An assessment of the level of knowledge of health professionals on nutrition and diabetes self-management in treating patients with type 1 and type 2 diabetes Mellitus in South Africa

Catsicas, Maria Elizabeth (2014-04)

Thesis (MNutr)--Stellenbosch University, 2014.

Thesis

ENGLISH ABSTRACT: Objective: The objective of the study was to assess and compare the level of knowledge of South African health professionals) treating patients with Type 1 and Type 2 Diabetes Mellitus (T1 and T2 DM) with regard to nutrition and Diabetes Self-management (DSM). To achieve this objective, two questionnaires (one for T1 DM and one for T2 DM) was developed and validated. In addition the study identifies the areas in need for further education as well as to assess if socio-demographic factors influence the level of knowledge. Methods: The questionnaires were developed by: i) planning and developing constructs on nutrition and DSM by experts (n = 2) in the field of nutrition and diabetes care, ii) compilation and evaluation of a pool of 60 questions for face and content validity by an expert panel comprising six Registered Nurses / Diabetes Educators (RN / DE) and registered dieticians (RD) and iii) testing the questionnaires for criterion validity and reliability by a pilot group (n = 34 RN / DE and RD). Chronbach’s alpha values were calculated to determine validity and questions were disregarded or changed depending on this outcome. These questionnaires were then sent via electronic and hard mail to a randomised sample of RD (n = 1200) and RN / DE (n = 498). Data of 70 questionnaires on T1 DM and 105 on T2 DM was coded and analysed. The cut off value of 70% was considered as adequate knowledge. Results: With regard to questionnaire development, constructs were eliminated by the expert panel and this resulted in the acceptance of 60 constructs for the final questionnaires. Five constructs were replaced to improve content validity and an additional three constructs were adjusted to improve face validity. Recommended amendments were made to improve the criterion validity of the questionnaires. Internal consistency was shown with an overall Cronbach’s alpha value of 0.73 for the T1 DM questionnaire and 0.71 for the T2 DM questionnaire. In terms of the assessment of knowledge for T1 DM, the RD (75.4%) but not the RN/DE (67.2%) had adequate knowledge of nutrition. This was not statistically significant different from the RN / DE (p = 0.07). Both groups scored equally with regard to their knowledge of DSM with scores indicating inadequate knowledge (64.7% and 64.9% respectively) (p = 0.27). For T2 DM, the RD (74.6%) but not the RN / DE (61.6%) showed their knowledge of nutrition to be adequate, and statistically significantly better than the RN / DE (p = 0.0005). Both groups showed inadequate knowledge of DSM (56.0% and 61.9% respectively) (p = 0.31). The main areas of knowledge for diabetes mellitus (DM) identified in need for further education were the glycaemic index (GI) values of food, carbohydrate counting, the use of sugars / sweeteners, timing of meals and snacks with regard to activity, medication used, treatment of hypo- and hyperglycaemia and the use of alcohol. Age affected knowledge (for both nutrition and DSM) with regard to T1 DM, as the age group 30 - 49 years scored significantly better than the rest (nutrition p = 0.005, DSM p = 0.006 respectively). Health professionals in the private sector achieved higher scores compared to those working in the public sector (nutrition p = 0.011, DSM p = 0.016 respectively). Conclusion: Two valid and reliable quantitative questionnaires comprising 4 sections and 30 questions were developed to assess the level of knowledge of health professionals (RN / DE and RD) on nutrition and DSM treating patients with T1 and T2 DM in South Africa. RN / DE required further education towards key nutrition concepts and RN / DE and RD required further education on key concepts regarding DSM for both T1 and T2 DM.

