Inequalities and factors associated with adherence to diabetes self-care practices amongst patients at two public hospitals in Gauteng, South Africa

C. Mutyambizi; M. Pavlova; C. Hongoro; W. Groot

doi:10.1186/s12902-020-0492-y

Inequalities and factors associated with adherence to diabetes self-care practices amongst patients at two public hospitals in Gauteng, South Africa

C. Mutyambizi^*, M. Pavlova, C. Hongoro, W. Groot

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

This study aims to assess the diabetes self-care behaviours of patients attending two tertiary hospitals in Gauteng, South Africa. The study also seeks to estimate the inequalities in adherence to diabetes self-care practices and associated factors. Methods: A unique health-facilities based cross-sectional survey was conducted amongst diabetes patients in 2017. Our study sample included 396 people living with diabetes. Face-to-face interviews were conducted using a structured questionnaire. Diabetes self-management practices considered in this study are dietary diversity, medication adherence, physical activity, self-monitoring of blood-glucose, avoiding smoking and limited alcohol consumption. Concentration indices (CIs) were used to estimate inequalities in adherence to diabetes self-care practices. Multiple logistic regressions were fitted to determine factors associated with diabetes self-care practices. Results: Approximately 99% of the sample did not consume alcohol or consumed alcohol moderately, 92% adhered to self-monitoring of blood-glucose, 85% did not smoke tobacco, 67% adhered to their medication, 62% had a diverse diet and 9% adhered to physical activity. Self-care practices of dietary diversity (CI = 0.1512) and exercise (CI = 0.1067) were all concentrated amongst patients with higher socio-economic status as indicated by the positive CIs, whilst not smoking (CI = - 0.0994) was concentrated amongst those of lower socio-economic status as indicated by the negative CI. Dietary diversity was associated with being female, being retired and higher wealth index. Medication adherence was found to be associated with older age groups. Physical activity was found to be associated with tertiary education, being a student and those within higher wealth index. Self-monitoring of blood glucose was associated with being married. Not smoking was associated with being female and being retired. Conclusion: Adherence to exercising, dietary diversity and medication was found to be sub-optimal. Dietary diversity and exercise were more prevalent among patients with higher socio-economic status. Our findings suggest that efforts to improve self- management should focus on addressing socio-economic inequalities. It is critical to develop strategies that help those within low-socio-economic groups to adopt healthier diabetes self-care practices

Original language	English
Article number	15
Number of pages	10
Journal	BMC Endocrine Disorders
Volume	20
Issue number	1
DOIs	https://doi.org/10.1186/s12902-020-0492-y
Publication status	Published - 28 Jan 2020

JEL classifications

i14 - Health and Inequality

Keywords

Adherence
Article
Determinants
Diabetes
Inequalities
Self-care behaviours
South Africa
adult
age distribution
clinical practice
controlled study
cross-sectional study
diabetes mellitus
dietary compliance
dietary pattern
exercise
female
food frequency questionnaire
glycemic control
health care facility
health care quality
health education
human
insulin
major clinical study
male
medication compliance
middle aged
oral antidiabetic agent
patient compliance
physical activity
public hospital
quality of life
self care
self monitoring
sex difference
smoking
smoking cessation
social status
unemployment
young adult
MEDICATION
BLOOD-GLUCOSE
MANAGEMENT
URBAN
ADULTS
FOOD VARIETY
MELLITUS

Access to Document

10.1186/s12902-020-0492-yLicence: CC BY

Cite this

@article{96a737c9800944659d6845d84b12c01c,

title = "Inequalities and factors associated with adherence to diabetes self-care practices amongst patients at two public hospitals in Gauteng, South Africa",

