Thesis presentation By Rebira Workineh.pptx

Frailty

1. WOLLEGA UNIVERSITY INSTITUTE OF HEALTH SCIENCE SCHOOL OF NURSING AND MIDWIFERY DEPARTMENT OF SURGICALAND OPERATION THEATHRE NURSING ADHERENCE TO INSULIN SELF ADMINISTRATION AND ASSOCIATED FACTORS AMONG PATIENTS ON CHRONIC FOLLOW UP OF DIABETES MELLITUS AT NEKEMTE TOWN PUBLIC HOSPITALS, OROMIA, WESTERN ETHIOPIA, 2021 1/1/2022 1

2. By Group – III Beri Taye Gadise Hailu Gemechu Diriba Talema Workineh Advisors Mr. Diriba Mulisa (BSC, MSC) Mr. Lami Bayisa (BSC, MSC) Nekemte, Ethiopia December, 2021 1/1/2022 2

3. Presentation O utline Introduction Objectives Method of study Result and discussion Strength and limitation C onclusion and recommendation References Acknowledgment 1/1/2022 3

4. INTRODUCTION Background Information Definition Diabetes: Is defined as a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both ( Diabetes Care. 2010 ). Insulin I s a hormone made by the pancreas in the body. Helps your body use glucose for energy and lowers blood glucose levels ( Swinnen SG, Hoekstra JB, DeVries JH (2009 ). 1/1/2022 4

5. Problem of the Statement Diabetes is a significant & growing health problem worldwide. It will affect 360 million individuals around the world. Is also an important problem in Africa. Sub-Saharan Africa (SSA) has shared 77% of global burden of diabetes . In Ethiopia it will affect around 3.3 million people by 2030 (IDF data) ( Osterberg L, Blaschke T,2005, Rwegerera, Mutashambara G,2010 ). 1/1/2022 5

6. Significance of the Study In this current study area, there is no study conducted to assess adherence to ISA and associated factors . Helped us to know the gap between clients and health providers related to adherence to ISA. So, it is expected To provide basic information for other researchers who want to conduct a study on related topics. 1/1/2022 6

7. Conceptual Framework . 1/1/2022 7

8. OBJECTIVES General Objective To assess adherence to ISA and associated factors among patients on chronic follow up of diabetes mellitus at Nekemte Town Public Hospitals, Oromia , Western Ethiopia, 2021. Specific Objectives To assess the magnitude of adherence to ISA among patients on chronic follow up of diabetes mellitus. To identify factors associated with adherence to ISA among patients on chronic follow up of diabetes mellitus. 1/1/2022 8

9. METHODS AND MATERIALS Study Area This study was carried out in Nekemte Town Public Hospitals. Study Period This project was conducted from November 14 to December 15, 2021 . Study Design An institution based cross-sectional study design was conducted. 1/1/2022 9

10. Population Sources Population All adult patients with diabetes taking ISA, who had been attending Nekemte Town Public Hospitals, 2021. Study Population All sampled adult patients with diabetes taking ISA who visited diabetes Care unit of Nekemte Town Public Hospitals at the time of data collection period. 1/1/2022 10

11. Inclusion and Exclusion Criteria Inclusion Criteria Patients who have either type 1 or type 2 diabetes Non-pregnant Women who have history of DM and taking insulin before they become pregnant Aged at least 18 years regardless of gender Giving written informed consent to participate in the study Exclusion Criteria Mentally ill, senility Hearing impairment, vision impairment Subjects who are taking oral anti-diabetic therapy Pregnant with diabetes or diagnosed with gestational diabetes due to different criteria on standard of control Newly diagnosed at the time of data collection   1/1/2022 11

