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ORIGINAL ARTICLE
Year : 2019  |  Volume : 6  |  Issue : 2  |  Page : 40-44

Attitude and practice toward diabetic retinopathy among omani population


Department of Optometry, College of Health Sciences, University of Buraimi, Al Buraimi, Oman

Date of Submission02-May-2020
Date of Acceptance02-Sep-2020
Date of Web Publication27-Nov-2020

Correspondence Address:
Dr. Gopi Suresh Vankudre
University of Buraimi, Al Buraimi
Oman
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DOI: 10.4103/bijo.bijo_4_20

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  Abstract 


Background: Poor patient compliances toward diabetic retinopathy (DR)-related care are associated with the barriers at a personal, interpersonal, societal, organizational, or a policy level. The personal factors contributing to noncompliance are linked with their negative attitude toward the disease management.
Materials and Methods: It is a cross-sectional, questionnaire-based, prospective study. The study involved 232 participants from different provinces in Oman and with different socioeconomic and educational levels through a convenient sampling method. Participants' attitude toward DR was assessed using the responses for the provided statement related to the condition through a self-designed and validated questionnaire.
Statistical Analysis Used: The Shapiro–Wilk normality test was applied and observed the nonnormal distribution of the attitude scores. Hence, the nonparametric Mann–Whitney U test was applied to compare the percentage score with the independent groups of the study. Practicing pattern of the participants having a personal or family history of diabetes mellitus was evaluated using descriptive statistics.
Results: Two hundred and thirty-two participants having mean age of 31.12 (standard deviation [SD] = 12.02) years responded to the questionnaire, of which 39.22% were male and 60.78% were female. The mean percentage attitude score was 83.09 (SD = 12.90, 24.44–100). About 82% of the study participants had a very positive attitude. Very few (12.73%) were noncompliant toward routine ocular examination. 82% of the study participants had a positive attitude and 87.27% were positively following eye care visits.
Conclusions: Majority of the study participants have positive attitude toward the management of DR and practice for follow-up eye care visits as recommended by their eye care practitioners. DR-related health promotional activities within the population having lower educational status can support in improving their compliance.

Keywords: Diabetic retinopathies, diabetic retinopathy-related attitude and practice, diabetic retinopathy-related patient compliance


How to cite this article:
Vankudre GS, Ismail G, Al-Maamari NS. Attitude and practice toward diabetic retinopathy among omani population. Albasar Int J Ophthalmol 2019;6:40-4

How to cite this URL:
Vankudre GS, Ismail G, Al-Maamari NS. Attitude and practice toward diabetic retinopathy among omani population. Albasar Int J Ophthalmol [serial online] 2019 [cited 2021 Sep 19];6:40-4. Available from: https://www.bijojournal.org/text.asp?2019/6/2/40/301682




  Introduction Top


“The Middle East and North African” region is the second leading prevalent region for diabetes mellitus (DM).[1] The increasing prevalence of DM in Oman has become a major public health issue. Furthermore, higher life expectancy and associated complications of visual impairments due to diabetic retinopathy (DR) are also contributing to this disease burden.[2] Prior studies have observed the community's poor compliance toward the routine ocular examinations and have recommended, monitoring the implemented health initiatives such as condition-related health promotions.[2] Poor patient compliances are associated with the barriers at a personal, interpersonal, societal, organizational, or at a policy level.[3] The personal factors contributing to noncompliance are linked with the disease-related knowledge, attitude, and practice of the at-risk community.[3] Hence, this study provides an insight into one of these personal barriers and focuses on the community's attitude toward the management of DR.