AFRIKAANSE OPSOMMING: Doel: Die doel van die studie was om die hoeveelheid van kennis van verpleeg en dieetkunde personeel wat persone met Tipe 1 en Tipe 2 Diabetes Mellitus (T1DM en T2DM) in Suid – Afrika behandel, te bepaal en te vergelyk. Die studie het gefokus op kennis t.o.v. voeding en diabetiese self-sorg. Om die doel te bereik was twee vrae lyste, een vir T1 DM en een vir T 2 DM ontwikkel. Die verskillende aspekte van kennis wat verdere opleiding benodig is geidentifiseer asook of enige demografiese faktore wat kennis kon beinvloed. Metode: Die volgende stappe was geneem om voldoende geldigheid en betroubaarhied te bereik: 1. Twee kenners het verskeie belangrike aspekte van voeding en diabetiese self-sorg geidentifiseer en ontwikkel. 2. ‘n Paneel van 34 geregistreerde dieetkundiges en verpleeg personeel wat in Diabetes Mellitus spesialiseer , het die inhoud van ‘n totaal van 60 vrae ge- evalueer vir geldigheid en toepaslikheid. 3. Die paneel het die vraelyste verder ge- evalueer vir ‘n aanvaarbare standard van betroubaarheid. Chronbach-alfa waardes was gebruik vir die aanvaarbaarheid van alle vrae. 4. Die finale weergawe van 30 aanvaarbare vrae in elke vraelys was gestuur via elektroniese en normale pos na 1200 RD en 489 verpleegpersoneel wat spesialiseer in T1 en T2 DM. 5. Inligting van onderskeidelik 70 T1DM en 105 T2 DM vraelyste was gekodeer en ge-analiseer. Resultate: Tydens die ontwikkeling van die vraelyste, was sekere aspekte van kennis deur die twee kenners ge-elimineer. Die evaluering van die groep van dieetkundiges en verpleeg personeel het verder bygedra tot die vervanging en aanpassing van sekere aspekte van kennis. Dit het bygedra tot die vlak van voldoende geldigheid en toepaslikheid. Vir voldoende betroubaarheid was die Chronbach- alfa waardes van 0.73 vir T1DM and 0.71 vir T2 DM onderskeidelik aanvaar. Die studie het getoon dat die dieetkundiges voldoende kennis besit t.o.v. voeding vir T1 DM (75.4%). Dit was egter nie statisties betekenisvol meer in vergelyking met die kennis soos behaal deur die verpleegpersoneel (62.2%) (p = 0.07). Beide groepe se kennis t.o.v diabetiese self sorg was bepaal as onvoldoende met onderskeidelik 64.7% en 64.9%. In terme van T2 DM, het die dieetkundiges statisties betekenisvol beter kennis getoon vir voeding (74.6%) in vergelyking met die vlak van kennis soos behaal deur die verpleeg personeel (61.6%) (p = 0.0005). Soos in die geval van T1 DM het beide groepe onvoldoede kennis getoon vir diabetiese self sorg met onderskeidelike waardes van 56.0% en 61.9%. (p = 0.31). Die areas van kennis wat geidentifiseer was vir verdere opleidig, was die glisemiese indeks van voedsel, bepaling van die hoeveelheid koolhidrate in voedsel, die gebruik van suiker en versoeters, die neem van maaltye en versnapperinge, oefening, medikasie, voorkoming van lae en hoe blood glukose vlakke asook die gebruik vam alkoholiese drankies. Die ouderdoms groep tussen 30-49 jaar het statisties ‘n hoer vlak van kennis getoon vir beide voeding (p = 0.005) en diabetiese self sorg (p = 0.006) vir T 1 DM in vergelyking met die ander ouderdoms groepe. Personeel wat in die private sektor werk het ‘n beter vlak van kennis getoon in vergelyking met personeel wat in die openbare sektor werk (p = 0.011 en p = 0.016 vir voeding en diabetiese self sorg onderskeidelik. Samevatting: Twee geldige en betroubare vrae lyste met 30 vrae in totaal was ontwikkel om die vlak van kennis van dieetkundiges en verpleeg personeel te bepaal in terme van voeding en diabetiese self sorg vir beide T1 en T2 DM. Die verpleegpersoneel benodig verder opleiding t.o.v sekere aspekte van voeding en diabetiese self -sorg en die dieetkundiges t.o.v. diabetiese self -sorg vir beide T1 en T2 DM.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/86529
This item appears in the following collections: