Project Materials

HEALTH-RELATED QUALITY OF LIFE OF DIABETES MELLITUS PATIENTS AND NON-DIABETICS.

ABSTRACT

Nigeria has the highest prevalence of diabetes in Sub-Saharan Africa. Diabetes mellitus (DM) is a chronic illness that poses significant limits on those who live with it. Short-term and long-term issues impacting diabetics’ physical, psychological, and social functioning might have an impact on their health-related quality of life (HRQOL). This study evaluated and compared the HRQOL of diabetes and non-diabetic patients in Port Harcourt, Rivers State, Nigeria. Four objectives and two null hypotheses were developed to lead the investigation. The study used a descriptive cross-sectional survey design. It was held at the diabetes outpatient clinic of the University of Port Harcourt Teaching Hospital in Port Harcourt. Power analysis was done to define a minimum sample size of 200 for both the diabetic and non-diabetic comparison groups. Diabetics who met the inclusion criteria were purposefully recruited, while non-diabetics of similar age and gender were recruited from the Catholic Community of Mater Misericordiae Catholic Church, Rumumasi, and the Anglican Community of Anglican Church of Messiah, Elekahia Housing Estate, both in Port Harcourt. Data was collected using the World Health Quality of Life-Bref (WHOQOL-BREF), a 26-item standardised questionnaire with 12 supplementary questions asking for demographic and clinical information. The instrument’s reliability was assessed using the split-half approach, with Cronbach’s alpha coefficients of 0.70 for the physical domain, 0.76 for the psychological domain, 0.78 for the social domain, and 0.70 for the environmental domain. The interviewer administered the instrument, and data was analysed using Chi-square, student t-test, and analysis of variance at a significance level of P<0.05. In terms of demographic factors, diabetics and non-diabetics did not differ significantly (p > 0.05). Diabetics had mean ratings of 23.17 ± 3.39 in physical, 20.06 ± 3.32 in psychological, 10.20 ± 2.47 in social, and 28.00 ± 5.15 in environmental categories on the WHOQOL-BREF survey. The mean scores for non-diabetics in the four areas were: physical 24.17 ± 2.42, psychological 21.53 ± 2.51, social 11.43 ± 1.87, and environmental 28.68 ± 5.044. Diabetics had significantly lower HRQOL (p < 0.05) than non-diabetics in physical, psychological, and social domains. Of the 200 diabetics, 92 reported co-morbidities. Diabetics with co-morbidities had mean scores of 22.73 ± 3.30 in physical, 19.63 ± 3.08 in psychological, 9.96 in social, and 27.41 ± 4.98 in environmental. Diabetics without co-morbidities had mean scores of 23.55 ± 3.43 in physical, 20.39 ± 3.48 in psychological, 10.40 ± 2.62 in social, and 28.50 ± 5.25 in environmental. There was no significant difference (p > 0.05) between diabetic patients with and without co-morbidities in all four domains. Diabetics with post-secondary education scored significantly higher (3.93 ± 0.81) compared to those with secondary and primary education (3.75 ± 1.12 and 3.37 ± 1.06, respectively). In conclusion, DM has a negative impact on patients’ HRQOL. Efforts to improve diabetics’ HRQOL should be pushed.

Chapter one
INTRODUCTION

Background of the Study

Diabetes mellitus is a collection of metabolic illnesses characterised by elevated blood glucose levels due to abnormalities in insulin production, insulin action, or both [American Diabetic Association (ADA), (2014); Huang, Hwang, Wu, Lin, Leite, & Wu, (2014)].

It is a severe sickness with physical, social, emotional, and financial consequences. It has an impact on the quality of life and general health condition of individuals, as well as direct health care expenses and indirect costs to society due to missed productivity.

It is a chronic and stressful sickness that puts a strain on the individual by causing several short- and long-term problems that are potentially fatal.

Diabetes mellitus is the leading cause of non-traumatic amputation and blindness in working-age adults, as well as the third leading cause of death from diseases, owing to the high prevalence of cardiovascular complications (myocardial infarction, stroke, and peripheral vascular disease) among diabetics (Smeltzer, Bare, Hinkle, & Cheever, 2010).

According to studies, the incidence of diabetes is increasing. According to the Centres for Disease Control and Prevention (CDC) (2011), there were an estimated 79 million American people aged 20 and up with pre-diabetes in 2010.

In 2000, the world-wide estimate of the prevalence of diabetes was 171 million people, and by 2030, this is anticipated to climb to 366 million (Wild, Roglic, Green et al, 2004).

The International Diabetes Federation (IDF) reported that 194 million individuals had diabetes in 2003, with almost two-thirds of these people living in developing nations, including Nigeria.

The President of the IDF (2006-2009) warned that if left unchecked, the number of diabetics would exceed 380 million in less than 20 years. By 2025, one out of every fourteen persons globally will have diabetes. The loss of earnings and life will be hard to endure.

Diabetes mellitus was once thought to be a disease of the wealthy, but it is now widely recognised as a rising health issue in developing nations, with about 80% of diabetes deaths occurring in low and middle-income countries, including Nigeria (Diabetes Atlas, 2016).

Available research suggests that it is becoming as a major health problem in Africa, especially Nigeria. Diabetes is frequently undiagnosed in Africa.

In most situations, it is discovered by chance during a routine check-up or when the patient presents with complications (International Diabetes Federation African Region, 2016). According to WHO statistics, Nigeria has the most diabetics in Sub-Saharan Africa (Chinenye & Ogbera, 2013).

Diabetes mellitus incidence and prevalence in Nigeria continue to rise despite extensive research and funding. With the current trend of transition from communicable to noncommunicable disease, it is projected that noncommunicable diseases will equal or even exceed communicable diseases in developing nations, including Nigeria, resulting in a double burden of disease (Chinenye & Ogbera, 2013).

The crude prevalence rate of diabetes mellitus in Port Harcourt, Nigeria is 6.8% (Nyenwe, Odia, Ihekwaba, Ojule, & Babatunde, 2013).

With the alarming growth in the number of people suffering The multiple complications of the disease and its management place a strain on the quality of life of those suffering from it, necessitating an assessment of their quality of life (QOL).

Quality of life (Q0L) is a descriptive phrase that relates to people’s emotional, social, and physical well-being, as well as their capacity to function in everyday activities (Donald, 2010).

Health researchers favour health-related quality of life (HRQ0L) since it is used to focus on characteristics of functioning that are directly related to diseases and/or medical treatment (Odili, Ugboka, & Oparah, 2010).

Studies on quality of life are conducted for two purposes. First, they assess the psychosocial functioning of the patient population and identify unique difficulties and demands of patients at various stages of the disease process. Second, and most commonly, HRQOL studies are done to analyse the influence of various regimens on patient well-being and treatment satisfaction (Snoek 2010).

Researchers show decreased HRQOL in diabetics compared to non-diabetics (Andayani, Ibrahim, & Aside, 2010; Odili et al, 2010). In Nigeria, studies on HRQOL with diabetics have been conducted at the University of Benin Teaching Hospital (UBTH) (Odili et al., 2010) and the University of Ilorin Teaching Hospital (UITH) (Issa & Baiyewu, 2016).

The UBTH study stated that diabetes has an influence on the lives of diabetic patients, but the UITH study concluded that lower income, poorer education, low-rated employment, and physical issues all had a negative impact on the HRQOL of diabetic patients.

Both research focused on the psychological characteristics of diabetics. Therefore, this study investigated the HRQOL of individuals with diabetes mellitus in Port Harcourt.

Statement of the Problem

Diabetes mellitus is a continuously distressing illness to live with. According to Polonsky (2010), many patients find the need for self-care to be difficult, irritating, and overwhelming.

According to Kubler Ross (2015) and Berman, Synder, Kozier, and Erb (2014), the individual must go through the stages of grief, which are denial, anger, bargaining, sadness, and acceptance of the diagnosis.

People with diabetes mellitus face significant stress in order to survive. The condition, being a chronic sickness, severely limits people’s activities due to its numerous demands. Individuals with diabetes must consider what and when to eat, exercise, determine whether to test plasma glucose, and, based on the results, schedule when to eat or take their medications.

They also carry glucose beverages in case of hypoglycemia and frequently stop to check for indications of hypo or hyperglycemia. Finally, they are constantly plagued by the prospect of complications, particularly foot issues and amputation. Many patients grow disappointed, discouraged, and/or involved with a condition that does not appear to react to their best efforts.

Rubin (2010) referred to this as “diabetes overwhelmus”. Diabetes can have a significant negative impact on quality of life in terms of social and psychological well-being, as well as physical and environmental health.

As the disease progresses, psychosocial problems arise as a result of complications, medical treatment, and self-management.

To what extent do the disease and its management affect patients’ quality of life? This study therefore assessed the HRQOL of patients with diabetes mellitus.

The purpose of the study

The goal of this study was to evaluate the health-related quality of life (HRQOL) of diabetic patients at the University of Port Harcourt Teaching Hospital and compare it to that of non-diabetic Port Harcourt residents. Non-diabetics are comparable healthy people taken from the hospital’s catchment region. They are a matching group.

Objectives of the Study

The study’s aims were:

1. Determine the HRQOL scores of diabetic patients versus non-diabetics in the four WHOQOL-BREF domains.

2. Compare diabetes mellitus patients’ HRQOL scores to those of non-diabetics in all four domains of the World Health Organisation Quality Of Life-BREF (WHOQOL-BREF).

3. Compare the HRQOL scores of DM patients with co-morbidities with the scores of DM patients without co-morbidities in the four domains of WHOQOL-BREF.

4. Determine the influence of socio-demographic variables on the HRQOL overall mean score of the DM patients.

Research Hypotheses

1. In the four domains of the WHOQOL-BREF, there is no significant difference in HRQOL scores between patients with diabetes mellitus and those without diabetes.

2. There is no significant difference in HRQOL scores between diabetes individuals with and without co-morbidities across all four WHOQOL-BREF domains.

Scope of the Study

This study was conducted at the University of Port Harcourt Teaching Hospital with diabetes patients who visited the diabetic clinic on Wednesdays. Only people aged 30 and up were recruited.

The non-diabetic participants were drawn from the Catholic community of Mater Misericordiae Catholic Church Rumumasi in Port Harcourt and the Anglican community of the Anglican Church of Messiah in Port Harcourt. The Anglican and Catholic churches are the two largest in this area.

Significance of the Study

The current study’s findings will provide an overall picture of how diabetes people cope with life, disease, and treatment. The findings will focus on diabetic patients’ quality of life in the physical, psychological, social, and environmental domains.

The study’s findings will provide clinicians with valuable information to enhance therapeutic decision-making in diabetic care, taking into account both biological and psychosocial elements.

To the nurse in particular, targeted education and management based on the study’s identified needs will go a long way towards assisting the patient in living a normal life and coping with the issues connected with the illness.

Improved management based on the study’s conclusions will increase production and lower the economic burden on both individuals and society as a whole. The individual’s quality of life will improve.

The study’s findings will encourage policymakers to address diabetic-related concerns such as insurance, employment, and so on.

This study will not only teach us about the patient’s subjective experience of living with diabetes, but will also inspire new and or better strategies to improve on diabetes care.

Operational Definition of Terms

Health Related Quality of Life (HRQOL): This refers to the disease’s (diabetes mellitus) impact on an individual’s subjective description of various aspects of human functioning and well-being.

In this study, these functions will be assessed using the four-domain World Health Organisation Quality of Life (WHOQOL-BREF) instrument. The four domains are physical, psychological, social, and environmental.

Diabetes Mellitus is a group of diseases characterised by an increased level of glucose in the blood. It is medically diagnosed if the fasting blood glucose is 126mg/dl (7.0mmol/L) or higher, random plasma, 2 hours post prandial glucose levels exceed 200mg/dl (11.1mmol/L), and the Glucose Tolerant Test result is 180mg/dl (11.1mmol/L) 2 hours after glucose load.

Diabetic patients are those aged 30 and up who have been diagnosed with diabetes mellitus and are attending a clinic at the University of Port Harcourt Teaching Hospital in Port Harcourt.

Non-Diabetics are people over the age of 30 who are clinically healthy and have never been diagnosed with diabetes mellitus or any other chronic disease such as asthma, hypertension, congestive cardiac failure, arthritis, pulmonary tuberculosis, duodenal or stomach ulcers, HIV/AIDS, or cancer.

In this environment, no WHOQOL-BREF norm data exist. Those who met the study’s inclusion criteria were recruited from the study’s target area.