- Research article
- Open Access
Determinants of diabetes knowledge in a cohort of Nigerian diabetics
© Jasper et al.; licensee BioMed Central Ltd. 2014
- Received: 11 April 2013
- Accepted: 8 February 2014
- Published: 4 March 2014
One of the consequences of the generational paradigm shift of lifestyle from the traditional African model to a more "western" standard is a replacement of communicable diseases by non-communicable or life style related diseases like diabetes. To address this trend, diabetes education along with continuous assessment of diabetes related knowledge has been advocated. Since most of the Nigerian studies assessing knowledge of diabetes were hospital-based, we decided to evaluate the diabetes related knowledge and its sociodemographic determinants in a general population of diabetics.
Diabetics (n = 184) attending the 2012 world diabetes day celebration in a Nigerian community were surveyed using a two part questionnaire. Section A elicited information on their demographics characteristics and participation in update courses, and exercise, while section B assessed knowledge of diabetes using the 14 item Michigan Diabetes Research and Training Centre's Brief Diabetes Knowledge Test.
We found that Nigerian diabetics had poor knowledge of diabetes, with pervasive fallacies. Majority did not have knowledge of "diabetes diet", "fatty food", "free food", effect of unsweetened fruit juice on blood glucose, treatment of hypoglycaemia, and the average duration glycosylated haemoglobin (haemoglobin A1) test measures blood glucose. Attaining tertiary education, falling under the 51-60 years age group, frequent attendance at seminars/updates and satisfaction with education received, being employed by or formerly working for the government, and claiming an intermediate, or wealthy income status was associated with better knowledge of diabetes.
Nigerian diabetics' knowledge of diabetes was poor and related to age, level of education, satisfaction with education received, employment status and household wealth.
Diabetes is projected to become one of the world's main disabler and killer within the next twenty-five years  and the developing countries in Africa are not left out. This can be attributed to advancement in education and technology, coupled with increase in urbanization and exchange of ideas between the developed and developing countries. The resultant effect is a continuous generational paradigm shift of lifestyle from the customary African model to a more “western” standard. One of the consequences of this transition is a change in disease patterns with communicable diseases being replaced by non-communicable or life style related diseases like diabetes, obesity, cardiovascular disease and cancer . This is because the healthier conventional lifestyles which was characterised by regular and vigorous physical activity accompanied by sustenance on high fibre whole grain-based diet, rich in vegetables, and fruits2 has been replaced by over-reliance on motorised transport and consumption of unhealthy diets rich in carbohydrates, fats, sugars, and salts . The resultant effects of this “adopted” regime are an upsurge in the levels of obesity and overweight in the population, itself a risk factor for diabetes.
The sole greatest panacea and deterrent against diabetes is adequate knowledge of the condition. It has been reported that information can help people assess their risk of diabetes, motivate them to seek proper treatment and care, and inspire them to take charge of their disease [4, 5]. Knowledge of diabetes forms the basis for informed decisions about diet, exercise, weight control, blood glucose monitoring, use of medications, foot and eye care, and control of macro vascular risk factors . Knowledge and awareness about DM, its risk factors, complications, and management are important aspects for better control and better quality of life [7, 8]. As diabetes mellitus is a chronic disease, adherence to appropriate self-care practices leads to improved glycaemic control. Furthermore, Ranjini et al.  showed that more knowledgeable diabetic patients had better attitude towards the care of their own disease. If proper education is incorporated into a structured diabetic care programme in health care settings, more value will be added to patients' knowledge and self-care behaviour.
In Nigeria, a substantial number of studies have assessed knowledge of the causes, risk factors, complications, and management of diabetes among diabetic patients [10–12], diabetic and non diabetics , and to evaluate the effect of an educational intervention on diabetes knowledge 21 . While some studies reported poor knowledge [11, 12], another reported good to fair knowledge [10, 13] and Puepet et al.  found that educational programme impacts positively on the knowledge of diabetes. However, most of these studies were hospital based and may therefore not have assessed other diabetes patients who for one reason or another do not visit the hospital regularly or go to a diabetes centre for check up or follow up. Therefore the aim of this study was to assess diabetes knowledge and its sociodemographic determinants among a general population of diabetes patients.
This study was a descriptive cross-sectional study which utilized a sampling of convenience to recruit all eligible diabetic patients who attended the 2012 world diabetes day celebration at a diabetes screening centre in Jos, Plateau State, Nigeria.
