Study Area and period
The Study was conducted in Dire Dawa Administrative city from the1st of February to the 1st of March 2018. Dire Dawa is located in the Eastern part of the country enclosed by Ethiopian Somalia and the State of Oromia. It is 515 kilometers from Addis Ababa and 47 kilometers from Harar town. It has hot temperature with a mean of 25 degree centigrade. Based on the 2007 Census, the total population of Drie Dawa Administrative is 395,000 of which females account 51.6%
It has 9 urban kebeles (small administrative unity of Ethiopia) and 38 rural kebeles. In terms of distribution of health facilities, the City has two governmental and 4 private hospitals and 8 health centers. There are 6 specialty units (internal medicine, surgery, gynecology/ obstetrics, pediatrics, dentistry, and psychiatry) run by the hospitals. Besides these, the hospital has many follow-up clinics for both pediatric and adult patients. Diabetic clinic is one of such chronic follow-up clinics. The service is rendered by physician and nurses and 2171 Diabetic patients were registered for follow-up in the past one year
Institutional based cross- sectional study design was conducted.
Inclusion and Exclusion criteria
All adults with diabetes who has one year follow up and came in to diabetic clinics was included in the study.
Those adults with diabetes who are critically and mentally ill, pregnant women’s and newly diagnosed adults with DM was excluding.
Sample Size Determination and sampling procedures
The required sample size is determined by using a formula for single population proportion by taking different p values from different studies; and the sample size for some of the factors for diabetic self-care practices obtained from different literatures was calculated by Epi Info 7 menu statically, by considering the following assumptions: confidence level 95%, power 80% and exposed to unexposed ratio of 1. So, the sample size for this study was 466 by adding non-response rate of 10% the final sample size was 513.
In the study area there are two governmental hospitals (SGH=Sabian General Hospital and DCRH=Dill Chora referral hospital) and these two governmental hospitals was selected purposively. These two hospitals have separate clinics for diabetes follow-up. The numbers of study participants from the selected health facilities was determined from the previous total number of diabetic patients who have follow up which is 2171 in two hospitals.
Samples were allocated to each of the selected Hospitals based on proportional allocation to sample size. The lists of respondents or sampling frame were obtained from the updated registration books of each follow up clinics of the hospitals. After establishing the sampling frames of respondents, simple random sampling technique was used to identify the study unit to be included to the study. Adults with Diabetes was selected by computer method using updated registration books as sampling frame until reach 513 samples.
Data collection tools
Six trained nurses conducted the interview using a structured pretested questionnaire. The PI and an assistant supervised the data collection. Face to face interviewer administered validated questionnaire was used to measure self-care practice and which was contextualized to the study area. It was prepared originally in English and was translated to Amharic, and then translated back to English for checking the consistency of the questionnaire. The questionnaire consists of socio demographic variables which contains (8 items), health-related variables having (14 items), diabetic knowledge which accounts from (15 items), treatment satisfaction which consists of (6 items) and self-care practice which contains (15 items).
Data collection was carried out by 6 diploma Nurse Data collectors and 2 BSC Nurse Supervisors for a period of one month.
Data Collection Technique
The data collection was conducted in an institution-based exit interview by using pre-tested Amharic, and English questionnaires. All the necessary trainings were provided for the data collectors and Supervisors by the principal investigator. All adults with diabetes who are selected and fulfill the inclusion criteria were interviewed. Confidentiality and privacy were kept. The purpose of data collection and importance of the study was told to the participants in order to maximize the response rate and generate quality data as intended.
Data Processing and Analysis
The collected data was checked by the principal investigator, and then data was coded, entered and cleaned using Epi Data version 3.3.1 software and finally exported into SPSS version 22.0 software for analysis. Descriptive statistics of different variables was determined and the result was presented in tables and graphs using summary measures such as percentages mean and median. Binary logistic regression was used for the analysis of outcome variable.
A Hosmer-Lemeshow and Omnibus test was done to test for model fitness. Bivariate logistic regression was carried out to identify the factors associated with diabetic self-care practice.
All variables were taken into the multivariable model by considering a p-value of ≤ 0.25, context and previous studies to control for all possible confounders and multivariate stepwise logistic regression was applied to see the independent effect of each variable on the outcome variable. Multi co-linearity test was carried out to see the correlation between independent variables using standard error and one of the independent variables was dropped for those with standard error of > 2. Finally, the result of bivariate and multivariable logistic regression analysis was presented in a crude and adjusted odds ratio with 95% confidence intervals. All tests were two-sided and P ≤ 0.05 was considered statistically significant.
Self-care Practices: It is the practice of activities that individual diabetics will initiate and perform on their own behalf in controlling their disease, maintaining life, health and wellbeing (10)
Good Self-Care Practices: individuals who have scored mean and above the mean value of the total 15 self-care practice questions. These 15 items which evaluates the status of patients’ self-care during the last seven days. Responses in each subscale were based on 7-days, ranged from 0 to7, the higher number was indicative of days reflecting better self-care operation. The minimum score is 0 and the maximum score in this tool is105, which is indicative of the highest quality of self-care
Knowledge about Diabetes: Is measured by fifteen items in yes-no format. Correct answer will be given “1” and “0” is given for incorrect and don’t know. Then a total score is computed out of fifteen marks (with the range of 0-15) those who Score mean and above the mean have a good knowledge where as those score below the mean value have not good knowledge (11)