Practices of Lifestyle Modification Regarding T2DM

Chapter 5 – Discussion, Recommendation & Conclusion

5.1 Introduction

Assessing knowledge, attitudes, and practices (KAP) regarding type 2 diabetes mellitus among the general population — rather than among diagnosed patients — offers a distinctive epidemiological window into the pre-clinical phase of the disease, where preventive interventions are most likely to produce lasting population-level benefit. Most studies on the KAP on diabetes both in developing and developed countries targeted patients with diabetes. (Ben Abdelaziz, Thabet, Soltane, Gaha K, Gaha R, et al., 2007). Unlike these, this study targeted the general population. Therefore adequate comparative data is lacking for the study and the discussion is based on knowledge, attitudes and practices of the population of Saint Lucia. There is no study concerning KAP regarding T2DM available in Saint Lucia, hence, this study is an attempt to gather the data regarding the same. The Caribbean region carries one of the highest age-standardised diabetes prevalence rates in the Americas, with Saint Lucia and several neighbouring nations reporting adult T2DM prevalence figures approaching or exceeding 14% according to International Diabetes Federation data, making KAP research in this population both timely and public-health relevant (IDF, 2021). This chapter discusses a collaboration of major finding of the study, the relevant discussion, recommendation and conclusion. The study was a cross-sectional study in an attempt to collect sufficient information on knowledge, attitudes and practices of lifestyle modification regarding T2DM among the population of Saint Lucia.

5.1.1 Demographic

Majority of the participants in this study were in the age group 25-34 years (39.5%). Capturing the 25-34 age cohort as the dominant participant group is particularly valuable from a prevention standpoint, as lifestyle behaviours established in early adulthood — dietary patterns, physical activity levels, and attitudes toward healthcare engagement — are predictive of chronic disease risk over the subsequent three to four decades. This in general accordance with the national census which conducted in the 2015 (Department of Statistic, 2015) In regard to participants with no formal education was very low 1.3%, and participants with primary , secondary and tertiary level together constituted an overwhelming (98.7%) of the participants in this study. This indicates that most participants are well educated, a finding which is similar to the results of another study conducted by Karir Consultant Limited.

A majority of the participants were poverty-stricken (34.1%) earning between $0.00 – $1,499.99 eastern Caribbean dollars per household. Poverty could limit accessibility to and affordability of a well-balanced diet and healthy food. And this could explain why a large percentage of the participants had low level of practice towards T2DM regarding regular doctor visits. Income-related barriers to healthcare access are well documented in low- and middle-income Caribbean settings, where out-of-pocket costs for blood glucose testing, dietary counselling, and regular specialist review represent a disproportionate burden for households earning below the regional poverty line (Hassell et al., 2021). The finding is in keeping with a survey conducted by KAIRI Consultant Limited where 43.8% of the population was shown to have very low income (KAIRI, 2007).

5.1.2 Knowledge

In this study it is found that knowledge is statistically high amongst the respondents. The finding that 76.1% of participants demonstrated good knowledge of T2DM suggests that health literacy campaigns and school-based diabetes education in Saint Lucia may have been reasonably effective at raising general awareness, even if this awareness has not yet translated into corresponding improvements in preventive health behaviours. 76.1% of the respondents had good knowledge of T2DM. The results also indicated that the respondents were very knowledgeable on the general awareness of T2DM such as the symptoms, complications and prevention of the specific disease.

The result was consistent with a study done by Ambigapathy and colleagues found in their study that majority of respondents (67.0%) were knowledgeable about lifestyle modifications. The respondents scored 50% and above of the total score for all the categories of questions asked (Ambigapathy R. et al, 2006).

In contrast R. Malathy and colleague in their study concluded low education amongst majority of their respondents. 83.3% had poor knowledge of the benefits of exercise, weight loss and healthy diet (R. Malathy et al, 2011).

5.1.3 Attitude

Majority of the respondents agreed that it is important to engage in regular exercise, to follow a controlled diet and to maintain a healthy lifestyle. Results indicated that 90.5% of the respondents had positively agreed that regular exercise is necessary to help manage T2DM. While 80.9% agreed that diet modification is essential to control the disease by getting correct advice and clarification. These findings imply that the respondents had good attitude towards diabetes prevention and control practices.

This finding is similar to that of Mukhopadhyay P et al in which majority of the respondents 82.3% had positive attitude towards lifestyle modifications (Mukhopadhyay P et al, 2010). Similar results were revealed in a study conducted by Upadhyay DK et al 60.3% of the respondents had positive attitude towards lifestyle modifications (Upadhyay DK et al, 2008).

5.1.4 Practice

Results indicated that the respondents had poor practices towards regularly exercise and diabetes preventative measure such foot and eye examinations. The disconnect between positive attitudes and poor practices observed in this study is consistent with the health belief model’s prediction that perceived barriers — including cost, time, and limited access to safe exercise environments — are often more powerful determinants of health behaviour than health knowledge or attitudinal endorsement of healthy practices alone (Hassell et al., 2021). This was evidenced by results which indicated that the respondents did not exercise regularly while majority of the respondents never visited heath care provider for diet advice, never checked their blood pressure and never checked their blood sugar level.

This finding is similar to those of W.M Kiberenge and colleagues in which majority of respondents (75.6%) had bad practices in relation to lifestyle modifications (W.M Kiberenge et al, 2010).

