|Year : 2021 | Volume
| Issue : 1 | Page : 33-38
Health-seeking behavior of patients with diabetes mellitus: A community-based cross-sectional study in an urban area of Pondicherry
Balakrishnan Vaishnavi1, Amit Kumar Mishra2
1 Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
2 Department of Community & Family Medicine, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
|Date of Submission||23-Oct-2020|
|Date of Decision||28-Oct-2020|
|Date of Acceptance||01-Dec-2020|
|Date of Web Publication||02-Jul-2021|
Amit Kumar Mishra
Department of Community & Family Medicine, All India Institute of Medical Sciences, Raipur, Chhattisgarh
Source of Support: None, Conflict of Interest: None
Introduction: Health-seeking behavior is a complex outcome of many independent factors operating at individual, family, and community level. Studies have shown that there is an improvement in compliance to treatment and a decrease in the complications with an increase in patients' knowledge about the disease and its complications. The current study was done to explore the health-seeking behavior among patients diagnosed with diabetes mellitus (DM).
Materials and Methods: A community-based cross-sectional descriptive study was conducted among patients diagnosed with DM in an urban area of Pondicherry. A simple random sampling method was used to recruit the study participants in the community. A predesigned structured questionnaire was used to collect information from the participants by conducting face-to-face interview. Data entry was done in EpiData and the analysis was done using the Statistical Package for the Social Sciences Version 21.
Results: In the present study, 109 participants were included and interviewed. Majority of participants (29.4%) belonged to 61–70 years. Most of the respondents (56.8%) seek treatment from a private health facility. The most common comorbidity reported was hypertension (59.6%). Participants shared that unhealthy diet (55%), family history (25.7%), sedentary lifestyle (23.9%), and obesity (17.4%) were the risk factors of DM. Only 12.8% of participants were testing their blood glucose level at monthly intervals. Eight participants were on irregular medication, and among them, three participants told that they were irregular on treatment because their blood glucose levels were normal.
Conclusion: The level of awareness on diabetes among the participants is not satisfactory though the overall treatment-seeking behavior is found to be satisfactory among the study participants. It is recommended to plan and implement various Information, Education and Communication (IEC) activities in the study area to increase the level awareness.
Keywords: Awareness, behavior, diabetes mellitus, health seeking, risk factor
|How to cite this article:|
Vaishnavi B, Mishra AK. Health-seeking behavior of patients with diabetes mellitus: A community-based cross-sectional study in an urban area of Pondicherry. J Curr Res Sci Med 2021;7:33-8
|How to cite this URL:|
Vaishnavi B, Mishra AK. Health-seeking behavior of patients with diabetes mellitus: A community-based cross-sectional study in an urban area of Pondicherry. J Curr Res Sci Med [serial online] 2021 [cited 2021 Oct 26];7:33-8. Available from: https://www.jcrsmed.org/text.asp?2021/7/1/33/320509
| Introduction|| |
Health-seeking behavior is a combined outcome of many independent factors operating at individual, family, and community levels. It is related to the disease incidence, prevalence, and complications caused by the disease. Diabetes mellitus (DM) is a metabolic disorder characterized by hyperglycemia. DM is a chronic, progressive disease with micro- and macrovascular complications affecting all organs of the human body including the eye, kidney, lower extremity, and heart, likely to develop over time in relation to the glycemic control.,, According to the International Diabetes Federation, 463 million people have diabetes in the world and 88 million people in the South East Asia (SEA) region; by 2045, this will rise to 153 million. In India, the prevalence of diabetes in adults is 8.9% and currently, a total of 77,005,600 cases exist in India. The rapid increase in the prevalence of diabetes is a significant cause for concern now.
Besides the impact on health of an individual, the economic costs of the disease and related complications of the disease are enormous in health care and loss of productivity. For people living with insulin-dependent diabetes, accessible affordable treatment with insulin is critical to their survival. There is a globally agreed target to halt the rise in diabetes burden and obesity by 2025. Medical anthropology studies have made important contributions to the understanding of the behavior of the patients and their family members in seeking health care.,,,,, Many studies have shown that there is an improvement in compliance to treatment and a decrease in the complications associated with the disease with an increase in patients' knowledge about the disease and its complications. Positive health-seeking behavior (i.e., the early recognition of symptoms, presentation to health facilities, and compliance with effective treatment) could improve control of diabetes and thereby reduce the incidence of complications. There are limited studies on this area in the current study settings of Pondicherry, India. Keeping the above facts in mind, the present study was conducted to explore the health-seeking behavior among patients diagnosed with DM in an urban area of Pondicherry.
| Materials and Methods|| |
A community-based cross-sectional study was conducted to assess the health-seeking behavior and awareness on diabetes and its complications among patients with DM in an urban area of Pondicherry. Ethical approval for the study was obtained from the Institute Ethics Committee of a tertiary medical college hospital in Pondicherry (RC/19/35). The study was conducted in the service area of the Urban Health Center (UHC) of the Department of Community Medicine of a medical college in Pondicherry. The list of patients with DM who are residents of the UHC service area is being maintained in the UHC. Participants who were >18 years of age, permanent residents, and had a history of diabetes for more than a year were included in the study. Participants who did not give consent for the study or unavailable even after two scheduled visits were excluded from the study. The required number of participants was selected by a simple random selection method from the available register in the health center based on the above inclusion criteria. The selected participants were contacted through telephone and an appointment for the personal interview was fixed based on the participant's convenience. House visits were made to the selected participants' household based on prior telephonic communication/appointment and face-to-face interview was conducted. Participant information sheet was given to them and written consent was obtained from each participants before personal interview. A predesigned structured questionnaire was used to collect information from the study participants and recorded in the printed format.
