Approval from the institutional review board was obtained from King Saud University prior to the start of the study. Consent was received from all patients via a consent form to allow for inclusion of their non-identifiable information in the study. This is a cross sectional study of type 1 and 2 adult diabetic patients, aged 18 years or older, conducted between May 2018 and December 2018 in Riyadh, Saudi Arabia. A list of all 418 primary care centers in the Riyadh region was drawn up from the Ministry of Health website. The list was further filtered to include only centers inside Riyadh City. A random number table was used to select 50 primary care centers from each region of Riyadh City (West, East, Center, North, South). In addition, two university hospitals in Riyadh; King Khalid University Hospital and King Abdulaziz University Hospital were included
Sample Size and Sampling Technique
The sample size was calculated using Roasoft using the single proportion sample size formulae, where precision is 5%, with a 95% confidence interval and the percentage of diabetic patients with significant knowledge was assumed to be 85%. Participants were selected by the systematic random sampling method. All patients that attended the previously selected centers during the selected period of the study were included.
The demographic variables included in the study were: gender, age, marital status, educational level, and monthly income. The Knowledge, Attitude, and Practice − 45 points (KAP-45) questionnaire was formulated by Sheeja Susan John et al.12 Permission to use the KAP-45 questionnaire was granted after communication with its main authors. The KAP-45 questionnaire is divided into: 13 questions in the knowledge section (five to assess patient knowledge of diabetes and eight to assess patient knowledge of diabetic retinopathy), eight questions in the attitude section (four to assess patients’ attitude towards diabetes and four to assess patients’ attitude towards diabetic retinopathy), and 24 questions in the practice section (six to assess patients’ practice patterns regarding diabetes and 18 to assess patients’ practice patterns regarding diabetic retinopathy). Some of the questions in the knowledge and practice sections of the questionnaire were constructed as open-ended questions, whereas questions in the attitude section were framed as statements.
Participants were categorized as having “sufficient knowledge” if they answered nine or more of the “must know” questions regarding diabetes and if they answered five or more of the “must know” questions regarding diabetic retinopathy. In addition, participants were categorized as having “good practice” if they answered four or more of the “must do” questions regarding diabetes and if they answered four or more from the “must do” questions regarding diabetic retinopathy. In the attitude section of the questionnaire, participants were categorized as having a “positive attitude” when they scored a three or higher from responses best indicative of a positive attitude statements toward diabetes and diabetic retinopathy.
The KAP-45 questionnaire was validated by a face validity method into Arabic. Two bilingual Arabic-English speakers translated the original English version of the questionnaire into Arabic, then an expert committee was formed to review and culturally adapt the KAP-45 questionnaire. Lastly, feedback from the pilot was taken into consideration to finalize the Arabic version of KAP-45 questionnaire.
The analysis was performed using SPSS version 22.0 software (SPSS Inc., Chicago, IL, U.S.), which helped calculate the demographics and responses to the questionnaire. Categorical data was expressed as frequencies and percentages. Continuous data was expressed using median and interquartile range (IQ) or mean and standard deviation (SD), as appropriate. Chi-Squares and Fischer's exact tests were used to compare between the variables, A P-value of less than 0.05 was considered statistically significant for all analyses.