12. . Sample Size Determination Where n = sample size required P = Population proportion (33.1 %) (Yusuf Gareda Haji , 2009) d = the marginal error 5%, and a confidence interval (CI) will be taken to be 95% n = ( 1.96) 2 0.331(1-0.331) = 340 d 2 (0.05) 2 N = Total diabetic patients attending Nekemte Town Public Hospitals for insulin self- therapy 2021 E.C. (575) nf = = = = 214 Considering 5% non-response rate, 225 diabetic patients were on insulin self-therapy and planned to be included in this study.   1/1/2022 12

13. Sampling Procedures A systematic sampling technique was used to conduct this study. Data were collected from NSH and WURH The study populations at NSH and WURH were 324 (Sample size was 127) and 251(sample size was 98) respectively . Both study area had the same sampling interval (K). K = N/n, 324/127 = 2.55 ~ 3 (NSH) and K= N/n, 251/98 =2.56 ~ 3 (WURH). The K” value was 3 for both study areas. 1/1/2022 13

14. Study Variables Dependent Variable Adherence to ISA Independent Variables Socio-demographic characteristics Support system Environmental Factors Psychological factors Diabetic disease condition related factors 1/1/2022 14

15. Operational Definition Adherence D escribed as taking 80 % of the prescribed doses of insulin and/or agrees between the patient and the health care providers ( Belayneh K, 2014 ) . Non- adherence D escribed as taking 80% of the prescribed doses of insulin by omitting insulin medication without health personnel orders ( Belayneh K, 2014 ) .   1/1/2022 15

16. Data Collection Tools and Techniques S emi-structured interviewer-questionnaire was used. Data were collected by five staff degree Nurses . Patients were asked if they missed any doses of insulin on a day by day basis over a period of1month. The number of insulin injection missed was calculated based on the prescribed dose. Patients who reported taking 80% of their prescribed insulin injection were considered not to be adherent to ISA ( Yusuf Gareda Haji , 2009 ) .   1/1/2022 16

17. Data Quality Assurance Tools were adopted from previous studies Information was given to data collectors on technique of data collection. The process of data collection was followed & checked by principal investigator. Clarity and completeness of the filled questionnaire was checked by supervisor & principal investigator. Confidentiality of each client was assured 1/1/2022 17

18. Data Processing, Analysis and Presentation Each completed questionnaire was coded. Data entry and analysis was done using SPSS ver. 20. Descriptive statistics, binary & multinomial logistic regression was implemented to see the association between the independent and out-come variables . Then significant factors with p- value 0.25, CI- 95 % in binary analysis were entered into multinomial logistic regression models to control the effect of confounding factors, the statistical test of association was considered significant at a p-value 0.05. T he result of this study was presented in the form of narratives, tables, figures and graphs.   1/1/2022 18

19. Ethical Consideration Ethical approval was obtained from Ethical Research institution review board of Wollega University Plan of Dissemination of the Result This finding will be submitted to WU To diabetes care units of NTPH Finally the research will be sent to publishing agents for public utilization of the findings. 1/1/2022 19

20. Result and Discussion 5.1. Diabetic Disease Conditions Most (92, [40.9%]) of the respondents had started insulin self-administration therapy since 5–10 years. Greater than half (185, [82.2%]) of participants had been using insulin syringe for self -injection. More than half (135, [60%]) of the respondents had discarded insulin after one month opening. More than half (179, [79.6]) of the respondents were recommended twice per day (60 injections per month). Most (182, (80.9%]) of the participants took their insulin self-injection as recommended by the physician ( For more information table 1 & Figure1). 1/1/2022 20

21. Result and Discussion… Table 1 : Diabetes disease conditions distribution 1/1/2022 21 Variables ( n=225) Options Frequency Percent Duration of insulin self- therapy 1-4 Years 74 32.9 5-10 Years 92 40.9 11 years 59 26.2 Discarding insulin after one month opening Yes 135 60 No 90 40 Prescribed doses of insulin injection for the last 1 month 30 41 18.2 60 179 79.6 90 5 2.2 Prescribed doses of insulin injection taken for the last 1 month <80% 43 19.1 80% 182 80.9 Variables ( n=225) Options Frequency Percent Duration of insulin self- therapy 1-4 Years 74 32.9 5-10 Years 92 40.9 59 26.2 Discarding insulin after one month opening Yes 135 60 No 90 40 Prescribed doses of insulin injection for the last 1 month 30 41 18.2 60 179 79.6 90 5 2.2 Prescribed doses of insulin injection taken for the last 1 month <80% 43 19.1 182 80.9