abstract = "This study aims to assess the diabetes self-care behaviours of patients attending two tertiary hospitals in Gauteng, South Africa. The study also seeks to estimate the inequalities in adherence to diabetes self-care practices and associated factors. Methods: A unique health-facilities based cross-sectional survey was conducted amongst diabetes patients in 2017. Our study sample included 396 people living with diabetes. Face-to-face interviews were conducted using a structured questionnaire. Diabetes self-management practices considered in this study are dietary diversity, medication adherence, physical activity, self-monitoring of blood-glucose, avoiding smoking and limited alcohol consumption. Concentration indices (CIs) were used to estimate inequalities in adherence to diabetes self-care practices. Multiple logistic regressions were fitted to determine factors associated with diabetes self-care practices. Results: Approximately 99% of the sample did not consume alcohol or consumed alcohol moderately, 92% adhered to self-monitoring of blood-glucose, 85% did not smoke tobacco, 67% adhered to their medication, 62% had a diverse diet and 9% adhered to physical activity. Self-care practices of dietary diversity (CI = 0.1512) and exercise (CI = 0.1067) were all concentrated amongst patients with higher socio-economic status as indicated by the positive CIs, whilst not smoking (CI = - 0.0994) was concentrated amongst those of lower socio-economic status as indicated by the negative CI. Dietary diversity was associated with being female, being retired and higher wealth index. Medication adherence was found to be associated with older age groups. Physical activity was found to be associated with tertiary education, being a student and those within higher wealth index. Self-monitoring of blood glucose was associated with being married. Not smoking was associated with being female and being retired. Conclusion: Adherence to exercising, dietary diversity and medication was found to be sub-optimal. Dietary diversity and exercise were more prevalent among patients with higher socio-economic status. Our findings suggest that efforts to improve self- management should focus on addressing socio-economic inequalities. It is critical to develop strategies that help those within low-socio-economic groups to adopt healthier diabetes self-care practices",

keywords = "Adherence, Article, Determinants, Diabetes, Inequalities, Self-care behaviours, South Africa, adult, age distribution, clinical practice, controlled study, cross-sectional study, diabetes mellitus, dietary compliance, dietary pattern, exercise, female, food frequency questionnaire, glycemic control, health care facility, health care quality, health education, human, insulin, major clinical study, male, medication compliance, middle aged, oral antidiabetic agent, patient compliance, physical activity, public hospital, quality of life, self care, self monitoring, sex difference, smoking, smoking cessation, social status, unemployment, young adult, MEDICATION, BLOOD-GLUCOSE, MANAGEMENT, URBAN, ADULTS, FOOD VARIETY, MELLITUS",

