 was given to yes and 0 otherwise. For each subject, a maximum score of 1 was calculated. The knowledge level score was categorized into 2 levels indicated by poor knowledge (0) and good knowledge (1).

Ethical considerations:-
An informed consent was obtained from the participants included in this research before filling the questionnaire.

Results:-I-Examine community health beliefs regarding diabetes and their perceptions related to it: 1-Demographics of the studied subjects:
The socio-demographic characteristics are shown in table (1)  100,0 Out of 454 subjects, 360 (79,3%) subjects reported not being affected with diabetes, 13% did not knew if they are affected or not and 35 (7,7%) respondents reported that they suffer from diabetes, as it is shown in the figure below:  thought that psychological pressure is one of diabetes factors.  Only 65 (14,3%) subjects knew that diabetes increases the risk of heart disease.  Most of the subjects 250 (55,1%) knew that diabetes may begin at any age.  The majority of respondents 181 (40,9%) did not know if they will be ashamed or not, if they have diabetes.  The majority of respondents 327 (72%) think that diabetes can be cured and only 10,4% of the subjects knew the fact that the disease is not curable.  The results of the study suggested that 227 (49,9%) subjects were aware of the fact that diabetes cannot cause death. ,656 N of Valid Cases 435 a. 0 cells (0,0%) have expected count less than 5. The minimum expected count is 10,24. There is a statistical significant association between gender, educational level and the level of awareness about diabetes, respectively (p=0,01 < 0,05) and (p=0,027 < 0,05).

III-Assessment of possible associations between demographic characteristics with the preventive behavior of interest.
Psychological pressure is one of the diabetes factors, which is reported in the fifth question; that is why it is important to avoid stress as prevention of the disease. N of Valid Cases 449 a. 0 cells (0,0%) have expected count less than 5. The minimum expected count is 81,59. b. Computed only for a 2x2 table There is a statistical significant association between age, gender, nationality, marital status and the level of knowledge about stress as factor of diabetes, respectively (p=0,17 < 0,05), (p=0,42 <0,05), (p=0,19 < 0,05) and (p=0,41 <0,05).

Discussion:-
This study identified that:  The majority of respondents have an average level of awareness toward diabetes.  The majority of the studied subjects have a good knowledge about the fact that psychological stress is one of the factors of the pathology of diabetes.