22. Result and Discussion… The result in figure 1 below indicates diabetes patients’ adherence & non-adherence to insulin self-administration. It was derived from the summation of correct answers of the 43 ISA assessment measure questionnaires for each respondent. Most (182, [80.9%]) of the respondents were adherent to ISA while (43, [19.1%)] of respondents were non-adherent to ISA. If the participants had taken doses of insulin 80% of recommended, they were considered as adherent to ISA. However, if the participants had taken doses of insulin 80% of prescribed, and then they were considered as non-adherent to ISA ( Belayneh K, 2014 ) .   1/1/2022 22

23. Result and Discussion… 1/1/2022 23 Figure 1 :Pie chart showing adherence and non-adherence distribution

24. Result and Discussion… 5.2. Environmental Related Factors One in five (39, [17.3%]) of respondents were being busy with their work and more than half (186,[82.7]) of the respondents were not being busy with their work. More than half (160, [71.1%]) of respondents couldn’t afford to buy Insulin and only (65, [28.9%]) of the respondents got thei r insulin as free distribution ( see figure 2). 1/1/2022 24

25. Result and Discussion… 1/1/2022 25 Figure 2: S howing free distribution and purchasing of insulin by the study participants

26. Result and Discussion… 5.3. Psychological Related factors Table 2 : Psychological related factors 1/1/2022 26 Variable( n=225) Options Frequency (n) Percent (%) Forgetting to take insulin injection Yes 76 33.8 No 149 66.2 Missing insulin injection purposely Yes 38 16.9 No 187 83.1 Stopping taking insulin injection when feeling better Yes 19 8.4 No 206 91.6 Stopping taking insulin injection when feeling worse Yes 5 2.2 No 220 97.8

27. Result and Discussion… 5.4. Support systems About two fifth or (99, [44%]) of participants visited healthcare providers once in a month as recommended, (70, [31.1%]) of participants had visited health care providers once in three month, and (56, [24.9]) of participants had visited health care providers once in six month. 1/1/2022 27

28. Result and Discussion… 5.5. Factors associated with adherence to ISA In this study some variables showed significant association with insulin self-therapy. Accordingly, regarding duration of insulin self-therapy, participants who had been taking insulin for 1-4 and 5-10 years 3.731 and 2.811 times less adherent than those who had been taking insulin self –therapy for greater than or equal to 11 years. Related to f requency of visiting health care provider, those participants who visited health care provider once in a month and once in three month were 2.276 and 0.491 times more adherent than those participants who had visited health care provider once in six month (see table 3 below). 1/1/2022 28

29. Result and Discussion… Table 3: Factors associated with adherence to ISA 1/1/2022 29 Variable Options N (%) 95%CI For COR 95%CI For AOR P-V Discarding insulin after one month opening Yes 90(40%) 3.613(1.798,7.261) 0.277(0.138,0.556) 0.01* No 135(60%) R(1) R(1)   Being busy with work Yes 39(17.3%) 0.156(0.073,0.334) 6.413(2.998,13.716) 0.01* No 186(82.7%) R(1) R(1)   Bringing insulin and its syringe   Purchase 160(71.1%) 0.268(0.100,0.714) 3.738(1.400,9.982) 0.01* Free distribution 65(28.9%) R(1) R(1)   Price of insulin   Cost 160(71.1%) 3.646(1.365,9.740 ) 3.646(1.365,9.740 ) 0.01* Cheap 65(28.9%) R(1) R(1)  