author = "C. Mutyambizi and M. Pavlova and C. Hongoro and W. Groot",

note = "Correspondence Address: Mutyambizi, C.; Research Use and Impact Assessment, Human Sciences Research Council, HSRC Building, 134 Pretorius Street, South Africa; email: [email protected] Chemicals/CAS: insulin, 9004-10-8 References: (2016) Global Report on Diabetes, , World Health Organization World Health Organization Geneva; (2015) IDF Diabetes Atlas, , International Diabetes Federation 7 International Diabetes Federation Brussels; Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: A collaborative meta-analysis of 102 prospective studies (2010) Lancet, 375 (9733), pp. 2215-2222. , Emerging Risk Factors Collaboration 1:CAS:528:DC%2BC3cXotVagtr0%3D; Diabetes mellitus, fasting glucose, and risk of cause-specific death (2011) N Engl J Med, 364 (9), pp. 829-841. , Emerging Risk Factors Collaboration; (2019) IDF Diabetes Atlas, , International Diabetes Federation 9 International Diabetes Federation Brussels; Standards of medical care indiabetes-2017 (2017) Diabetes Care, 40, pp. 1-142. , American Diabetes Association; Govender, R.D., Gathiram, P., Panajatovic, M., Poor control and management of type 2 diabetes mellitus at an under-resourced south African hospital: Is it a case of clinical inertia? (2017) S Afr Fam Pract, 59 (5), pp. 154-159; Shilubane, N., Factors contributing to poor glycaemic control in diabetic patients at Mopani District (2010) Curationis., 33 (3), pp. 43-47. , 1:STN:280:DC%2BC3M3ptVOltw%3D%3D 21428238; Erasmus, R., Blanco, E.B., Okesina, A., Gqweta, Z., Matsha, T., Assessment of glycaemic control in stable type 2 black south African diabetics attending a peri-urban clinic (1999) Postgrad Med J, 75 (888), pp. 603-606. , 1:STN:280:DC%2BD3c%2FoslOrsw%3D%3D 10621901 1741374; Nthangeni, G., Steyn, N.P., Alberts, M., Steyn, K., Levitt, N.S., Laubscher, R., Dietary intake and barriers to dietary compliance in black type 2 diabetic patients attending primary health-care services (2002) Public Health Nutr, 5 (2), pp. 329-338. , 12020385; Pinchevsky, Y., Butkow, N., Chirwa, T., Raal, F., Treatment gaps found in the Management of type 2 diabetes at a community health Centre in Johannesburg, South Africa (2017) J Diabetes Res, 2017, p. 9536025. , 29130053 5654246 1:CAS:528:DC%2BC1MXhtlWltbk%3D; Stokes, A., Berry, K.M., McHiza, Z., Parker, W.-A., Labadarios, D., Chola, L., Prevalence and unmet need for diabetes care across the care continuum in a national sample of South African adults: Evidence from the SANHANES-1, 2011-2012 (2017) PLoS One, 12 (10), p. e0184264. , 28968435 5624573 1:CAS:528:DC%2BC1cXhsFOmtrnJ; SEMDSA 2017 guidelines for the management of type 2 diabetes mellitus (2017) J Endocrinol Metab Diabetes S Afr, 22 (1), pp. S1-S196. , SEMDSA Type 2 Diabetes Guidelines Expert Committee; Amod, A., Berg, G., The 2012 SEMDSA guidelines for the management of type 2 diabetes (2012) J Endocrinol Metab Diabetes S Afr, 17 (2), p. S4; (2017) IDF Diabetes Atlas, , International Diabetes Federation 8 International Diabetes Federation Brussels; Kassahun, T., Gesesew, H., Mwanri, L., Eshetie, T., Diabetes related knowledge, self-care behaviours and adherence to medications among diabetic patients in Southwest Ethiopia: A cross-sectional survey (2016) BMC Endocr Disord, 16 (1), p. 28. , 27381349 4933997 1:CAS:528:DC%2BC2sXns1emsb8%3D; Mogre, V., Abanga, Z.O., Tzelepis, F., Johnson, N.A., Paul, C., Adherence to and factors associated with self-care behaviours in type 2 diabetes patients in Ghana (2017) BMC Endocr Disord, 17 (1), p. 20. , 28340613 5366118; Luo, X., Liu, T., Yuan, X., Ge, S., Yang, J., Li, C., Factors influencing self-management in Chinese adults with type 2 diabetes: A systematic review and meta-analysis (2015) Int J Environ Res Public Health, 12 (9), pp. 11304-11327. , 26378555 4586677; Gurmu, Y., Gela, D., Aga, F., Factors associated with self-care practice among adult diabetes patients in west Shoa zone, Oromia regional state, Ethiopia (2018) BMC Health