Manuel Carballo 1,2, Anwar Mohammad 1, Elizabeth C. Maclean 2, Noureen Khatoon 1, Mohammad Waheedi 3 and Smitha Abraham
1Dasman Diabetes Institute, Kuwait. 2International Centre for Migration, Health and Development, Geneva, Switzerland (Correspondence to: M. Carballo:
Abstract
Background: Rates of diabetes in Kuwait are among the highest in the world.
Aims: To inform prevention initiatives, this study assessed diabetes knowledge, attitudes towards it, and personal behaviour relating to risk factors among the Kuwaiti population.
Methods: A cross-sectional knowledge, attitudes, beliefs and practices survey of 1124 people was performed between July and September 2015. Descriptive analysis and χ2 tests were performed.
Results: Although most participants (94%) had heard of diabetes and 87% believed type 2 diabetes to be preventable, knowledge of risk factors was poor [family history (87%), age (44%), low exercise (10%), obesity (4%), diet (0%) and stress (0%)]. Dietary patterns in Kuwait were variable and, of concern, 42% of those with diabetes had been eating more since diagnosis. Lifestyle, particularly among Kuwaitis and people with diabetes, was sedentary – 47% of participants walked < 20 minutes per day.
Conclusions: Despite the importance of diet and exercise for diabetes prevention, significant gaps in public education clearly exist. At a policy level, much remains to be done and intensified intersectoral programmes are required to improve public awareness.
Keywords: diabetes mellitus, diet, exercise, Kuwait, prevention.
Citation: Carballo M; Mohammad A; Maclean EC; Khatoon N; Waheedi M; Abraham S. Knowledge, attitudes, behaviours and practices towards diabetes mellitus in Kuwait. East Mediterr Health J. 2018;24(11):1098–1102. https://doi.org/10.26719/2018.24.11.1098
Received: 20/04/17; accepted: 15/08/17
Copyright © World Health Organization (WHO) 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).
Introduction
Type 1 and type 2 diabetes have become a major health and healthcare challenge in Kuwait and other parts of the world. Globally, over 415 million people are thought to be now living with the disease, and up to 12% of health expenditure is currently taken up by its treatment and care (1). In the Gulf Cooperation Council region (Bahrain, Kuwait, Oman, Qatar, United Arab Emirates and Saudi Arabia) where the prevalence of obesity has increased in the last 3 decades, diabetes rates have also risen and are now among the highest anywhere in the world (2,3).
The fact that type 2 diabetes, which is by far the more common form of the disease, is largely preventable with a mix of dietary management and physical exercise, calls for an understanding of how people perceive the threat of diabetes and what they feel can be done to prevent it. A growing body of evidence from surveys on the knowledge, attitudes, beliefs and practices (KABP) of people in different parts of the world suggests that sizable gaps exist with respect to public awareness of the risk factors for diabetes and how these factors can be avoided or mitigated (4–6).
In order to inform and guide national prevention initiatives in Kuwait, this study looked at what people know about diabetes, what their attitude to it is, what they believe are its causes and how their personal behaviour may relate to diabetes and its risk factors.
Methods
Ethics statement
The study was approved by the Ethical Review Committee and International Scientific Advisory Board of the Dasman Diabetes Institute, Kuwait. All participants gave signed informed consent.
Study design
A random-sample, cross-sectional KABP survey was designed, and a standardized questionnaire was developed and pretested by the Dasman Diabetes Institute, building on previous validated KABP surveys and guidelines (7,8). Face validity of questions was determined by expert review. Medical students from the University of Kuwait were trained in the reliable use of the questionnaire that was then used in face-to-face interviews or self-completed by participants selected in shopping malls and government offices. Questionnaires were available in both English and Arabic, so as to cover the large expatriate population in Kuwait as well as Kuwaiti nationals. The survey was undertaken between July and September 2015. A total of 1124 people were invited to participate. Only adults over the age of 21 years (n = 1088) were included in the analysis.
Data analysis
Data were analysed using SPSS version 21, with P = 0.05 as the significance level. Frequencies and descriptive statistics were used to assess the data, with χ2 and odds ratios being used to compare groups. Confidence intervals (CIs) were assessed at 95%. For height, weight and body mass index, outliers were removed based on z scores > 3 standard deviations from the mean.
Results
Demographics
Of the 1088 people who were selected, 566 were female and 522 were male. The higher proportion of women may reflect that most of the interviews were conducted in shopping malls. In all, 647 (59.5%) participants were non-Kuwaiti and 441 (40.5%) were Kuwaiti. The main countries of origin for non-Kuwaitis were Egypt (17%), India (12%), Philippines (6%), Pakistan (4%), Syrian Arab Republic (4%), Lebanon (3%) and Jordan (2%). The mean number of years that expatriates had spent in Kuwait was 14.4 (standard deviation 11.4; 95% CI 13.5–15.3). According to national estimates, 69% of the Kuwait population is expatriate (8); therefore, non-Kuwaitis were underestimated in our sample. The educational level of the participants was high; 642 (60%) had completed a university education and 123 (12%) had postgraduate degrees. According to self-reported height and weight measures, 36% of the respondents were overweight and 24% were obese. Furthermore, 101 participants (9.3%) stated that they had been diagnosed with diabetes.
Diabetes knowledge
The vast majority (806, 93.9%) of the respondents said they had heard of diabetes before the interview, and 662 (65.5%) had a family member who had been diagnosed with diabetes; in 64% of these cases the family member was a parent or sibling. Indeed, 944 (86.8%) respondents said that they saw diabetes as a disease that runs in the family, and respondents who had a relative with diabetes were significantly more likely to recognize the hereditary traits of the disease (P < 0.001). All participants with family members with diabetes stated that it ran in the family.
Almost half (474, 44%) of the respondents also saw age as a risk factor for diabetes, agreeing with the statement that “you get it when you get older”. Older participants were nevertheless more likely than younger people to see age as a risk factor for diabetes (P = 0.048), and non-Kuwaitis were more likely than Kuwaitis (51.5% and 32%) to see age as a risk factor (P < 0.001) (OR = 2.256; 95% CI 1.75–2.9).
Despite 36% of participants being overweight and 24% being obese, only 41 (3.8%) respondents saw obesity as a risk factor for diabetes.
While 865 (87%) respondents recognised that type 2 diabetes is preventable, none of them highlighted poor diet as a factor, and the preventative role of exercise was only recognized by 112 (10.3%) respondents. Among those who acknowledged the preventative role of exercise, a -GB/en-GB.plg_editors-xtd_image.ini
