Main findings of study and comparison with previous literature
This was the first study in Malaysia determining the distribution of T2DM patients
who were willing to accept training to speak to their offspring to prevent diabetes
and the factors associated with it. Our study shows that 61.6% were willing to accept
training to speak to their offspring, a figure comparable to that (56%) from a previous
study in Ireland [8]. A subsequent study conducted by the same group of researchers
comparing T2DM patients in Ireland and Bahrain showed that the proportion of patients
willing to speak to their family members was significantly higher in Ireland compared
to Bahrain (75% vs. 54%, p < 0.001) [12]. These findings suggest that T2DM patients in these countries are willing
to accept training if offered. This opportunity should be explored further and a training
module for T2DM patients should be developed as a potential means of preventing diabetes
in their offspring. At present, the evidence on effectiveness of this intervention
is lacking. A randomised controlled trial is required to prove its value.
The univariate analysis from our study shows that six items from the domains of the
HBM were found to demonstrate significant trends. Some of the items were consistent
with the multivariate analysis where six variables were found to be significantly
associated with the willingness of T2DM patients to accept training to speak to their
offspring. These are i) having a family history of T2DM, ii) correctly identifying
that overweight is a diabetes risk factor, iii) correctly identifying age 40 years
old as a diabetes risk factor, iv) perceiving the benefit of speaking to offspring
to help prevent them from developing diabetes, v) perceiving not having much contact
with offspring as a barrier and vi) perceiving their offspring to not being open to
advice from them as a barrier.
T2DM patients who have a positive family history were twice as likely to be willing
to accept training compared to those who did not have a family history [Adj. OR 2.06
(95% CI: 1.27, 3.35)]. Direct comparison to other studies is not possible as no data
was presented in the same manner. Our finding is unique and highlights the importance
of targeting those with a strong family history of diabetes in our population in terms
of training them to speak to their offspring to prevent diabetes.
With regards to knowledge of risk factors, participants who had the correct knowledge
that being overweight [Adj. OR 1.49 (95%CI: 1.01, 2.29)] and age 40 years old [Adj.
OR 1.88 (95%CI: 1.22, 2.90)] are risk factors for T2DM were more likely to be willing
to accept training compared to those who did not know. Again, direct comparison to
other studies is not possible as no data was presented in similar manner. Our study
shows that enhancing knowledge of T2DM risk factors among patients would potentially
improve their willingness to accept training for diabetes prevention in their offspring.
In terms of perceived susceptibility, our univariate analysis reveals that those who
worry and perceived that their offspring were likely to get diabetes showed significant
trends in terms of willingness to accept training. However, our multivariate analysis
did not reveal that these items were significantly associated with willingness to
accept training. Direct comparison with other studies was not possible as no data
was presented in a similar presentation. However, Whitford et. al. found that Irish T2DM patients who worried about their children developing diabetes
were more likely to speak to their family members about their risk of diabetes [OR
4.37 (95% CI: 1.75, 10.92)] [8].
Regarding perceived benefits, patients who agreed that speaking to their offspring
would help them to prevent T2DM, were four times more likely to be willing to accept
training compared to those who disagreed [Adj. OR 4.34 (95%: 1.07, 17.73)]. This is
consistent with the study by Whitford et. al. which showed that patients who exhibited an increased appreciation of the benefits
of speaking to their offspring were more likely to have engaged in preventive behaviours
[8]. Perceived benefit is reflected as the individual’s estimate of a likelihood that
a given action will achieve a specific goal [17]. However, in the context of preventing
diabetes, the challenge would be to educate those who do not appreciate the importance
of speaking to their offspring.
In terms of perceived barriers, patients who were neutral with the statements ‘I do
not have much contact with my offspring’ [Adj. OR: 0.31 (95% CI: 0.12, 0.810] and
‘my offspring are not open to advice from me’ [Adj. OR: 0.63 (95% CI: 0.31, 0.84],
were more likely to be willing to accept training compared to those who agreed with
the negative statements. This is comparable to a study by Becker et. al. which found that ‘perceived barriers’ construct of the HBM to be the most powerful
construct across various preventive health study designs and behaviour [17]. However,
our findings are unique as patients who were neutral with the statements on communication
with their offspring are more likely to be willing to accept training.
Our study therefore suggests that emphasizing HBM parameters when consulting T2DM
patients in the clinical setting may lead to an increased willingness to accept training
to initiate discussion with their offspring.
Strengths and limitations of the study
The main strength of this study is the novelty of its findings in demonstrating the
willingness of T2DM patients to accept training to speak to their offspring and the
factors associated with it. Another strength is the utilisation of the DMOQ Malay
version which is a valid and reliable tool to assess the perceptions of T2DM patients
towards their offspring’s risk of developing T2DM and the possibility of prevention
based on the HBM. One of the study limitations was that the DMOQ Malay version could
only be administered to participants who were able to read and understand the Malay
language. As a result of this, a majority of patients who were included in this study
were of the Malay ethnic group. Thus, findings of this study would only be generalisable
to the T2DM patients who could read and understand the Malay language. Another limitation
was the use of non-probability sampling method which could be vulnerable to sampling
bias. However, efforts were made to invite all patients with T2DM in the waiting area
of both clinics to participate in this study during the data collection period.
Implications for clinical practice and future research
Findings from this study suggest that T2DM patients in Malaysia are willing to accept
training if offered. A training module should be developed to train T2DM patients
to speak to their offspring as a potential means of preventing diabetes. Due to the
potential of social influence within families as shown in this study, interventions
should be designed with the goals to enhance knowledge, attitude and skills of T2DM
patients to become family health educators and model healthy behaviours. It should
also facilitate intra-familial communication about risk-reducing behaviours. The module
should include i) strengthening knowledge on diabetes risk factors, ii) improving
attitude and perception towards the benefit of speaking to offspring to help prevent
them from developing diabetes and iii) enhancing communication skills to speak to
their offspring. Future research should include a pragmatic randomised controlled
trial to evaluate the effectiveness of the training module. There is also a need for
further research to explore the views of perceived diabetes risk in the offspring
of T2DM patients and their willingness to engage in preventive lifestyle behaviour.