Serv Res, 18 (1), p. 732. , 30249246 6154910; Stephani, V., Opoku, D., Beran, D., Self-management of diabetes in sub-Saharan Africa: A systematic review (2018) BMC Public Health, 18 (1), p. 1148. , 30268115 6162903; Steyl, T., Phillips, J., Management of type 2 diabetes mellitus: Adherence challenges in environments of low socio-economic status (2014) Afr J Prim Health Care Fam Med, 6 (1), pp. 1-7; Murphy, K., Chuma, T., Mathews, C., Steyn, K., Levitt, N., A qualitative study of the experiences of care and motivation for effective self-management among diabetic and hypertensive patients attending public sector primary health care services in South Africa (2015) BMC Health Serv Res, 15 (1), p. 303. , 26231178 4522057; Mendenhall, E., Norris, S.A., Diabetes care among urban women in Soweto, South Africa: A qualitative study (2015) BMC Public Health, 15 (1), p. 1300. , 26706228 4691296; Adeniyi, O.V., Yogeswaran, P., Wright, G., Longo-Mbenza, B., Diabetic patients' perspectives on the challenges of glycaemic control (2015) Afr J Prim Health Care Fam Med, 7 (1), pp. 1-8; Masupe, T., Ndayi, K., Tsolekile, L., Delobelle, P., Puoane, T., Redefining diabetes and the concept of self-management from a patient's perspective: Implications for disease risk factor management (2018) Health Educ Res, 33 (1), pp. 40-54. , 1:STN:280:DC%2BC1MzovV2nuw%3D%3D 29315392 6018984; Okonta, H.I., Ikombele, J.B., Ogunbanjo, G.A., Knowledge, attitude and practice regarding lifestyle modification in type 2 diabetic patients (2014) Afr J Prim Health Care Fam Med, 6 (1), pp. 1-6; Adegbola, S.A., Marincowitz, G.J., Govender, I., Ogunbanjo, G.A., Assessment of self-reported adherence among patients with type 2 diabetes in Matlala District Hospital, Limpopo Province (2016) Afr J Prim Health Care Fam Med, 8 (1), pp. e1-e5. , 27543285; (2016) City of Tshwane, 2016/17 IDP, , City of Tshwane; Massyn, N., Tanna, G., Day, C., Ndlovu, N., (2018) District Health Barometer: District Health Profiles 2017/18, , Health Systems Trust Durban; Mutyambizi, C., Pavlova, M., Hongoro, C., Booysen, F., Groot, W., Incidence, socio-economic inequalities and determinants of catastrophic health expenditure and impoverishment for diabetes care in South Africa: A study at two public hospitals in Tshwane (2019) Int J Equity Health, 18 (1), p. 73. , 31118033 6530010; O'Donnell, O., Van Doorslaer, E., Adam, W., Lindelow, M., (2008) Analyzing Health Equity Using Household Survey Data, , The World Bank Washington DC; O'Donnell, O., O'Neill, S., Van Ourti, T., Walsh, B., Conindex: Estimation of concentration indices (2016) Stata J, 16 (1), p. 112. , 27053927 4819995; Labadarios, D., Steyn, N.P., Nel, J., How diverse is the diet of adult south Africans? (2011) Nutr J, 10 (1), p. 33. , 21496326 3094278; Kennedy, G.L., (2009) Evaluation of Dietary Diversity Scores for Assessment of Micronutrient Intake and Food Security in Developing Countries; Hatl{\o}y, A., Torheim, L., Oshaug, A., Food variety - A good indicator of nutritional adequacy of the diet? A case study from an urban area in Mali, West Africa (1998) Eur J Clin Nutr, 52 (12), p. 891. , 9881884; Steyn, N., Nel, J., (2006) Dietary Intake of Adult Women in South Africa and Nigeria with A Focus on the Use of Spreads, , South African Medical Research Council Tygerberg; Steyn, N., Nel, J., Nantel, G., Kennedy, G., Labadarios, D., Food variety and dietary diversity scores in children: Are they good indicators of dietary adequacy? (2006) Public Health Nutr, 9 (5), pp. 644-650. , 1:STN:280:DC%2BD28rgtVWntg%3D%3D 16923296; Morisky, D.E., Green, L.W., Levine, D.M., Concurrent and predictive validity of a self-reported measure of medication adherence (1986) Med Care, 24, pp. 67-74. , 1:STN:280:DyaL287hslWjsg%3D%3D 3945130; Sharma, T., Kalra, J., Dhasmana, D., Basera, H., Poor adherence to treatment: A major challenge in diabetes (2014) J Indian Acad Clin Med, 15 (1), pp. 26-29; (2010) Global Recommendations on Physical Activity for Health, , World Health Organization; (2009) Guideline