IMPACT OF HEALTH EDUCATION ON QUALITY OF LIFE IN EGYPTIAN TYPE 2 DIABETIC PATIENTS

Ayman M.E.M. Sadek 1 , Ahmad Maher 1 , Ashraf Khalifa 1 , Rehab S. Mahdy 2 , Amira A. Fouad 2 and Heba A. Fouad 2 . 1. MD, Internal Medicine, Zagazig University, Egypt. 2. MD, Psychiatry departments, Zagazig University, Egypt. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


ISSN: 2320-5407
Int. J. Adv. Res. 5 (5), 1850-1856 1851 Africa regions, with mortality resulted from diabetes being equal in males (141,000) and females (138,000). About fifty percent of mortality related to diabetes in this region occurs in patients under the age of sixty years (Sreedevi et., 2016). In Egypt, the comparative diabetes prevalence was 16.9% with 3,123,700 affected adult males and 4,199,500 affected adult females (Whiting et al, 2011).
Diabetes leads to huge economical costs mainly caused by debilitating micro-and macro-vascular complications and is a burdensome disease that can seriously impair the quality of patient's life (Davies et al., 2008). Hyper/hypoglycemia may also adversely influence QoL (Testa and Simonson, 1998), also; the depression in these patients (Goldney et al., 2004). Prove demonstrates that patients with diabetes have bring down QoL than nondiabetic people (Thommasen et al., 2005).
Quality of life (QoL) identification is one of the lifestyle analysis methods, which are considered the most important aspect in primary and secondary prevention of many non-transmissible chronic diseases such as diabetes, hypertension, coronary heart disease, cancer (Warburton et al., 2006;WHO J and Consultation FE 2003).
World Health Organization (WHO) defines QoL as "an individual's perception of their position in life in the context of the culture and value systems in which they live in relation to their goals, expectations, standards and concerns" (The World Health Organization Quality of Life Assessment, 1998). It is a broad idea impacted by various physical, psychological, social, and environmental variables (Alavi et al., 2007).
QoL is considered as a marker to evaluate the impact of chronic diseases on patients' lives, and also to assess the effectiveness of the treatments and caring programs (Aghakoochak et al., 2014).
As ethnicity, culture, beliefs, and social realities moderate the perception of the patients about their illness (Sreedevi et al., 2016). So; this study was aiming to assessthe QoL in Egyptian type 2 diabetics and the impact of health education intervention.

Subjects:
Cases recruited from diabetes clinic in Internal Medicine department. Each patient rechecked every three months. Inclusion Criteria included type 2 diabetic patients with age ranges from 30 to 60 years old and both genders. Exclusion criteria included people with chronic and painful health conditions like cancer, spine injury, and psychiatric morbidity.

Sampling size and technique:-
According to the pilot study, the estimated sample size was 480 patients at 80% power and 95% Confidence Interval(CI) (Epi info version 6). Systematic random sample, obtained after the acceptance of patients to share in the study and with the support of the headmaster of the internal medicine department, targeting eight patients per day out of those attending the clinic, the sampling interval was every fourth or fifth patient from the list of patients who presented at the clinic.
Operational Design:-Data Collection:-First: a pilot study conducted, to assess the feasibility and the time needed to fill the questionnaire and to carry out health education, on 100 patients who attended diabetes outpatient clinic (excluded from the main study sample). Data obtained from the pilot study analyzed and accordingly necessary modifications in the questionnaire, health education message and the way of its delivery were done. The time needed for filling the sheet was about 40 minutes and the time needed for delivery of health education message was about 20 minutes. Difficult and unclear questions modified into easier and clearer ones.
1852 Second: The data were collected by an interview questionnaire as the following; a) First stage (pre-intervention stage) which contains  Form a(Data collection sheet for type 2 diabetics) that includes socio-demographic characteristics, history of diabetes, symptoms, associated health problems, compliance to treatment, and activities of daily living (ADL).  Form b: (Diabetes Knowledge Questionnaire) included 11 multiple choice questions on knowledge about diabetes. Each question scored as two or zero for a correct or wrong answer, respectively. A score of one given to an answer of "I do not know". The lowest knowledge score was zero and the highest was twentytwo. Total score equal to 11 or more considered adequate knowledge, and less than 11 considered inadequate knowledge.  Form c: WHOQoL-BREF scale Arabic version (Ohaeria and Awadalla 2009) that includes 26 questions reflecting four domains; physical health (seven questions), psychological status (six questions), social relationships (three questions), and environmental (eight questions). There were two global scores of overall QoL (one question) and overall satisfaction with health (one question). The raw scores of each domain were converted to transformed scores from 0-100 scale, where 100 is the highest and 0 is the lowest in the quality of life. Total domain score equal to 50 or more considered good, and less than 50 considered bad. b) Second stage (intervention stage) health education sessions in verbal form and posters, about 20-30 minute every three months, to increase knowledge about diabetes (definition, risk factor, causes, clinical picture, acute and chronic complications of diabetes and treatment). c) Third stage (post-intervention stage) three months after implementation of the health education message, the same group was asked the same questionnaire that was used in pre-test to detect the effect of health education. Hypertension was the most frequent health problem (31.3%) in overall diabetic patients. Impotence occurred in 45.5% of diabetic males (table 2).
Adequate knowledge about diabetes mellitus was associated with controlled diabetes. Patients who had foot ulcer, neuropathy and arthralgia were found to have inadequate knowledge about diabetes (table 3).
More than half of patients had a bad score in all QoL domains except for the physical domain (table 4).
Diabetic patients ≤50 years old with a disease duration ≤ 10 years and adequate knowledge had a higher total QoL score (table 5).

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Health education intervention program resulted into significant improvement in the score of physical and psychological domains of QoL, and total QoL score. However, social and environmental domains score were not significantly affected (table 6).

Discussion:-
The present work was done to survey QoLin Egyptiantype2DM patients, to identify the most important determinants affecting their QoL, and to measure the impact of diabetes health education intervention on QoL.

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The majority of the studied diabetics were females (77.1%), it could be explained by the high susceptibility of females to different diseases and due to their numerous participations; as a housewife, a mother, and probably an employee; in the society. The duration of illness was ≤ 10 years in the larger part of the studied subjects (79.2%), most of the diabetics studied aged between 30 to 65 years. Similar characteristics found in other studies (Ferrannini et  On the contrary to Sreedevi et al., 2016, who found that education was an independent determinant of good QoL in all the domains except social, explaining this by the fact that education reduces distress largely by way of paid work, non-alienated work, and economic resources, which are associated with high personal control. In our study level of education had no effect on QoL score and this point needs more