5.1.5 Variables Combined

The association between KAP in this study was selectively determined; that is only specific questions were used. These questions comprise of two aspects diet modification and practice question such as regular exercise, maintaining healthy lifestyle and regular doctor visits respectively.

There was a significant positive correlation (r= 0.233, p=0.000) and (r=.201, p=0.000) between the knowledge level and the attitude level of respondents in this study. The weak and non-significant correlation between knowledge and practice (r= -0.064, p=0.259) is a finding of considerable practical importance for programme designers: it suggests that knowledge-based educational interventions alone are insufficient to drive behaviour change, and that effective T2DM prevention programmes must address structural barriers to healthy behaviour alongside information provision. This means that the better respondents were knowledgeable, the better they were willing to observe healthy lifestyle habits. There was a very weak, non-significant positive correlation (r=-0.064, p=0.259) between the knowledge level and practice level of respondents. This means that being knowledgeable did not necessarily translate to healthy lifestyle practices.

The results found in this study were similar to those in the study by Ambigapathy R. and colleagues in which a significant positive correlation (r=0.536, p<0.01) was found between knowledge and attitude scores (Ambigapathy R. et al., 2003).

The knowledge-attitude-practice gap identified in this Saint Lucia study mirrors findings reported across multiple Caribbean and sub-Saharan African populations, suggesting that the structural determinants driving the gap — financial constraints, limited built-environment support for physical activity, and inadequate follow-up mechanisms in primary care — may be common to many low- and middle-income settings facing a rapidly rising T2DM burden. International Diabetes Federation data indicate that 537 million adults worldwide were living with diabetes in 2021, with 90% of cases attributable to type 2 diabetes, and that low- and middle-income countries account for the largest and fastest-growing share of this burden (IDF, 2021). Addressing this gap at the population level in Saint Lucia may require targeted interventions at three complementary levels: individual-level motivational interviewing delivered through primary care contacts; community-level programmes leveraging faith organisations, schools, and workplaces as venues for lifestyle modification support; and policy-level actions such as taxation of ultra-processed foods, subsidisation of fresh produce, and the creation of safe neighbourhood walking and cycling infrastructure. Evaluating the cost-effectiveness of such multi-level interventions in small island developing states represents an important priority for future public health research in the Caribbean region (Hassell et al., 2021).

5.2 Recommendation

The government must take a lead in creating awareness about diabetes disease country wide and in the counties that are adversely affected. In addition to developing the Saint Lucia national diabetes center, a community awareness program targeting rural and semi-urban communities should be developed using a multi-sectoral approach in order to address the knowledge gaps and influence behavior towards diabetes prevention.

Given the low and uncertain incomes characteristic among the people, free screening for chronic diseases should be availed to the residents by the county government to increase their knowledge level on diabetes status. This can be done in a similar manner to the ante natal care program targeting all government facilities right from level 2 health facilities.

In order to ensure that once a community member seeking for health care services is managed well right from the start, there is a need for an increase in the awareness of diabetes management and its complications in the primary healthcare sector especially at level two facilities such as dispensaries and health care centers due to their proximity to members of the public. Thus, continuous education on diabetes mellitus and its complications for primary healthcare providers should be accompanied by regular assessments on the knowledge level. Screening for diabetes is important, but equally crucial is patient education and counseling.

The following measures are recommended to address the knowledge and practice deficits uncovered in this study:

1. There is need for the implementation of community or national based lifestyle intervention program to improve the knowledge of patients regarding healthy lifestyle and emphasize the importance of exercise and weight loss in the management of type 2 diabetes mellitus. This should be extended to the primary health care clinics where the majority of patients are seen.

2. Medical nutrition intervention program should be implemented with a multidisciplinary team (Doctor, dietician, social worker, psychologist…)

3. Empower Mamelodi healthcare workers with motivational interviewing knowledge and skills to promote behavior change and adoption of healthy lifestyle practices by patients

5.3 Conclusion

The knowledge and attitude levels of lifestyle modifications among the population of Saint Lucia was generally high. Nevertheless, majority of these people have poor practices toward healthy lifestyle habits.

Majority of the respondents had poor practices such as regularly exercise, checking their blood glucose level, and visiting the doctor for regular check-ups. This implies that there is need to develop community based health promotion programs to bring about paradigm shifts that will promote healthily choices and behavior as well as understand the impact of culture and beliefs to these practices.

The low incomes suggest the respondents’ inability or difficulties in meeting health care costs when they arise, this may explain the poor practice of visiting health facility for regular check-ups.

References

International Diabetes Federation (IDF). (2021). IDF diabetes atlas (10th ed.). https://www.diabetesatlas.org

Hassell, T. A., Gaskin, P. S., Callender, J., & Fraser, H. S. (2021). Diabetes prevention and management in the Caribbean — current challenges and future directions. Annals of Global Health, 87(1), 1–12. https://doi.org/10.5334/aogh.3028

Chatterjee, S., Khunti, K., & Davies, M. J. (2018). Type 2 diabetes. The Lancet, 389(10085), 2239–2251. https://doi.org/10.1016/S0140-6736(17)30058-2

Ben Abdelaziz A, Thabet H, Soltane I, Gaha K, Gaha R, et al. (2007) Knowledge of patients with type 2 diabetes about their condition in Sousse, Tunisia. East Mediterr Health J May-Jun; 13 (3) 505-14.)

Department of Statistics. Unpublished data. Saint Lucia; 2013