on Self-monitoring of Blood Glucose in Non-insulin Treated Type 2 Diabetes, , International Diabetes Federation International Diabetes Federation Brussels; Bonger, Z., Shiferaw, S., Tariku, E.Z., Adherence to diabetic self-care practices and its associated factors among patients with type 2 diabetes in Addis Ababa, Ethiopia (2018) Patient Prefer Adherence, 12, p. 963. , 29922042 5995298; Tiew, K.F., Chan, Y.M., Lye, M.S., Loke, S.C., Factors associated with dietary diversity score among individuals with type 2 diabetes mellitus (2014) J Health Popul Nutr, 32 (4), p. 665. , 25895200 4438697; Guerci, B., Drouin, P., Grange, V., Bougneres, P., Fontaine, P., Kerlan, V., Self-monitoring of blood glucose significantly improves metabolic control in patients with type 2 diabetes mellitus: The auto-surveillance intervention active (ASIA) study (2003) Diabetes Metab, 29 (6), pp. 587-594. , 1:STN:280:DC%2BD2c%2FmtFOrtA%3D%3D 14707887 14707887; The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus (1993) N Engl J Med, 329 (14), pp. 977-986. , Diabetes Control and Complications Trial Research Group; Mohandas, A., Bhasin, S., Upadhyay, M., Madhu, S., Diabetes self care activities among adults 20 years and above residing in a resettlement colony in East Delhi (2018) Indian J Public Health, 62 (2), p. 104. , 29923533; Xu, Y., Pan, W., Liu, H., Self-management practices of Chinese Americans with type 2 diabetes (2010) Nurs Health Sci, 12 (2), pp. 228-234. , 20602696; Harris, M.I., Cowie, C.C., Howie, L.J., Self-monitoring of blood glucose by adults with diabetes in the United States population (1993) Diabetes Care, 16 (8), pp. 1116-1123. , 1:STN:280:DyaK3szoslSrsQ%3D%3D 8375241; Krass, I., Schieback, P., Dhippayom, T., Adherence to diabetes medication: A systematic review (2015) Diabet Med, 32 (6), pp. 725-737. , 1:STN:280:DC%2BC2MzhvF2rsA%3D%3D 25440507; Bagonza, J., Rutebemberwa, E., Bazeyo, W., Adherence to anti diabetic medication among patients with diabetes in eastern Uganda; A cross sectional study (2015) BMC Health Serv Res, 15 (1), p. 168. , 25898973 4405852; Siddiqui, M.A., Bhana, S., Daya, R., The relationship between objectively measured physical activity and parameters of disease control in an African population of type 2 diabetes mellitus (2018) J Endocrinol Metab Diabetes S Afr, 23 (3), pp. 80-85; Shaw, B.A., Gallant, M.P., Riley-Jacome, M., Spokane, L.S., Assessing sources of support for diabetes self-care in urban and rural underserved communities (2006) J Community Health, 31 (5), pp. 393-412. , 17094647; Gill, G., Rolfe, M., Macfarlane, I., Huddle, K., Smoking habits of black South African patients with diabetes mellitus (1996) Diabet Med, 13 (11), pp. 996-999. , 1:STN:280:DyaK2s7gtFKnsA%3D%3D 8946160; Engler, P.A., Ramsey, S.E., Smith, R.J., Alcohol use of diabetes patients: The need for assessment and intervention (2013) Acta Diabetol, 50 (2), pp. 93-99. , 20532803; Bhana, A., Rathod, S.D., Selohilwe, O., Kathree, T., Petersen, I., Characteristics and correlates of alcohol consumption among adult chronic care patients in North West Province, South Africa (2017) S Afr Med J, 107 (7), pp. 636-642. , 29025457; Funnell, M.M., Anderson, R.M., The problem with compliance in diabetes (2000) JAMA., 284 (13), p. 1709. , 1:STN:280:DC%2BD3cvmsF2jug%3D%3D 11015809; Van Dam, H.A., Van Der Horst, F., Van Den Borne, B., Ryckman, R., Crebolder, H., Provider-patient interaction in diabetes care: Effects on patient self-care and outcomes: A systematic review (2003) Patient Educ Couns, 51 (1), pp. 17-28. , 12915276; Heisler, M., Bouknight, R.R., Hayward, R.A., Smith, D.M., Kerr, E.A., The relative importance of physician communication, participatory decision making, and patient understanding in diabetes self-management (2002) J Gen Intern Med, 17 (4), pp. 243-252. , 11972720 1495033; Beverly, E.A., Worley, M., Prokopakis, K., Ivanov, N., Patient-physician communication and diabetes self-care (2016) J Clin Outcomes Manag, 23 (11), pp. 509-518",