The instrument utilized in this study was a two-part questionnaire. Section A dealt with patient demographics (age, gender, religion, level of education, occupation/employment status, level of household wealth and family history of diabetes etc) and the disease (time since diagnosis, type of treatment, regularity on medication and type of diabetes). It also contains questions on their involvement in exercise, whether exercise is beneficial for diabetes, reading/attending update courses and satisfaction with information gathered. Section B assessed basic knowledge of diabetes mellitus using the Michigan Diabetes Research and Training Centre’s Brief Diabetes Knowledge Test, which was created for adults with either type 1 or type 2 diabetes . Fourteen multiple-choice questions assess basic patient knowledge of diabetes, while nine assess patient’s knowledge of insulin use. A reliability coefficient of 0.70 was reported for the general knowledge subscale .
Approval to carry out this study was sought and obtained from the management of the diabetes screening centre in Jos, Plateau State, Nigeria. Prior to the commencement of the interview, the purpose of the study was thoroughly explained to the participants. All the participants who had a good grasp of English language or who could understand the contents of the questionnaire when it was explained to them, and were willing to participate in the study were assessed. Furthermore the researchers were on hand to attend to any questions arising from the respondents, while they assisted those who could neither read nor write to complete their questionnaires.
It was ensured that the feedback came from them so as to ensure that they understood the questions very well. For those with visual impairments, the questions were read out to them and they provided answers. However, participants who have not previously been diagnosed of diabetes were excluded from the study as were those who could not understand the contents of the questionnaire after it has been explained to them (illiterate or visually impaired). Participants who were under 18 years, mentally or speech impaired were also excluded.
Participants who are on other medications apart from insulin were required to answer questions 1-14 (general knowledge of diabetes test) on section B of the questionnaire . A score of ≥ seven was considered satisfactory in this study. Each correct answer was awarded one point and the total score was rated as good (>7), or poor knowledge (<7), with the maximum score obtainable being 14. Higher scores indicate higher knowledge of diabetes.
Using SPSS version 17, descriptive statistics of percentages was computed for the sociodemographic variables, previous education, satisfaction with education, involvement in regular exercise, knowledge of benefit of exercise and correct response to each question in section B. Analysis of variance (ANOVA) and independent t-test was used to determine the influence of sociodemographic variables on knowledge of diabetes. Proportional differences were explored using chi statistics. Differences were considered significant at an alpha level of 0.05.
Sociodemographic variables of participants
7 · 1
19 · 1
17 · 3
108 · 9
34 · 2
17 · 9
4 · 3
37 · 0
63 · 0
12 · 5
0 · 000
79 · 9
20 · 1
65 · 8
0 · 000
4 · 9
80 · 4
1 · 6
306 · 7
0 · 000
13 · 0
Level of education
19 · 0
23 · 9
41 · 3
28 · 5
0 · 000
15 · 8
22 · 5
23 · 9
31 · 0
39 · 1
0 · 000
19 · 0
3 · 3
Level of household wealth
21 · 2
69 · 0
109 · 1
0 · 000
9 · 8
Do you have a family history of diabetes?
51 · 6
32 · 6
35 · 6
0 · 000
15 · 8
When were you diagnosed of diabetes
Less than 5 years
43 · 5
38 · 6
9 · 8
202 · 5
0 · 000
15-22 1 · 6
2 · 2
4 · 3
Type of diabetes
32 · 6
22 · 3
0 · 000
67 · 4
Are you currently on insulin?
30 · 4
28 · 2
0 · 000
69 · 6
Where were you diagnosed of diabetes?
32 · 6
52 · 2
37 · 7
0 · 000
15 · 2
Regular on medication
79 · 3
286 · 4
0 · 000
20 · 7
47 · 3
0 · 54
1 · 857
52 · 7
Exercise is beneficial for diabetes
76 · 1
3 · 3
159 · 7
0 · 000
20 · 6
Read articles/Attend update courses
Not at all
30 · 4
32 · 6
23 · 4
16 · 2
0 · 976
13 · 6
Satisfied with instruction
10 · 8
40 · 8
33 · 2
0 · 000
48 · 4
Knowledge of diabetes
Most commonly missed questions on the diabetes knowledge test
Question (correct answer is in bold)
The diabetes diet is?
