@2024 Afarand., IRAN

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ISSN: 2383-2150    Journal of Education and Community Health 2015;2(1):38-49

Background
... [1-3]. Diabetes is the reason of 60% of non-traumatic lower-limb amputations, 2% of blindness, 10%of the need for dialysis and 67%ofhigh blood pressure among patients [4].
Previous Studies
... [5-22]. In order to change the self-treatment behaviors,recognizing the status quo and analyzing the factors affecting on these behaviors seem to help planners to design and implement effective interventions. Meanwhile, the use of theories, behavior change models and defining the existing problem based on various constructs of these theories will help achieving the intended goals [23].BASNEF model is one of the most useful patterns in the health education, which has been obtained from the combination of two models of behavioral intention and PRECEDE [24].
Aim(s)
This study aimed to examine the state of self-treatment behavior among type 2 diabetic patients in Kermanshah using BASNEF model.
Research type
This is a descriptive-analytic, cross-sectional study.
Research society, place and time
This study was carried out in 2014 on type 2 diabetic patients who had referred to Kermanshah diabetes clinic.
Sampling method and number
Regarding 45 % of prevalence of self-treatment behaviors among diabetic patients in previous studies (18), the required sample size for this study was estimated 380 people with 95% of assurance and 0.05 of permissible error. This study was done through simple random sampling and the samples were chosen according to the list of patients in Kermanshah diabetes clinic and they were included in the research in case of having the criteria for entering the study. These criteria comprised of having an active case in diabetes clinic, not having serious mental illness and the ability to respond to the questionnaire by the interviewer as well as the agreement of the participants.
Used devices&materials
Data was collected using the written questionnaire, and through interviews and self-reporting. The questionnaire consisted of two parts; the first part contained 10 questions about demographic characteristics such as age, gender, marital status, residence location, occupation, education, records of diabetes in close relatives (father, mother, sister or brother), duration of illness and suffering from the side effects of diabetes for the subjects. The second part was the researcher- made questionnaire of BASNEF Model constructs. The attitude construct was measured on 9 questions with 5-point Likert scale ranging from strongly agreed (5) to strongly disagreed (1) (score range of 9 to 45), which earning higher scores indicated negative attitude towards the self-treatment. Enabling factors were measured with 4 questions of three-choice scale (yes, to some extentand no) in which 2, 1 and zero score was considered for the Yes option, to some extent and no option, respectively (score range of 0 to 8).In this construct obtaining higher scores illustrated the existence of enabling factors in order to not doing the self-treatment. The construct of subjective norms was determined with 6 questions of 5-point Likert scale ranging from strongly agreed (5) to strongly disagreed (1) (score range of 6 to 30), which getting higher scores showedthe existence of persuasive subjective norms of not doing the self-treatment. Moreover, the construct of behavioral intention was measured with 6 questions of 5-point Likert scale ranging from strongly agreed (5) to strongly disagreed (1) (score range of 6 to 30) and earning higher scores revealed the lack of diabetic patients’ intention for doing the self-treatment behavior. In this study, patients' knowledge of the consequences of self-treatment was examined in the form of 15 questions with answers of yes, no and I do not know. The grading was in the form of zero or onepoint for each question (if answered correctly, one point and if answered wrongly, zero point) so the maximum obtainable score was 15 points. Self-treatment behavior of diabetes consisted of 5 questions with the answers of yes and no in which 1 point was regarded for yes option as was zero points for no option. In this study, self-treatment behavior meant a behavior of drug self-treatment, use of herbal medicines and herbal extracts, consuming opium and doing according to other patients` recommendation. Evaluating and confirming the content validity and BASNEF questionnaire construct were performed through using the opinions of6 health education and health promotion experts, and the final form of questions was determined by applying the experts’ intended changes in each section. The reliability of the questionnaire was evaluated through a pilot study on 38 patients (10%) with type II diabetes. Cronbach's alpha for the questions was calculated 0.74, 0.71, 0.70, 0.78, 0.71 and 0.72 for the attitude, enabling factors, subjective norms, behavioral intention, self-treatment behavior and knowledge, respectively. Statistical analysis Data was analyzed using SPSS-16 software. In this study, data was obtained from the constructs of studied model was not normally distributed so appropriate non-parametric tests such as the Mann-Whitney, Kruskal-Wallis, and logistic regression and chi-square tests were used. The significance level for all the tests was less than 0.05.
Findings by Text