year = "2020",

month = jan,

day = "28",

doi = "10.1186/s12902-020-0492-y",

language = "English",

volume = "20",

journal = "BMC Endocrine Disorders",

issn = "1472-6823",

publisher = "BioMed Central",

number = "1",

}

TY - JOUR

T1 - Inequalities and factors associated with adherence to diabetes self-care practices amongst patients at two public hospitals in Gauteng, South Africa

AU - Mutyambizi, C.

AU - Pavlova, M.

AU - Hongoro, C.

AU - Groot, W.

N1 - Correspondence Address: Mutyambizi, C.; Research Use and Impact Assessment, Human Sciences Research Council, HSRC Building, 134 Pretorius Street, South Africa; email: [email protected] Chemicals/CAS: insulin, 9004-10-8 References: (2016) Global Report on Diabetes, , World Health Organization World Health Organization Geneva; (2015) IDF Diabetes Atlas, , International Diabetes Federation 7 International Diabetes Federation Brussels; Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: A collaborative meta-analysis of 102 prospective studies (2010) Lancet, 375 (9733), pp. 2215-2222. , Emerging Risk Factors Collaboration 1:CAS:528:DC%2BC3cXotVagtr0%3D; Diabetes mellitus, fasting glucose, and risk of cause-specific death (2011) N Engl J Med, 364 (9), pp. 829-841. , Emerging Risk Factors Collaboration; (2019) IDF Diabetes Atlas, , International Diabetes Federation 9 International Diabetes Federation Brussels; Standards of medical care indiabetes-2017 (2017) Diabetes Care, 40, pp. 1-142. , American Diabetes Association; Govender, R.D., Gathiram, P., Panajatovic, M., Poor control and management of type 2 diabetes mellitus at an under-resourced south African hospital: Is it a case of clinical inertia? (2017) S Afr Fam Pract, 59 (5), pp. 154-159; Shilubane, N., Factors contributing to poor glycaemic control in diabetic patients at Mopani District (2010) Curationis., 33 (3), pp. 43-47. , 1:STN:280:DC%2BC3M3ptVOltw%3D%3D 21428238; Erasmus, R., Blanco, E.B., Okesina, A., Gqweta, Z., Matsha, T., Assessment of glycaemic control in stable type 2 black south African diabetics attending a peri-urban clinic (1999) Postgrad Med J, 75 (888), pp. 603-606. , 1:STN:280:DC%2BD3c%2FoslOrsw%3D%3D 10621901 1741374; Nthangeni, G., Steyn, N.P., Alberts, M., Steyn, K., Levitt, N.S., Laubscher, R., Dietary intake and barriers to dietary compliance in black type 2 diabetic patients attending primary health-care services (2002) Public Health Nutr, 5 (2), pp. 329-338. , 12020385; Pinchevsky, Y., Butkow, N., Chirwa, T., Raal, F., Treatment gaps found in the Management of type 2 diabetes at a community health Centre in Johannesburg, South Africa (2017) J Diabetes Res, 2017, p. 9536025. , 29130053 5654246 1:CAS:528:DC%2BC1MXhtlWltbk%3D; Stokes, A., Berry, K.M., McHiza, Z., Parker, W.-A., Labadarios, D., Chola, L., Prevalence and unmet need for diabetes care across the care continuum in a national sample of South African adults: Evidence from the SANHANES-1, 2011-2012 (2017) PLoS One, 12 (10), p. e0184264. , 28968435 5624573 1:CAS:528:DC%2BC1cXhsFOmtrnJ; SEMDSA 2017 guidelines for the management of type 2 diabetes mellitus (2017) J Endocrinol Metab Diabetes S Afr, 22 (1), pp. S1-S196. , SEMDSA Type 2 Diabetes Guidelines Expert Committee; Amod, A., Berg, G., The 2012 SEMDSA guidelines for the management of type 2 diabetes (2012) J Endocrinol Metab Diabetes S Afr, 17 (2), p. S4; (2017) IDF Diabetes Atlas, , International Diabetes Federation 8 International Diabetes Federation Brussels; Kassahun, T., Gesesew, H., Mwanri, L., Eshetie, T., Diabetes related knowledge, self-care behaviours and adherence to medications among diabetic patients in Southwest Ethiopia: A cross-sectional survey (2016) BMC Endocr Disord, 16 (1), p. 28. , 27381349 4933997 1:CAS:528:DC%2BC2sXns1emsb8%3D; Mogre, V., Abanga, Z.O., Tzelepis, F., Johnson, N.A., Paul, C., Adherence to and factors associated with self-care behaviours in type 2 diabetes patients in Ghana (2017) BMC Endocr Disord, 17 (1), p. 20. , 28340613 