The sample size estimated for the study assuming that 67.1% were checking their blood sugar level regularly every month with a 95% confidence interval and relative precision of 15% was 88. The collected data were entered in EpiData version 3.1 (The EpiData Association, Odense, Denmark). Data analysis was done using IBM Statistical Package for the Social Sciences Statistics for Windows, Version 21.0 (developed by IBM Corp, Armonk, New York, USA). Descriptive statistics was used to present the results of the study.
| Results|| |
The present study assessed the health-seeking behavior among the individuals diagnosed with diabetes residing in an urban area of Pondicherry. In the present study, 109 participants were included and interviewed. Among the participants included in the study, around 80% of them were more than 50 years of age with the majority of them belonging to the range of 61–70 years (29.4%). The female-to-male ratio in the study was 1.7 (63.3%/36.7%). About 79.8% were unemployed or retired, but majority (34.9%) of the participants educated up to high school. Majority (27.5%) of them belonged to Class I of Modified Prasad's Socio-Economic Classification System, followed by 23.4% belonging to Class II [Table 1].
About 30.3% had reported having a history of diabetes for over 10 years and most (96.3%) of the participants shared that they started the treatment for diabetes immediately after diagnosis of the disease. On family history, 46.8% had reported that their family members also have/had diabetes. Most (56.8%) of the respondents seek treatment from a private health facility. Around two-fifth of the participants shared that they are more concerned about the money they were spending to access the heath facility, and 9.2% of participants shared that the distance they were traveling was the main barrier for them to access the health facility. The most common comorbidity among the participants was hypertension (59.6%), followed by eye diseases (28.4%) [Table 2].
Among the study participants interviewed, 44% were told that the disease is due to eating too much sugar/sweets, followed by 22.9% told it is due to stress. Around one-fifth of the participants were aware that there is an increase in blood glucose level in diabetes. When asked regarding the symptoms of diabetes, 59.6%, 55%, and 54.1% were aware of polydipsia, polyphagia, and polyuria, respectively. On risk factors for diabetes, participants shared that unhealthy diet (55%), family history (25.7%), sedentary lifestyle (23.9%), and obesity (17.4%) are the risk factors. About 75.2% of the study participants believed that the eye gets affected, followed by the kidney (64.2%) and heart (18.3%) [Table 3].
About 12.8% of participants were testing their blood glucose level at monthly intervals and 24.8% of participants were irregular in testing their blood glucose levels. Among the study participants, 72.5% were following the diet advised to them and two-fourth of the participants were doing regular exercises. The treatment plan they were advised was 85.3%, 98.2%, 20.2%, and 89.9% for diet modification alone, drugs, insulin, and physical activity with other treatment plans respectively. Most of the participants (92.7%) were taking the medicines regularly, as suggested by their consultants/doctors. Eight participants were on irregular medication and among them, three participants told that they were irregular on treatment because their blood glucose levels were normal [Table 4].
Sixty-eight (62.4%) of the study participants told that diabetes does not affect their work, while 24.8% of participants told it affects less often. Most (47.7%) of the participants shared that they were moderately satisfied with their own health due to diabetes, while 33.9% told that they were very satisfied with their health even though they have diabetes. More than half (56%) of participants told that they never got discouraged by their health condition, while 35.8% told that sometimes they got discouraged due to their diabetic health status. Around one-fourth of the participants were worried about their long-term medication for diabetes. Nine (8.3%) participants shared that the diabetes had affected their daily routine, while most of the participants (52.3%) told that it did not affect their daily routine [Table 5].
| Discussion|| |
In the current study, 109 participants from an Urban area of Pondicherry were included and interviewed, and majority (79%) of the respondents were aged more than 50 years which is similar to the findings of a hospital-based study conducted in Nepal. A study at Chandigarh showed that only 36.7% of the respondents seek health care from a public health facility. On the contrary, this study shows that most of the respondents (86.2%) seek treatment from the public health facility. This finding is in accordance with the results from a study among people with Type-2 Diabetes in eastern Nepal. This difference may be because of the availability of the public health facility near to the residence of the participants. Majority of the patients (44%) were diagnosed in health facilities after getting symptoms of diabetes. Similar findings were demonstrated by a study conducted in South India.