a. The way most American people eat
b. A healthy diet for most people
c. Too high in carbohydrate for most people
d. Too high in protein for most people
Which of the following is highest in carbohydrate?
a. Baked chicken
b. Swiss cheese
c. Baked potato
d. Peanut butter
Which of the following is highest in fat?
a. Low fat milk
b. Orange juice
Which of the following is a “free food”?
a. Any unsweetened food
b. Any dietetic food
c. Any food that says “sugar free” on the label
d. Any food that has less than 20 calories per serving
Glycosylated haemoglobin (haemoglobin A1) is a test that is a measure of your average blood glucose level for the past:
c. 6–10 weeks
d. 6 months
What effect does unsweetened fruit juice have on blood glucose?
a. Lowers it
b. Raises it
c. Has no effect
Which should not be used to treat low blood glucose?
a. 3 hard candies
b. 1/2 cup orange juice
c. 1 cup diet soft drink
d. 1 cup skim milk
Numbness and tingling may be symptoms of
a. Kidney disease
b. Nerve disease
c. Eye disease
d. Liver disease
Sociodemographic determinants of diabetes knowledge
Sociodemographic determinants of diabetes knowledge
Level of education attained
Read articles/Attend update seminar
Not at all
Satisfaction with education received
Satisfied 7.6 (0.9)a
Level of household wealth
Knowledge of diabetes was not associated with gender, religious afffiliation, having a family history of diabetes, duration since diagnosis, type of diabetes and where they were diagnosed of diabetes (p > 0.05).
With the increase in diabetes toward an epidemic dimension, diabetic patients need to be furnished with sufficient and all encompassing knowledge of this condition so as to ensure optimal self-management. This is especially pertinent in the African setting where people tend to hold tenaciously unto time-honoured beliefs about diseases such as diabetes and invariably search for treatment or cure within this traditional setup.
Even though a slight majority (56.5%) of the diabetes patients in this study had satisfactory knowledge scores, the overall mean knowledge score was poor (6.2 ± 2.2) thus explaining the misconceptions depicted in their answers. Majority (88.0%) did not know what a “free food” is, a figure higher than the 58% reported by Murata et al.  among diabetic veterans in US, but lower than 98% found in another Nigerian study . This is probably due to difference in geography, and also because of the widespread long-established misconception in Nigeria that any “sugar free” or “unsweetened” food is the ideal meal for diabetic patients. Moreover, this traditional belief may have been responsible for their ignorance that “unsweetened fruit juice” raises blood glucose (78.2%), a comparable result to the 73% reported by Odili, Isiboge and Eregie , but lower than 35% in another study .
In the present study, only 14.7% knew the relevance of the HbA1c test. A finding lower than the 44% reported by Murata et al. , but in the range of 11% reported in Nigeria . Poor knowledge of the HbA1c has also been reported by Arslantas et al. . A possible reason for this is unavailability or scarcity of this test in Nigeria at this time. While daily blood glucose monitoring tells how blood sugar is doing at a specific point in time (allowing necessary changes in medicine, food, and exercise), the HbA1c test show an individual’s glucose control and thus risk of complications . It also identifies changes in response to alterations in management and therefore gives a picture of long term diabetes management success . The result in the present study would therefore portray that a majority of Nigerian diabetics are unaware of their risk of developing complications, and in the dark in terms of the long term management of their condition. A resultant effect of this will be deficient coping strategies and in the long run poor quality of life.
Furthermore, the population that knew that diet soft drink should not be used to treat low blood glucose was lower than that reported in US by Murata et al.  (19.6% vs. 57%), but almost at par with the 21% reported by Odili, Isiboge and Eregie . It is also lower than in an earlier Nigerian study which revealed that 53.8% knew how to manage hypoglycaemia  This shows a near total lack of awareness of this complication, which may stem from a lack of or poor education from the health team, as it has been shown that there is even a low knowledge of diabetes among healthcare workers who are expected to deliver health education to the community .
