Respondent characteristics
This study involved a total of 166 participants of this (54.8%) were males while the remaining (45.2%) were females. Most of respondents (29.5%) were between the ages of 18-27 years with a mean age of 38.46±13.8 years. There is no gender difference (p= 0.778) among the age groups. Greater than half of the respondents (56.6%) were married and 33.7% were single. There is a gender difference in marital status (p=0.02). Most of the study samples (31.32%) completed their primary (1-8 grades) and secondary (9-12 grades) education. Almost half (48.8%) of the participants were living with DM for 1-5 years with a mean (SD) of 2.51 ± 0.89 years and there was a significant gender difference with durations of the diseases (p=0.002). Majority (58.4%) of the respondents used insulin therapy for about 1-5 years with a mean (SD) duration of 2.31 ± 0.76 years. There was a substantial gender difference with insulin therapy (p<0.001). More than half (55.4%) of the participants had to pay for getting insulin (Table 1).
Knowledge score
The mean knowledge score of the study subjects on insulin storage and handling techniques was found to be 9.16 ± 2.58 (out of 14) (65.4%) (Fig. 1). Most of the participants (44%) had moderately adequate knowledge, while 31.3% had adequate knowledge and the remaining (24.7%) had inadequate knowledge. One-way ANOVA was conducted to compare the effect of education level, ways of instruction of insulin injection, insulin therapy duration, and assessing insulin storage on the level of knowledge for insulin storage and administration techniques. There was a substantial effect of the level of education [F (3, 162) = 7.283, p<0.001], ways of instruction of insulin injection [F (2, 163) =3.32, p = 0.039], insulin therapy duration [F (3,162) = 3.59, p= 0.015], and assessing insulin storage [F (2,163) = 4.45, p = 0.013] on level of knowledge for insulin storage and administration techniques. The post hoc comparisons using Tukey HSD test showed that the mean score for joined colleges and above (mean (M) = 10.5, SD = 2.89) was significantly different than the Illiterates (M = 8.00, SD = 2.59). But there was no difference between colleges (above) and other educational ranks. This test result showed that patients achieved higher education ranks had good knowledge on insulin storage and administration techniques. However, those who could only read and write and attended primary and secondary educations do not seem to improve storage and injection knowledge. Likewise, post hoc Tukey HSD test showed that the mean score of instructed both orally and practically (M = 9.61, SD = 2.04) was importantly differ than orally instructed alone (M= 8.42, SD =3.42); the mean score of taking insulin for 5-10 years (M = 9.92, SD = 2.59) was better than those who were on for 0.25-1 year (M= 7.69, SD = 2.81) and the mean score of patients whose storage conditions assessed last month just before data collections (M= 10, SD = 2.22) was greater than those whose conditions had been never assessed (M= 8.65, SD =2.37) (Table 2).
An independent samples t-test was conducted to compare the effect of residency, means of getting insulin, receiving training by professionals, and receiving injection demonstration at first prescriptions on the levels of knowledge for insulin storage and administration techniques. There was a significant difference in mean knowledge score between patients resided in the urban areas and rural areas (t159.956=3.11, P= 0.002), getting insulin for free and with payment (t158.75=-5.47, P < 0.001), trained by professionals and not trained (t164=2.11, P= 0.036), and receiving injection demonstration or not (t164=2.813, P= 0.006). The mean knowledge score for respondents live in urban areas was 1.21 greater than the mean knowledge score for respondents live in rural areas. The mean score of patients getting insulin for free was -2.03 less than from getting by payment means, the mean score of subjects trained by professionals was 2,73 greater than from not trained and getting insulin by free means was 2.03 less than by payment means, and the mean score of individuals performed injection demonstration in first encounter was 1.27 better than not preformed (Table 3).
Practice score
The participants ‘insulin storage and injection practices score were assessed by the stated 14 item questions and the mean score of practice of study subjects was 30.18 ± 5.34 (out of 56) (53.89%) (Fig. 2). Most (64.5%) participants practiced fairly, but only 1.2% of them had good practice and the rest (34.3.3%) had poor practice. The effects of predictor variables on the level of practice for insulin storage and administration techniques was computed with one-way ANOVA; and there was a substantial effect of knowledge level [F (2,163) = 14.17, p < 0.001], educational status [F (3,162) = 10.57, p <0.001], occupation type [F (4,161) = 5.43, p <0.001], time since insulin therapy [F (3, 162) = 5.46, p = 0.001] and diagnosis [F (3,162) = 3.36, p= 0.02] on patients’ insulin storage and administration practices. The post hoc Tukey HSD test comparison on practice disclosed that the mean score of patients who had adequate knowledge (M = 32.83, SD = 4.93) was significantly different than those who had moderate (M = 29.88, SD = 4.65) and inadequate knowledge (M = 27.37, SD = 5.49) and the mean score of moderate knowledge also (M = 29.88, SD = 4.65) had a noteworthy difference than inadequate knowledge (M = 27.37, SD = 5.49). The mean score of patients that attended in colleges and above (M = 33.14, SD = 5.1) was significantly different than illiterates (M =27.71, SD = 4.98) and those who can only read and write (M = 28.5, SD = 4.58). The mean score of employers (M = 32.32, SD = 5.93) was significantly different than farmers (M =28.15, SD = 4.82) and merchants (M = 28.29, SD = 5.0). Students mean score (M = 32.41, SD = 3.53) was also substantially different from farmers and merchants. The mean score for taking insulin for 1-5 years (M = 31.39, SD = 5.56) was significantly higher than who used for 0.25-1 years (M = 26.5, SD = 6.55) and 5-10 years (M = 28.85, SD = 3.67). Similarly, the mean score of patients who stayed with the disease for 1-5 years (M = 31.31, SD = 5.57) was higher than those who stayed for 0.25-1 year (M= 27.13, SD = 6.74) (Table 2).
Self-insulin administration skill assessment
Based on the observational checklists used to assess the patients’ skills related to self-insulin administration, only insulin injection sites on their body parts were correctly shown by significant (94.6%) number of respondents and about seventy percent of the participants properly indicated how to rotate the injection sites. Conversely, about half of the respondents either performed incorrectly or skipped very critical and important steps like shaking of cloudy NPH insulin, skin pinching and 45o injection skill, and drawing of insulin from the vails (Table 4).