Original Data

Rev Diabet Stud, 2019, 15(1):26-34 DOI 10.1900/RDS.2019.15.26

Management of Type 2 Diabetes and Chronic Kidney Disease in Fiji in 2018: Knowledge, Attitude, and Practice of Patients

Mohammed Alvis Zibran, Masoud Mohammadnezhad

School of Public Health and Primary Care, Fiji National University
Address correspondence to: Masoud Mohammadnezhad, e-mail: masoud.m@fnu.ac.fj


OBJECTIVE: The aim was to identify the level of knowledge, attitude, and practice (KAP) in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD) at Sigatoka Subdivisional Hospital (SSH) in 2018 since no studies have been done on this issue so far in Fiji. METHODS: A quantitative, cross-sectional study including 225 patients was carried out July 1, 2018, through August 31, 2018, using a validated self-structured questionnaire. Fijians, aged 30 years or above, with confirmed T2D and CKD who were attending the Special Outpatient Department (SOPD) at SSH, were included in the study using a purposive sampling method to identify eligible participants. Data was gathered by a questionnaire that covered questions related to each aspect of KAP. RESULTS: The relation of native Fijians (i-Taukei) to Fijians of Indian descent (FID) was approximately 1:1. The majority of participants had high levels of knowledge, attitude, and practice (61.8%, 63.6%, and 88.4%, respectively). However, a few areas of low knowledge were evident, such as the relation between high blood pressure and renal status in people with diabetes and the need for renal transplant in end-stage kidney disease (ESKD) abroad. Low attitude was apparent for the impact and management of diabetic kidney disease (DKD). Low practice was evident regarding clinic attendance, self-monitoring, and opting for non-medical treatment. CONCLUSIONS: The majority of T2D patients with CKD had a high level of knowledge, but weaknesses were observed in the self-management of CKD and clinic attendance. This information should be considered by clinicians and policy-makers to improve management and treatment of CKD in T2D.

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Rev Diabet Stud, 2019, 15(1):49-57 DOI 10.1900/RDS.2019.15.49

Healthcare Providers' Perception of Healthcare System Factors Associated with Poor Glycemic Control among Type 2 Diabetes Patients in Fiji

Pablo Romakin1, Mohammadnezhad Masoud2

1Ministry of Health and Medical Services, Suva, Fiji
2School of Public Health and Primary Care, Fiji National University, Suva, Fiji
Address correspondence to: Masoud Mohammadnezhad, e-mail: masraqo@hotmail.com


OBJECTIVE: This study aims to explore the perceptions and experiences of healthcare providers regarding the role of healthcare system factors on glycemic control among type 2 diabetes (T2D) patients in Fiji in 2018. METHODS: Nineteen healthcare providers (physicians and nurses) from three randomly selected urban healthcare centers in Suva, Fiji, were selected through purposive variation sampling to participate in three focus group discussions (FGDs). The participants in this study were healthcare providers working in diabetes clinics, and medical officers and nurse team leaders from the selected healthcare centers. The data were analyzed by means of thematic analysis using Attride-Stirling's thematic network analysis framework. RESULTS: The majority of the participants (52.6%) were nurses, most of them female (84.2%), with a mean age of 39 years (SD ±9.2). A large part of the participants had been working in the diabetes clinics for more than 5 years (52.6%) and had more than 10 years' experience (52.6%) in their current employment. Five main healthcare system factors that may affect glycemic control were identified during thematic analysis: 1. Healthcare workforce (shortage of staff, high workload). 2. Medicine, consumables, and equipment (regular stock-outs of basic diabetes medicines and consumables, poorly equipped diabetes clinics). 3. Service delivery (lack of effective diabetes service delivery, continuum of care). 4. Healthcare information system (inadequate, not fully functional, unreliable). 5. Infrastructure (lack of supportive diabetes clinic infrastructure and processes). CONCLUSIONS: Healthcare system factors influence glycemic control among T2D patients. Understanding these factors is important in order for healthcare providers to deliver an effective and efficient service for diabetes patients in Fiji.

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