As regards diet, majority (67.9%) could not identify baked potato as the diet with the highest carbohydrate content, a far cry from the 82%  and 50%  reported previously. This is plausibly due to the fact that Plateau state is the largest producer of potato in Nigeria and it is therefore one of the staple food in this area. It has been shown that potato may be beneficial to persons with diabetes because of its high fibre and manganese content, which aids in stabilizing blood sugar levels and reducing insulin resistance . However, literature has shown that the processing of potatoes by boiling elicits lower glycaemic index (GI) and glycaemic load (GL) values when compared to frying, baking, and roasting [19, 20]. The participants in this study will most likely be ignorant of this fact, considering “cooked” and “baked” to be no different from one another. It is pertinent that while educating patients on proper dieting; foods that are staple in these areas should be taken into consideration in terms of appropriate replacements, and difference in method of food preparation where applicable should be considered. This is because the method of cooking can alter the structure, and nature of the starches resulting in significant effects on postprandial blood glucose responses .
When asked what makes up a diabetes diet, only a slight majority answered correctly (50.5%), a figure lower than the 72% reported in a study among Pakistani Muslims . While the later study was carried out in a developed country, Nigeria is a developing country where people in the process of trying to adopt and embrace the “Western lifestyle” do so with many misconceptions–one of them being that a the diet of most American people is the healthy way of eating.
Sociodemographic determinants of diabetes knowledge
Knowledge increased exponentially as level of education, with those who had never attended school scoring lowest and those with tertiary education scoring highest. This is consistent with other studies in Kenya , and the US , but is at variant with other studies which reported no difference in knowledge with level of education [1, 24, 25]. Others have reported better knowledge among those who attained secondary education, possibly because majority of the participants were attending or had attended secondary education  and even among those who never attended school . A possible reason why Nigerian studies report that the less educated were more knowledgeable than the more educated is because the questions in these studies sometimes require interpretation to the illiterate ones, therefore the way a researcher asked a question may have guided them to the right answer. It may therefore advisable to translate the questionnaire to the local dialect of the target population if the illiterate group is to be included in a study as this will provide a balanced means of analysing the effect of education on knowledge. Furthermore, since a more educated person may be more inquisitive while being counselled or educated on diabetes by a health professional than an illiterate, educators should be more proactive and tune up their pedagogical skills while dealing with the less educated to ensure maximal participation and assimilation.
Satisfaction with education received whether update courses or seminars was associated with good knowledge of diabetes. Satisfaction will mean incorporation of information received into their daily routine of dieting; lifestyle modification and prevention of injuries or deformities (e.g. foot protection), which will go a long way to improving their coping strategies and invariably quality of life. It will also improve their attitude towards diabetes, and in the long run change their practices to embrace healthier lifestyles . Participants who either regularly read articles, or attended seminars on diabetes were more knowledgeable for obvious reasons. One of the most important being that traditional, time tested and outdated beliefs about diabetes will be done away with, paving way for embracing new and proven realization of the disease. A study in South Africa earlier reported that participants with counselling had better knowledge than those who had not received counselling .
Furthermore, the wealthy and those with intermediate income were shown to have better knowledge than the poor, a finding which is at variance with another Nigerian study  as well as that among Malaysian diabetics , but consistent with others among diabetics in Oman  and non diabetics in Malaysia . Government and retired workers also performed better than the self and unemployed participants, a result which is at variance with Odili et al.  who found that occupation did not affect knowledge. A possible reason for the above findings is that the wealthy, intermediate, government and retired workers were the most educated; satisfied with education received; and read educational materials/attended seminars more often than the poor, self, and unemployed. Furthermore, the government and retired workers who were also the rich ones would have had more as well as regular access to educational materials through the internet, along with seminars organised in their workplaces of which the poor, and self and unemployed would not be privy to. To increase the level of awareness of diabetes to all and sundry therefore, free educational courses should be provided at the community level so as to reach out to the less advantaged also.
Age was also associated with knowledge, with participants within the age group of 51-60 scoring higher than others, a result almost in line with another study which reported best knowledge among the 40-59 years age group . With the positive influence of education on knowledge in this study, this finding is probably explained by the fact that a majority of the participants in the above age group had attained tertiary education as compared to the others. This finding is at variance with other studies which have found younger age to be associated with better knowledge . Older persons with diabetes tend to have less education, worse cognitive function, and more barriers to practicing appropriate self care than their younger counterparts with diabetes [29, 30]. This reasoning may not have applied in this study because the diabetics aged 51-60 years either read more articles or participated in update courses and had better cognition of the education received than those of other age groups.