5366118; Luo, X., Liu, T., Yuan, X., Ge, S., Yang, J., Li, C., Factors influencing self-management in Chinese adults with type 2 diabetes: A systematic review and meta-analysis (2015) Int J Environ Res Public Health, 12 (9), pp. 11304-11327. , 26378555 4586677; Gurmu, Y., Gela, D., Aga, F., Factors associated with self-care practice among adult diabetes patients in west Shoa zone, Oromia regional state, Ethiopia (2018) BMC Health Serv Res, 18 (1), p. 732. , 30249246 6154910; Stephani, V., Opoku, D., Beran, D., Self-management of diabetes in sub-Saharan Africa: A systematic review (2018) BMC Public Health, 18 (1), p. 1148. , 30268115 6162903; Steyl, T., Phillips, J., Management of type 2 diabetes mellitus: Adherence challenges in environments of low socio-economic status (2014) Afr J Prim Health Care Fam Med, 6 (1), pp. 1-7; Murphy, K., Chuma, T., Mathews, C., Steyn, K., Levitt, N., A qualitative study of the experiences of care and motivation for effective self-management among diabetic and hypertensive patients attending public sector primary health care services in South Africa (2015) BMC Health Serv Res, 15 (1), p. 303. , 26231178 4522057; Mendenhall, E., Norris, S.A., Diabetes care among urban women in Soweto, South Africa: A qualitative study (2015) BMC Public Health, 15 (1), p. 1300. , 26706228 4691296; Adeniyi, O.V., Yogeswaran, P., Wright, G., Longo-Mbenza, B., Diabetic patients' perspectives on the challenges of glycaemic control (2015) Afr J Prim Health Care Fam Med, 7 (1), pp. 1-8; Masupe, T., Ndayi, K., Tsolekile, L., Delobelle, P., Puoane, T., Redefining diabetes and the concept of self-management from a patient's perspective: Implications for disease risk factor management (2018) Health Educ Res, 33 (1), pp. 40-54. , 1:STN:280:DC%2BC1MzovV2nuw%3D%3D 29315392 6018984; Okonta, H.I., Ikombele, J.B., Ogunbanjo, G.A., Knowledge, attitude and practice regarding lifestyle modification in type 2 diabetic patients (2014) Afr J Prim Health Care Fam Med, 6 (1), pp. 1-6; Adegbola, S.A., Marincowitz, G.J., Govender, I., Ogunbanjo, G.A., Assessment of self-reported adherence among patients with type 2 diabetes in Matlala District Hospital, Limpopo Province (2016) Afr J Prim Health Care Fam Med, 8 (1), pp. e1-e5. , 27543285; (2016) City of Tshwane, 2016/17 IDP, , City of Tshwane; Massyn, N., Tanna, G., Day, C., Ndlovu, N., (2018) District Health Barometer: District Health Profiles 2017/18, , Health Systems Trust Durban; Mutyambizi, C., Pavlova, M., Hongoro, C., Booysen, F., Groot, W., Incidence, socio-economic inequalities and determinants of catastrophic health expenditure and impoverishment for diabetes care in South Africa: A study at two public hospitals in Tshwane (2019) Int J Equity Health, 18 (1), p. 73. , 31118033 6530010; O'Donnell, O., Van Doorslaer, E., Adam, W., Lindelow, M., (2008) Analyzing Health Equity Using Household Survey Data, , The World Bank Washington DC; O'Donnell, O., O'Neill, S., Van Ourti, T., Walsh, B., Conindex: Estimation of concentration indices (2016) Stata J, 16 (1), p. 112. , 27053927 4819995; Labadarios, D., Steyn, N.P., Nel, J., How diverse is the diet of adult south Africans? (2011) Nutr J, 10 (1), p. 33. , 21496326 3094278; Kennedy, G.L., (2009) Evaluation of Dietary Diversity Scores for Assessment of Micronutrient Intake and Food Security in Developing Countries; Hatløy, A., Torheim, L., Oshaug, A., Food variety - A good indicator of nutritional adequacy of the diet? A case study from an urban area in Mali, West Africa (1998) Eur J Clin Nutr, 52 (12), p. 891. , 9881884; Steyn, N., Nel, J., (2006) Dietary Intake of Adult Women in South Africa and Nigeria with A Focus on the Use of Spreads, , South African Medical Research Council Tygerberg; Steyn, N., Nel, J., Nantel, G., Kennedy, G., Labadarios, D., Food variety and dietary diversity scores in children: Are they good indicators of dietary adequacy? 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PY - 2020/1/28

