COMPARATIVE STUDY OF HEALTH-RELATEDQUALITY OF LIFE OF ADULTS WITH DIABETES MELLITUS WITHIN AND OUTSIDE SUPPORT GROUPS IN LAGOS STATE
Abstract
Introduction: Diabetes mellitus is a chronic metabolic disease which requires lifelong medical treatments and self-management practices encompassing lifestyle changes in multiple domains such as blood glucosemonitoring, regular foot checks, smoking cessation, regular physical activity and the adoption of reduced fat and carbohydrate diets in order to prevent serious morbidity and mortality. These practices require great motivation and psychological balance and as such, patient reported outcome in form of health-related quality of lifehas now been recognized as an important outcome of diabetes care as well as a factor in sustaining the ongoing performance of diabetes self-care activities. The objective of this study was to determine and compare thehealth-related quality of life, self-care practices and perceived social supportand associated factors among adults with diabetes mellitus within and outside support groups in Lagos State.
Materials and methods: This was a comparativecross-sectional study of two groups of adults with type 2 diabetes mellitus. A total of 394 participants were selected using a two-stage sampling technique from 8 public secondary healthcare facilities in Lagos State, 4 of which had diabetes support groups, and 4 did not. A structured interviewer administered questionnaire was used to collect demographics, socio-economic and treatment status information. Health-related quality of life was determined using WHO Quality of Life- short version and Diabetes-39 questionnaire. Summary of Diabetes Self Care Activities was used to assess self-care practices(diet, exercise, blood sugar testing, foot care and smoking status) and Morisky Medication Adherence Scale for medication adherence. Perception of social support was assessed using Multidimensional Scale of Perceived Social Support. The data was analyzed using SPSS 20. Binary logistics regression model was usedto assess independent variables influencing health-related quality of life.
Results: The respondents within diabetes support groups were significantly younger, had
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larger household size and greater proportion of them were currently married, had tertiary education and engaged in skilled occupations. There was no difference in the generic quality of life of the two groups measured with WHOQuality of Life-BREF (p >0.05). However, the health-related quality of life was significantly better among respondents belonging to diabetes support groups(p <0.01)and across domains of energy and mobility (p <0.01), diabetes control (p <0.01), anxiety and worry (p <0.05). The median number of days per week on which respondents within support groups adhered to diet, exercise, blood glucose monitoring and foot carerecommendations were significantly higher than for those outside support group. The perceptions of social supportfrom family, friends, significant others and total composite domain was not significantly different between the two groups.The predictors of better health-related quality of life among respondents belonging to support groups were adherence to consumption of fruits and vegetables and exercise,medication type, absence of cataract and not having hypertension as comorbidity. Adherence to general dietary recommendations, higher monthly income and absence of neuropathy were the significant predictors of better health-related quality of lifeamong respondents outside support groups.
Conclusion: Thehealth-related quality of life of adults belonging to diabetes support groups was significantly better compared to those outside support group. There was no difference in the perception of social support between the two groups but perception of good social support was associated with betterhealth-related quality of life in both groups. Membership of diabetes support groups influence adherence to self-care practices positively except for medication adherence.
Recommendations:Clinical guidelines for the management of diabetes should emphasize measurement of health-related quality of life and adults with the disease should routinely be provided with social support inaddition to the usual medical care.