In this study there was no association between years since diagnosed of diabetes, having a family history of diabetes, type of diabetes and knowledge of diabetes. A finding at variance with other studies which have reported difference in knowledge by number of years with diabetes [10, 12, 27] and having a family history of diabetes [25, 28]. While the above studies were carried out in a hospital setting, this study was community based. Nonetheless, our finding is consistent with other studies which found no difference in knowledge by duration of diabetes  and family history of diabetes . A positive family history of a disease may affect one's level of perceived risk  and is the factor most significantly associated with the perceived risk of developing diabetes . However, in a randomized controlled trial, Pierce et al.  found that family members of individuals with type 2 diabetes underestimate their own risk of developing the disease. This perceived risk will only be possible if an individual is aware of his family’s history of diabetes and in this study only a slim majority (51.6%) were privy to this knowledge. This gap can be bridged if educators encourage diabetic patients to intimate their progeny of the disease and inspire them to learn more about it.
A majority of the participants in this study knew that exercise is beneficial for diabetes and the figure was higher than that reported in another Nigerian study  (76.1% vs. 52.1%), but lower than the 92.6% reported among Pakistani diabetics . However, the number of participants who exercised regularly in this study was higher than those reported by Tham et al.  (47.3% vs. 40%) and Okolie et al.  (47.3% vs. 7.3%). These results would probably portray that knowledge may not necessarily lead to good practice or performance; because even though they knew the benefits of exercise many of them did not participate in regular exercises. This may however be due to a number of factors that can either be modifiable (self efficacy and social support) or non-modifiable (age, sex, and race/ethnicity) [36–38]. While educating patients on the benefits of exercises, it is also crucial that modified factors hindering their regular participation should be identified and methods of tackling these impediments addressed pronto.
Strengths and limitations of the study
The strength of this study is that it was carried out in a community setting, where diabetics of different backgrounds were represented. However, the study was conducted in a single centre and therefore limits the generalization of its findings. A larger sample would provide more power to detect significant relationships between the study variables and differences between groups.
This cohort of Nigerian Diabetics had poor knowledge of diabetes, riddled with misconceptions owing to time tested and widespread traditional beliefs about the condition. They did not know a “diabetic diet”, “fatty food”, “free food”, effect of unsweetened fruit juice on blood glucose, treatment of hypoglycaemia and the average duration glycosylated haemoglobin (haemoglobin A1) test measures blood glucose. Age, level of education, regular attendance of update courses/reading updates regularly, satisfaction with updates received, employment, and level of household wealth were associated with good knowledge of diabetes. This study suggests that educators should be more proactive, while also tuning up their pedagogical skills so as to ensure maximal participation and assimilation especially for the less educated. Furthermore, free educational courses at the community level are justified so as to reach out to the less advantaged also.
- Ding CH, Teng CL, Koh CN: Knowledge of diabetes mellitus among diabetic and Non-diabetic patients in klinik kesihatan seremban. Med J Malaysia 2008, 61: 399–404.Google Scholar
- International Diabetes Federation (IDF): Diabetes atlas. 3rd edition. Belgium: Brussels; 2006.Google Scholar
- Mehta RS, Karki P, Sharma SK: Risk factors, associated health problems, reasons for admission and knowledge profile of diabetes patients admitted in BPKIHS. Kathmandu University Med J 2006, 4: 11–13.Google Scholar
- Gossain VV, Bowman KA, Rovner DR: The actual and self perceived knowledge of diabetes amongst staff nurses. The Diab Educator 1993, 19: 497–502. 10.1177/014572179301900604View ArticleGoogle Scholar