The age range of diabetic patients in this study was between 30 and 90 with the mean age of 54.28±10.1. According to the findings, 252 patients (66.4%) were female and 84.5% had education degrees of less than Diploma. 65.8%of respondents were housekeepers (240 people). The patients` mean duration of disease was 8.19± 6.13 and 51.8%of them (197 people) had diabetes complications and vision problems (27.3%) were the most common complication in patients. According to the findings, 234 (61.6%), 91 (23.9%) and 41 respondents (10.8%) controlled their disease only by oral pills, concomitant use of pills, and diets and insulin injections, respectively. The prevalence of self-treatment behaviors among patients participating in the study was reported 50.5%. Studying the relationship between demographic variables and self-treatment behavior using Chi-square test showed in Table 1 that there is a statistically significant relationship between age (p=0.035) and education (p=0.019) of participants with self-treatment behaviors. Examining the relationship between BASNEF model constructs and demographic variables of patients participating in the study using the Mann-Whitney statistical tests and Kruskal-Wallis test in Table 2 revealed that the mean scores for subjective norms’ construct (p=0.002) and enabling factors (p<0.001) were significantly different among various age groups of patients taking part in the study. Similarly, the mean scores of attitude construct (p<0.001), subjective norms (p=0.007), enabling factors (p=0.023) and behavioral intention (p=0.009) were significantly different between the genders.The mean scores of knowledge construct (p=0.027) and behavioral intention (p=0.016) among single patients were significantly more than others. According to the findings, the mean scores of knowledge construct (p<0.001), attitude (p=0.032), subjective norms (p<0.001) and enabling factors (p=0.002) differed significantly amid different occupations. Besides, a significant difference was observed in mean scores of knowledge construct (p<0.001), subjective norms (p>0.001), enabling factors (p<0.001) and behavioral intention (p<0.001) of participants’ different levels of education.Other results of this study demonstrated that among the enabling factors, issues such as the high expenses of treating diabetes (p=0.002) and lack of time to implement the doctor`s orders (p=0.024) were related significantly to self-treatment behavior among patients. Furthermore, among the resources of persuasive subjective norms of self-treatment behavior, the patient`s partner (p<0.001)and family members(p<0.001) had statistically significant relationship with self-treatment behaviors. Logistic regression test analysis showed that generally various constructs of BASNEF model used to explain 24% of the variance of doing self-treatment behavior in studied diabetic patients. According to the results, the constructs of attitude (ß=0.14), subjective norms (ß=0.08) and enabling factors (ß=0.201) had the ability to predict the behavior (p<0.05) among which the enabling factors showed higher predictability (Table 3).
Main comparison to the similar studies
... [25-35]. Rahaei et al. [36] stated in their study that enabling factors with their 61% of the total effect are the strongest predictor of self-control behavior among patients with hypertension. They did not recognize any significant role for the attitude in doing the correct treatment behavior among diabetic patients in some other studies [37].The role of enabling factors (β=0.20) and attitude (β=0.14) was more than other constructs in explaining the behavior and this result is in consistence with other studies regarding the importance of enabling factors and attitude’s roles in predicting the behavior [40-45].
Suggestions
Holding training classes about the side effects of self-treatment behaviors for patients and important peopleis recommended. Moreover, informing doctors and health workers for encouraging patients to correct self-care behaviors and to avoid self-treatment will also bring beneficial effects. Authorities and health planners` heed to increase the level of patients’ insurance coverage is also necessary.
Limitations
One of the limitations of this study has been data collection through interviews with patients.
Conclusions
The findings of this study showed that more than half of type 2 diabetic patients do the self-treatment behaviors and the structures of attitude, abstract norms and enabling factors are the best predictive factors of treatment behaviors.
Acknowledgments
Special regards are addressed to the cooperation of the officials and personnel of the central diabetes clinic of Kermanshah University of Medical Sciences while collecting data and to the patients participating in this study.
Conflict of interest
The results of this study were not associated with the personal interests of authors.
Ethical Permissions
Before the study and after the project`s approval by the Ethics Committee for Research of Hamadan University of Medical Sciences, the agreement of Kermanshah diabetes clinic was gained to determine an appropriate time for completing the questionnaires. Besides, in addition to obtaining written letters of consent from the patients, they were assured about the confidentiality of the data.
Funding Sources
This article is the result of a research project approved by Hamadan University of Medical Sciences and funded by Vice Chancellor for Research and Technology (Student Research Committee).

TABLES and CHARTS

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