Many of the respondents of the present study had comorbidities. Hypertension was one of the most commonly reported comorbidities (59.6%). This result was consistent with the findings of the study conducted in Africa. The presence of comorbidity is not considered as a factor of appropriate health-care-seeking behavior. It shows that those diabetic patients who were having comorbidity may have a financial burden, which restricts them from seeking a modern health-care facility. Unlikely to this result, a study conducted by Dominguez in Baguio City, Philippines found comorbidity as an important factor for health care-seeking behavior among diabetic patients. The difference might be due to the difference in the level of awareness and availability of health-care facility in different settings. Family history of diabetes is also considered as an important factor of health-care-seeking behavior. In the current study, 46.8% of the respondents had a family history of diabetes; the result is comparable to a study conducted in Bangladesh. A similar result was obtained by a study done in the rural area of eastern Nepal also. It shows that those people with a family history of diabetes may likely to practice self-medication and dietary modification or seek alternative health care.
The present study found that about 92.7% of patients were taking their medicines regularly, 85.3% were on controlled diet 76.1% of the study participants had no issues taking medications on a long-term basis, and 81.6% of them were quite satisfied with their health. The above findings showed that the participants were aware of their health status and it seems that all appropriate measures were being taken by the study participants to control diabetes, it is not to be neglected that 61.5% do not exercise regularly.
| Conclusion|| |
The present study shows that the level of awareness on diabetes among the participants is not satisfactory though the overall treatment-seeking behavior is found to be satisfactory among the study participants, as most of them are on regular medication, following the diet advised to them and quite satisfied with their health status. It is recommended to plan and implement various Information, Education and Communication (IEC) activities to increase the awareness level among the target population so that the health-care-seeking behavior could be changed toward a more positive health status.
The authors would like to acknowledge the participants who spared their valuable time for the research project without whom the study was not possible and the academic administrative staff of the tertiary medical college hospital who allowed the undergraduate student (author) to conduct the research project under the Institute Undergraduate Research Fellowship Program.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Deepali BS, Mangala S, Soumya G, Vikyath BR, Aarudhra P, Ankitha M, et al
. Knowledge of diabetes, its complications and treatment adherence among diabetic patients. Int J Community Med Public Health 2017;4:2428-34.
Hjelm K, Atwine F. Health-care seeking behaviour among persons with diabetes in Uganda: An interview study. BMC Int Health Hum Rights 2011;11:11.
Nimesh VV, Halder A, Mitra A, Kumar S, Joshi A, Joshi R, et al
. Patterns of healthcare seeking behavior among persons with diabetes in Central India: A mixed method study. J Family Med Prim Care 2019;8:677-83.
] [Full text]
Shahram B. Health Seeking Behavior in a Multi Cast Village of Mysore District. India: Unpublished PhD Thesis; 2009.
Chrisman NJ. The health seeking process: An approach to the natural history of illness. Cult Med Psychiatry 1977;1:351-77.
Dressler WW. Medical Anthropology: Toward a third movement in the medical Anthropology. Med Anthropol Q 2001;15:455-65.
Carol RE, Melvin E. Encyclopedia of Medical Anthropology. Health and Illness in the World's Cultures. New York: Springer; 2004.
Freed RS, Freed SA. Shantinagar: The Effects of Urbanization in a Village in North India, 3 Sickness and Health. New York: The American Museum of Natural History; 1979. p. 143.
Harwood A. Ethnicity and Medical Care. Cambridge: Harvard University Press; 1981. p. 43.
Bhosale S, Pawar AT, Kumar KD. Healthcare-seeking behavior among diabetic patients in Kozhikode, Kerala. Int J Med Sci Public Health 2017;6:1524-7.
Mehta RK, Subedi S, Bohora S. Health related quality of life of diabetic patients visited in Koshi Zonal Hospital, Biratnanar. JCMC 2015;4:13-6.
Khongbuh B, Walia I, Kapoor S. Prevalence of diabetes and treatment seeking behaviour among adult population at village Dhanas, UT, Chandigarh. NMRJ 2005;1:138-43.
Thapa S, Jha N, Baral DD, Pyakurel P. Health care seeking behaviour among people living with type-2 diabetes in rural area of Eastern, Nepal. Int J Pub Health Safe 2018;3:166.
Srinivas G, Suresh E, Jagadeesan M, Amalraj E, Datta M. Treatmentseeking behavior and compliance of diabetic patients in a rural area of South India. Ann N Y Acad Sci 2002;958:420-4.
Bastola P, Kahsay F, Zewengiel S, Muguleta MM. The prevalence of diabetic retinopathy, risk factors, visual impairment and ocular status among patients with diabetes mellitus presenting to Berhan Aini National Referral Hospital, Eritrea: A hospital based study. JCMC 2017;6:37-46.
Dominguez RJ. Health-seeking behavior of patients with diabetes mellitus in Baguio City. NLR Journal 2010:3:1-22.
Mumu SJ, Saleh F, Ara F, Haque MR, Ali L. Awareness regarding risk factors of type 2 diabetes among individuals attending a tertiary-care hospital in Bangladesh: A cross-sectional study. BMC Res Notes 2014;7:599.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]