A previous study has stressed the importance of following disease-related preventive measures to avoid future complications associated with DM of regularly controlling the blood sugar level.[4] Having adequate condition-related knowledge and a positive attitude toward treatment protocol can further enhance such control measures. The other regional studies assessed the knowledge, attitude, and practice of the health-care professionals during the management of diabetic patients.[5] A hospital-based study evaluating the knowledge, attitude, and practice of the at-risk community highlighted the importance of including the population from different provinces of the region.[6] Moreover, it is also necessary to evaluate the type and degree of positive attitude among the population of having DM. Despite the poor compliance toward eye care, a study has also highlighted the positive association between patient attitude and their practicing pattern among the diabetic population.[7]

The evaluation of attitude toward DR helps in understanding the impact of health promotional initiatives. Quantification of the attitude scores further provides a degree of positive attitude among the community and its association with their socioeconomic profiles. These findings of association between community's DR related attitude with their socioeconomic profiles can support in designing the future DR-related health promotional initiatives for improving patient compliance.

Hence, considering the importance of enhancing patient compliance toward eye care among at-risk communities of DR, this study aims to evaluate the community's attitude and practicing pattern toward the management of DR. The study also highlights the current gap between the attitude and practice within the community.


  Materials and Methods Top


It is a cross-sectional, questionnaire-based, prospective study. The study proposal obtained the necessary permissions from the Research and Ethics Committee, College of Health Sciences of a university in Oman. Prior consent was obtained from the interested participants. The study involved 232 participants from different provinces in Oman and with different socioeconomic and educational levels through a convenient sampling method. Participants aged 18 years and above from different regions were included in the study. The study was conducted from March 2018 to September 2018. The study followed the ethical guidelines set in the Declaration of Helsinki. It ensured the dignity of the participants, beneficence, and benefits or research burden in an equitable manner. All involved participants were above 18 years of age and able to decide on participating in the study. We used the validated study instruments which ensured the psychological and physical safety of the study participants. We also did not provide any monetary or nonmonetary benefits to the involved participants to limit the study bias. We excluded vulnerable population from the study. Study briefs were explained to involved participants before their inclusion in the study. We ensured the confidentiality of their data poststudy. A pilot study with the questionnaire was conducted to ensure the elimination of sensitive issues. The study benefits were also explained by all the participants.

Open Source Epidemiologic Statistics for Public Health Version 3.01 (Updated 06/04/2013), Center for Disease Control and Prevention, the United States, was used to calculate the sample size. A diabetic prevalence of 20% at a confidence interval of 95% is considered to calculate the sample size.

Participants' attitude toward DR was assessed using the responses for the provided statement related to the condition through a self-designed questionnaire based on the literature review.[2],[6],[7],[8],[9] A five-point Likert scale-strongly disagree (1) to strongly agree (5) was used to collect the responses for evaluating the attitude component related to the condition. The statements were focused on understanding the participant's attitude toward the need for ocular examination in different phases of glycemic control, impact on the visual acuity, dilated ocular examination, need to keep the updated records, obtaining further condition-related information, and providing it to the other at-risk population. Cronbach's alpha = 5% was used for assessing the internal consistency of the attitude section (95% confidence interval).

To evaluate condition-related practicing patterns within the community, responses in the practice section were collected only from the participants having personal or family DM history. The interview responses were focused on the practice related to ocular examination, follow-up, and type of treatment followed by the participants. This component consisted of a total of 11 questions. Patient responses were obtained using hard copies and then stored in soft copy form using Microsoft Excel 2013 in two separate personal computers. The attitude scores were assessed for the participants from the nonmedical background. We analyzed Likert's responses obtained for evaluating the participant's attitude toward DR. The total attitude score was given for each participant and further, it was converted to percentage scores. Percentage attitude score <25%, ≥25%<50%, ≥50%<75%, and ≥75% is considered very negative, negative, positive, and very positive attitude, respectively. The association of the factors responsible for the attitude toward the management of DR was analyzed using multiple regression analysis. “P” value of <0.05 was considered as statistically significant at a confidence interval of 95%. The analysis is represented in a tabular format as per gender, occupation, age group, and region and with different socioeconomic backgrounds. Patients' practice related to DR care was assessed for the participants having a personal or family history of DM. Descriptive statistics were performed to analyze the DR-related practicing pattern among the study participants.


  Results Top


Sociodemographic profile of study participants

Two hundred and thirty-two participants having mean age of 31.124 (standard deviation [SD] = 12.02) responded to the questionnaire, of which 39.22% were male and 60.78% were female. 70.26% (n = 163) of the study population were not having any medical background. 14.7% had a personal and 74.1% had a family history of DM. As per the national population statistics of Oman province mean population size of 252134.5,[10] and for comparing the attitude scores among regions, the provinces of Muscat, Al Batinah North, Al-Dakhiliyah, and Al Batinah South were categorized as having high population size and the other provinces, namely “Dhofar, Ash Sharqiyah South, Ash Sharqiyah North, Al Dhahirah, Al-Buraimi, Al-Wusta, and Musandam” were categorized as the regions of low population density.

Attitude toward diabetic retinopathy among study participants

Type of diabetic retinopathy-related attitude among the study participants

The mean percentage attitude score was 83.09 (SD = 12.90, 24.44–100). Only 0.5% of the study participants had a very negative attitude toward DR-related eye care, whereas 82% of the study participants had a very positive attitude [Figure 1].
Figure 1: Type of diabetic retinopathy-related attitude among the study participants

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Comparison of attitude scores with the independent study variables

The Shapiro–Wilk normality test was applied and observed the nonnormal distribution of the attitude scores. Hence, the nonparametric Mann–Whitney U test was applied to compare the percentage score with the independent groups of the study. Positive attitude scores were associated with only a higher self or fathers' educational level. The association of percentage attitude scores with other independent study variables was observed to be statistically insignificant [Table 1].
Table 1: Comparison of the participant's attitude scores with the independent study variables

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Diabetic retinopathy-related practicing pattern among study participants

Responses regarding the practicing pattern were obtained from requested from 176 participants who themselves or had a family history of DM. [Table 2] provides the eye care visit profile of the participants with personal or family history of DM. [Table 3] provides the descriptive statistics of the compliance pattern toward the recommended care among these study participants.
Table 2: Eye care visit profile of the participants with personal or family history of diabetes mellitus

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Table 3: Compliance toward the recommended care by participants with personal or family history of diabetes mellitus

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  Discussion Top


The study aimed to identify the attitude and practicing pattern toward DR among the Omani community. Most of the participants (82%) had a positive attitude toward the compliance required for DR [Figure 1]. The parental or self-educational level was associated with positive attitudes. The association of percentage attitude scores with other independent study variables was observed to be statistically insignificant. In the study done by Al Zarea, there was a statistically significant association between knowledge and attitude.[6] The author also observed that 73.80% of the study population mentioned that there is a need to follow the ocular examinations regularly and 65.10% mentioned that they should only visit the ophthalmologist after the occurrence of an ocular complication.[6] About 68.79% stated that timely treatment is necessary to avoid or delay future complications.[6] This reflects that the majority of our study participants have a positive attitude toward eye care related to the condition.

We requested the responses from 176 participants having family or personal history of DM, of which we received responses from 110 participants and very few (12.73%) were noncompliant toward routine ocular examination. A previous study done in Oman had observed the noncompliance rate of 48%.[9] This highlights the improved compliance rate among the community. Other studies conducted in different regions had observed the variations in follow-up compliance. Srinivasan et al. conducted a study in India observed the noncompliance of 61.10% toward routine ocular examinations,[7] whereas 95% of participants of the study done by Al Zarea followed regular ocular examinations.[6] Hence, despite having a higher level of follow-up compliance compared to the majority of the reviewed studies, there is still a further scope to stress the importance of compliance toward recommended care and uptake of eye care professional's advice.

This study found a very narrow gap between the patient attitude and their compliance with the follow-up eye care visits. Eighty-two percent of the study participants had a positive attitude [Figure 1] and 87.27% [Table 3] were positively following eye care visits. This gap between attitude and practice is very narrow compared to other studies, however our study had a higher nonresponse rate while evaluating the participants' practicing pattern. In a study done among the Indian population, 54.9% had a good practicing pattern, despite only 29.2% of study population having a positive attitude.[7] Similarly, in another study, 73.80% of population has highlighted the importance of routine ocular examinations and 95% of all the study population followed it regularly.[6] It is interesting to note that compliance to ocular examinations' follow-up is higher than the level of attitude in these studies.

Our study provides quantitative evidence on attitude toward eye care within the at-risk community. It also categorizes the degree of attitude with the sociodemographic profile of the participants. As observed from the study, the positive attitude is associated with a higher educational level. Hence, it is also necessary to conduct the health promotional initiatives within the population having a lower educational status to improve their eye care compliance.

The study involves the general population from the different provinces of Oman compared to the hospital-based population. However, the results of this study cannot be generalized due to the convenient sampling procedure considered in this study and due to the higher nonresponse rate while evaluating the practicing pattern of the participants. Moreover, qualitative studies evaluating the barriers to the uptake of eye care services at a personal, interpersonal, societal, organizational, or at a health policy level can be useful.[3] Further regional, culturally appropriate health promotional initiatives to enhance the community's uptake of eye care services support in reducing the DR-related disease burden.[3]


  Conclusions Top


Majority of the study participants have positive attitude toward the management of DR and practice for follow-up eye care visits as recommended by their eye care practitioners. DR-related health promotional activities within the population having lower educational status can support in improving their compliance.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Al-Lawati JA. Diabetes mellitus: A local and global public health emergency! Oman Med J 2017;32:177-9.  Back to cited text no. 1
    
2.
Khandekar RB, Al-Lawati JA. Epidemiology of diabetic retinopathy in Oman: Two decades of research. Oman J Ophthalmol 2015;8:1-2.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Piyasena MM, Murthy GV, Yip JL, Gilbert C, Peto T, Premarathna M, et al. A qualitative study on barriers and enablers to uptake of diabetic retinopathy screening by people with diabetes in the Western Province of Sri Lanka. Trop Med Health 2019;47:34.  Back to cited text no. 3
    
4.
Khandekar R, Lawati JA, Barakat N. A retrieval system for patients with avoidable blindness due to diabetic retinopathy who do not present for ophthalmic assessment in Oman. Middle East Afr J Ophthalmol 2011;18:93.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Khandekar R, Shah S, Al Lawatti J. Retinal examination of diabetic patients: knowledge, attitudes and practices of physicians in Oman. East Mediterr Health J 2008;14:850-7.  Back to cited text no. 5
    
6.
Al Zarea BK. Knowledge, attitude and practice of diabetic retinopathy amongst the diabetic patients of aljouf and hail province of Saudi Arabia. J Clin Diagn Res 2016;10:NC05-8.  Back to cited text no. 6
    
7.
Srinivasan NK, John D, Rebekah G, Kujur ES, Paul P, John SS. Diabetes and diabetic retinopathy: Knowledge, attitude, practice (KAP) among diabetic patients in a tertiary eye care centre. J Clin Diagn Res 2017;11:NC01-7.  Back to cited text no. 7
    
8.
Ismaile S, Alhosban F, Almoajel A, Albarrak A, Househ M. Knowledge, attitude and practice tools for health education among diabetic patients. Stud Health Technol Inform 2017;238:250-2.  Back to cited text no. 8
    
9.
Khandekar R, Harby SA, Harthy HA, Lawatti JA. Knowledge, attitude and practice regarding eye complications and care among Omani persons with diabetes-A cross sectional study. Oman J Ophthalmol 2010;3:60-5.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Ministry of Foreign Affairs. Governorates of Sultanate of Oman; 2013. Available from: https://www.mofa.gov.om? P= 1063&lang=en [Last accessed on 2019 May 30].  Back to cited text no. 10
    


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