30. Result and Discussion… Table 3: Factors associated with adherence to ISA… 1/1/2022 30 Forgetting to take insulin injection Yes 76(33.8%) 0.403(0.205,0.793) 2.483(1.261,4.888) 0.01* No 149(66.2%) R(1) R(1)   Missing insulin injection purposely Yes 38(16.95%) 0.171(0.080,0.368) 5.832(2.718,12.514) 0.01* No 187(83.1%) R(1) R(1)   Stopping taking insulin injection when feeling better Yes 19(8.4%) 0.079(0.028,0.223) 12.711(4.484,36.032) 0.01* No 106(91.6%) R(1) R(1)   Stopping taking insulin injection when feeling worse Yes 5(2.2%) 0.054(0.006,0.495) 18.564(2.019,170.662) 0.01* No 220(97.8%) R(1) R(1)   Forgetting to take insulin injection Yes 76(33.8%) 0.403(0.205,0.793) 2.483(1.261,4.888) 0.01* No 149(66.2%) R(1) R(1)   Missing insulin injection purposely Yes 38(16.95%) 0.171(0.080,0.368) 5.832(2.718,12.514) 0.01* No 187(83.1%) R(1) R(1)   Stopping taking insulin injection when feeling better Yes 19(8.4%) 0.079(0.028,0.223) 12.711(4.484,36.032) 0.01* No 106(91.6%) R(1) R(1)   Stopping taking insulin injection when feeling worse Yes 5(2.2%) 0.054(0.006,0.495) 18.564(2.019,170.662) 0.01* No 220(97.8%) R(1) R(1)  

31. Result and Discussion… Table 3: Factors associated with adherence to ISA… 1/1/2022 31 Variable Options N (%) Adherence to ISA 95%CI For COR 95%CI For AOR P-V Yes No Duration of insulin self-therapy 1-4 yrs. 74(32.9%) 54(24%) 20(8.9%) 0.268(0.093,0.769) 3.731(1.300,10.707) 0.01* 5-10yrs 92(40.9%) 74(32.9%) 18(8.4%) 0.356(0.125,1.013) 2.811(0.988,8.001)   11yrs 59(26.2%) 54(24%) 5(2.2%) R(1) R(1)   Frequency of visiting health care provider   Once in 6 month 56(24.9%) 36(16%) 20(8.9%) 6.319(2.553,15.640) 2.276(0.948,5.461) 0.01* Once in 3 month 70(31.1%) 55(24.4%) 15(6.7%) 2.037(0.924,4.490) 0.491(0.223,1.082)   Once in a month 99(44%) 91(40.4%) 8(3.6%) R(1) R(1)   Variable Options N (%) Adherence to ISA 95%CI For COR 95%CI For AOR P-V Yes No Duration of insulin self-therapy 1-4 yrs. 74(32.9%) 54(24%) 20(8.9%) 0.268(0.093,0.769) 3.731(1.300,10.707) 0.01* 5-10yrs 92(40.9%) 74(32.9%) 18(8.4%) 0.356(0.125,1.013) 2.811(0.988,8.001)   59(26.2%) 54(24%) 5(2.2%) R(1) R(1)   Frequency of visiting health care provider   Once in 6 month 56(24.9%) 36(16%) 20(8.9%) 6.319(2.553,15.640) 2.276(0.948,5.461) 0.01* Once in 3 month 70(31.1%) 55(24.4%) 15(6.7%) 2.037(0.924,4.490) 0.491(0.223,1.082)   Once in a month 99(44%) 91(40.4%) 8(3.6%) R(1) R(1)  

32. Result and Discussion… This study result showed that one fifth or (43, [19.1%)] of respondents were non-adherent to ISA. This indicates that there was inadequate understanding of adherence to ISA for the treatment of diabetes among participants. In this study some variables showed significant association with insulin self-therapy. Accordingly, regarding duration of insulin self-therapy, participants who had been taking insulin for 1-4 and 5-10 years 3.731 and 2.811 times less adherent than those who had been taking insulin self –therapy for greater than or equal to 11 years. 1/1/2022 32