Y1 - 2020/1/28

N2 - This study aims to assess the diabetes self-care behaviours of patients attending two tertiary hospitals in Gauteng, South Africa. The study also seeks to estimate the inequalities in adherence to diabetes self-care practices and associated factors. Methods: A unique health-facilities based cross-sectional survey was conducted amongst diabetes patients in 2017. Our study sample included 396 people living with diabetes. Face-to-face interviews were conducted using a structured questionnaire. Diabetes self-management practices considered in this study are dietary diversity, medication adherence, physical activity, self-monitoring of blood-glucose, avoiding smoking and limited alcohol consumption. Concentration indices (CIs) were used to estimate inequalities in adherence to diabetes self-care practices. Multiple logistic regressions were fitted to determine factors associated with diabetes self-care practices. Results: Approximately 99% of the sample did not consume alcohol or consumed alcohol moderately, 92% adhered to self-monitoring of blood-glucose, 85% did not smoke tobacco, 67% adhered to their medication, 62% had a diverse diet and 9% adhered to physical activity. Self-care practices of dietary diversity (CI = 0.1512) and exercise (CI = 0.1067) were all concentrated amongst patients with higher socio-economic status as indicated by the positive CIs, whilst not smoking (CI = - 0.0994) was concentrated amongst those of lower socio-economic status as indicated by the negative CI. Dietary diversity was associated with being female, being retired and higher wealth index. Medication adherence was found to be associated with older age groups. Physical activity was found to be associated with tertiary education, being a student and those within higher wealth index. Self-monitoring of blood glucose was associated with being married. Not smoking was associated with being female and being retired. Conclusion: Adherence to exercising, dietary diversity and medication was found to be sub-optimal. Dietary diversity and exercise were more prevalent among patients with higher socio-economic status. Our findings suggest that efforts to improve self- management should focus on addressing socio-economic inequalities. It is critical to develop strategies that help those within low-socio-economic groups to adopt healthier diabetes self-care practices

AB - This study aims to assess the diabetes self-care behaviours of patients attending two tertiary hospitals in Gauteng, South Africa. The study also seeks to estimate the inequalities in adherence to diabetes self-care practices and associated factors. Methods: A unique health-facilities based cross-sectional survey was conducted amongst diabetes patients in 2017. Our study sample included 396 people living with diabetes. Face-to-face interviews were conducted using a structured questionnaire. Diabetes self-management practices considered in this study are dietary diversity, medication adherence, physical activity, self-monitoring of blood-glucose, avoiding smoking and limited alcohol consumption. Concentration indices (CIs) were used to estimate inequalities in adherence to diabetes self-care practices. Multiple logistic regressions were fitted to determine factors associated with diabetes self-care practices. Results: Approximately 99% of the sample did not consume alcohol or consumed alcohol moderately, 92% adhered to self-monitoring of blood-glucose, 85% did not smoke tobacco, 67% adhered to their medication, 62% had a diverse diet and 9% adhered to physical activity. Self-care practices of dietary diversity (CI = 0.1512) and exercise (CI = 0.1067) were all concentrated amongst patients with higher socio-economic status as indicated by the positive CIs, whilst not smoking (CI = - 0.0994) was concentrated amongst those of lower socio-economic status as indicated by the negative CI. Dietary diversity was associated with being female, being retired and higher wealth index. Medication adherence was found to be associated with older age groups. Physical activity was found to be associated with tertiary education, being a student and those within higher wealth index. Self-monitoring of blood glucose was associated with being married. Not smoking was associated with being female and being retired. Conclusion: Adherence to exercising, dietary diversity and medication was found to be sub-optimal. Dietary diversity and exercise were more prevalent among patients with higher socio-economic status. Our findings suggest that efforts to improve self- management should focus on addressing socio-economic inequalities. It is critical to develop strategies that help those within low-socio-economic groups to adopt healthier diabetes self-care practices

KW - Adherence

KW - Article

KW - Determinants

KW - Diabetes

KW - Inequalities

KW - Self-care behaviours

KW - South Africa

KW - adult

KW - age distribution

KW - clinical practice

KW - controlled study

KW - cross-sectional study

KW - diabetes mellitus

KW - dietary compliance

KW - dietary pattern

KW - exercise

KW - female

KW - food frequency questionnaire

KW - glycemic control

KW - health care facility

KW - health care quality

KW - health education

KW - human

KW - insulin

KW - major clinical study

KW - male

KW - medication compliance

KW - middle aged

KW - oral antidiabetic agent

KW - patient compliance

KW - physical activity

KW - public hospital

KW - quality of life

KW - self care

KW - self monitoring

KW - sex difference

KW - smoking

KW - smoking cessation

KW - social status

KW - unemployment

KW - young adult

KW - MEDICATION

KW - BLOOD-GLUCOSE

KW - MANAGEMENT

KW - URBAN

KW - ADULTS

KW - FOOD VARIETY

KW - MELLITUS

U2 - 10.1186/s12902-020-0492-y

DO - 10.1186/s12902-020-0492-y

M3 - Article

C2 - 31992290

SN - 1472-6823

VL - 20

JO - BMC Endocrine Disorders

JF - BMC Endocrine Disorders

IS - 1

M1 - 15

ER -

Inequalities and factors associated with adherence to diabetes self-care practices amongst patients at two public hospitals in Gauteng, South Africa

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