Study area and period
The study was conducted in four public hospitals (Aksum University Referral Hospital, Saint Marry Hospital, Adwa Hospital, and Abyi-adi Hospital) of the central zone, from April one to March one 2018. These hospitals are providing a follow-up service for a total of 1600 diabetic patients.
Study design
A hospital-based cross-sectional study design was carried out among diabetes mellitus patients.
Population
The Source population was all diabetic mellitus patients who were on follow-up at the general public Hospitals of the central zone of Tigray during the data collection period and the Study population was all selected diabetes mellitus patients who were on follow-up at the general public Hospitals of the Central zone of Tigray, Ethiopia.
Sample size determination
Sample size was determined using single population proportion formula using EPI Info software version 7.1.1. Confidence level, 95%, marginal error (d) 5% and prevalence was taken from a study conducted in South Gondar, Northwest, and Ethiopia in 2015 which was 21.4% of good practice in hypoglycemia prevention (25). By adding 5% non-response rate the final size was 272.
Sampling procedure and techniques
The sample size was proportionally distributed into each hospital based on the number of diabetic patients on follow-up in each of them. Then, sampling interval was calculated by dividing the total number of diabetic patients in the selected hospitals to the required sample size (K = N/n). Participants were selected by systematic random sampling every Kth interval. However, the first individual participant was selected using simple random sampling technique by lottery method.
Data collection tool and technique
The data collection tool was adapted from similar literatures (25, 27, 28). The questionnaire had three parts. Part I contained socio-demographic data. Part II included health related data, knowledge on hypoglycemia and attitude towards diabetes mellitus of participants. Knowledge on hypoglycemia was assessed using 8 questions and participants score ranges from 0 to 8. Attitude towards Diabetes mellitus was assessed using 5 Likert scale questions. Part III contained hypoglycemia prevention practice. Hypoglycemia prevention practice was determined using 11 questions with only one possible answer. Data was collected through face to face interview using the structured questionnaire by four B.Sc. nurses with two supervisors.
Data quality assurance
The questionnaire was initially prepared in English, then translated into the local language (Tigrigna) by an individual who has a good ability of the two languages, then translated back to English by the different person to ensure consistency. Two days training was given for data collectors and supervisors. A week prior to the actual data collection period, the questionnaire was pre-tested on 5% of the total sample size outside the study area. The collected data were checked manually at the spot and cleaned in the SPSS for its completeness.
Data processing and analysis
Data was coded and entered into Epi-Data version 3.1 and then it was exported to SPSS version 22.0 for further analysis. Binary logistic regression model was used to identify the predictors of hypoglycemia prevention practice. Variables which were potential independent predictors on bi-variate analysis with P-value ≤ 0.2 were entered to multivariable logistic regression analysis. Finally, the magnitude of association between the dependent and independent variables was measured using odds ratios AOR with 95% confidence interval and statistical significance was declared at P-Value < 0.05.
Operational definitions
Good practice; participants who scored mean and above from the hypoglycemia prevention practice questions
Poor practice; participants who scored below the mean value from the hypoglycemia prevention practice questions (25). Mean score was calculated out of 12 by adding each participant’s score on the hypoglycemia prevention practice questions and dividing it to the total number of participants.
Good knowledge; mean and above knowledge score of participants from the knowledge questions on hypoglycemia
Poor knowledge; less than mean knowledge score of participants from the knowledge questions on hypoglycemia. Mean knowledge score was calculated out of 7.Favorable attitude; mean and above score of participants from the attitude questions towards diabetes mellitus.
Unfavorable attitude: less than mean score of participants from the attitude questions towards diabetes mellitus.
Ethical consideration
Ethical clearance was obtained from the Institutional Review Board of Aksum University, college of health science. Permission was obtained from the medical directors of the respective public hospitals. Verbal consent was obtained from each of the study participants. Respondents were allowed to refuse or discontinue participation at any time they want. Information was recorded anonymously. Confidentiality and privacy were ensured throughout the study.