33. Result and Discussion… Related to f requency of visiting health care provider, those participants who visited health care provider once in a month & once in 3 month were 2.276 & 0.491 times more adherent than those participants who had visited health care provider once in 6 month.   The result of this study (43, [19.1%)] is almost consistent or in line with the study conducted in Southeastern Brazil which revealed that 21.7% of the participants were non-adherent to ISA ( Abu Hassan et al,2013 ). 1/1/2022 33

34. Result and Discussion… This similarity might be due to small sample size taken by Southeastern Brazil & this current study area. However , the finding of this current result is higher than the study performed in French which was 12 % ( Ajay Kumar SK,2011 ) . In that study 5% and 18% of the participants stopped taking their insulin self-injection when feeling better and due to forgetfulness respectively. 1/1/2022 34

35. Result and Discussion… In contrast to this, 8.4% of the respondents stopped taking their insulin self-injection when feeling better in the current study. This difference might be due to socio-economic characteristics such as access to education about ISA in the treatment of diabetes. 1/1/2022 35

36. Strength and limitation of study Strength of Study Inclusion and exclusion criteria were set Data collectors were informed, questionnaires were prepared and necessary corrections were made. Systematic random sampling method was used to give equal chances for all study populations. Data were entered, and analyzed using SPSS software. 1/1/2022 36

37. Strength and limitation of study… Limitation of the Study Not generalize at community level Small sample size was taken Study design was cross-sectional in nature Does not confirm the definitive cause & effect relationship between the variables. Was conducted within a short period of time to use other study design. 1/1/2022 37

38. Conclusion and recommendation Conclusion One fifth (43, [19.1%]) of participants are found to be non-adherent to ISA. Binary and Multinomial regression analysis also identified some factors that had significant association with non-adherence to ISA. 1/1/2022 41

39. Conclusion and recommendation… Recommendation One fifth (43, [19.1%]) of participants are found to be non-adherent to ISA. This is significant number which needs intervention to minimize factors associated with non- adherence to ISA. Therefore, there is a need to design a means for patients to increase their adherence to ISA: It is important if continuous monitoring and patient education will be provided by healthcare professionals working in chronic follow up units of NTPHs in regular intervals. 1/1/2022 39

40. Conclusion and recommendation… It is helpful if the government, NGOs, and volunteers provide insulin devices It is advisable for WU to promote researchers to investigate assessment of adherence to ISA and associated factors in this study area. For researchers, it is vital to conduct another study to identify the root causes of non-adherence to ISA among the general popn . by using bigger sample size . 1/1/2022 40

41. Sample Reference Association AD. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2010;33(1): 62-9 Organization WH. Adherence to long term therapies, time for action. Geneva: World Health Organization Association AD. Standards of medical care in diabetes. Diabetes Care. 2011(1): 11-61 Yusuf T. Knowledge and Attitude on Insulin Self-Administration among Type 1 Diabetic Patients at Metu Karl Referral Hospital, Ethiopia 2019:7 1/1/2022 41

42. Acknowledgment First , we would like to thank the almighty “ Waaqa ” who gave us a good health, strength, courage, and commitment to complete this thesis . We would also like to extend our gratitude to Wollega University for provision of this important topic . Next, our deepest gratitude and special thanks goes to our advisors Mr . Diriba Mulisa (BSC, MSC) and Mr. Lami Bayisa (BSC, MSC) for their uninterrupted, support, advice, constructive suggestions, comments and unreserved guidance that helped us a lot to conduct and complete this research thesis. Finally , we would like to say thanks to all individuals who had put effects for the accomplishment of this research thesis. 1/1/2022 42

43. 1/1/2022 43