- Peyrot M, Rubin RR: Modelling the effect of diabetes education on glycaemic control. The Diab Educator 1994, 20: 143–148. 10.1177/014572179402000210View ArticleGoogle Scholar
- Murata GH, Shah JH, Adam KD, Wendel CS, Bokhari SU, Solvas PA, Hoffman RM, Duckworth WC: Factors affecting diabetes knowledge in Type 2 diabetic veterans. Diabetologia 2003, 46: 1170–1178. 10.1007/s00125-003-1161-1PubMedView ArticleGoogle Scholar
- Wild S, Roglic G, Green A, Sicree R, King H: Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diab Care 2004, 27: 1047–1053. 10.2337/diacare.27.5.1047View ArticleGoogle Scholar
- Ángeles-Llerenas A, Carbajal-Sánchez N, Allen B, Zamora-Muñoz S, Lazcano-Ponce E: Gender, body mass index and sociodemographic variables associated with knowledge about type 2 diabetes mellitus among 13,293 Mexican students. Acta Diabetol 2005, 42: 36–45. 10.1007/s00592-005-0172-4PubMedView ArticleGoogle Scholar
- Ranjini A, Subashini A, Ling HM: A Knowledge, attitude and practice (KAP) study of diabetes mellitus among 404 patients attending Klinik Kesihatan Seri Manjung. NCD Malaysia 2003, 2: 6–16.Google Scholar
- Adibe MO, Aguwa CN, Ukwe CV, Okonta JM, Udeogaranya OP: Diabetes self-care knowledge among type 2 diabetic outpatients in south-eastern Nigeria. Int J Drug Dev Res 2009, 1: 85–104.Google Scholar
- Okolie UV, Ijeoma EO, Peace IN, Ngozi KI: Knowledge of diabetes management and control by diabetic patients at federal medical centre umuahia abia state, Nigeria. Int J Med Med Sci 2009, 1: 353–358.Google Scholar
- Odili VU, Isiboge PD, Eregie A: Patients’ Knowledge of diabetes mellitus in a Nigerian city. Trop J Pharmaceutical Res 2011, 10: 637–642.Google Scholar
- Hamoudi N, Al Ayoubi ID, Vanama J, Yahaya H, Usman UF: Assessment of knowledge and awareness of diabetic and Non-diabetic population towards diabetes mellitus in Kaduna Nigeria. J Adv Sci Res 2012, 3: 46–50.Google Scholar
- Puepet FH, Mijinyawa BB, Akogu I, Azara I: Knowledge, attitude and practice of patients with diabetes mellitus before and after educational intervention in Jos, Nigeria. J Med Tropics 2007, 9: 3–10.Google Scholar
- Fitzgerald JT, Funnel MM, Hess GE, Barr PA, Anderson RM, Hiss RG, Davis WK: The reliability and validity of a brief diabetes knowledge test. Diabet care 1998, 21: 706–710. 10.2337/diacare.21.5.706View ArticleGoogle Scholar
- Arslantas D, Unsal A, Metintas S, Koc F: Knowledge of diabetic patients about diabetes at the primary stage in Eskisehir, Turkey. Pak J Med Sci 2008, 24: 263–268.Google Scholar
- Consensus statement on the worldwide standardisation of the HbA1c measurement Diabetologia 2007, 50: 2042–2043.Google Scholar
- Trepp R, Wille T, Wieland T, Reinhart WH: Diabetes-related knowledge among medical and nursing house staff. Swiss Med Wkly 2010, 140: 370–375.PubMedGoogle Scholar
- Bahado-Singh PS, Riley CK, Wheatley AO, Lowe HIC: Relationship between processing method and the glycemic indices of Ten sweet potato (ipomoea batatas) cultivars commonly consumed in Jamaica. J Nutri Metab 2011, 11: 1–6.View ArticleGoogle Scholar
- Foster-Powell K, Holt SHA, Brand-Miller JC: International tables of glycemic index and glycemic load values. Am J Clin Nutri 2002, 62: 5–56.Google Scholar
- Englyst HN, Cummings JH: Digestion of polysaccharides of potato in the small intestine of man. Am J Clin Nutri 1987, 45: 423–431.Google Scholar
- Hawthorne K, Tomlinson S: Pakistani Muslims with type 2 diabetes mellitus: effect of sex, literacy skills, known diabetic complications and place of care on diabetic knowledge, reported self-monitoring management and glycaemic control. Diabet Med 1999, 16: 591–597. 10.1046/j.1464-5491.1999.00102.xPubMedView ArticleGoogle Scholar
- Maina WK, Ndegwa ZM, Njenga EW, Muchemi EW: Knowledge, attitude, and practices related to diabetes among community members in four provinces in Kenya: a cross-sectional study. Afr J Diabet Med 2011, 19: 15–18.Google Scholar
- Tham KY, Ong JJY, Tan DKL, How KY: How much do diabetic patients know about diabetes mellitus and its complications? Ann Acad Med Singapore 2004, 33: 503–509.PubMedGoogle Scholar
- Ulvi OS, Chaudhary RY, Ali T, Alvi RA, Khan MF, Khan M, Malik FA, Mushtaq M, Sarwar A, Shahid T, Tahir N, Tahir Z, Shafiq S, Yar A, Alam AY: Investigating the awareness level about diabetes mellitus and associated factors in Tarlai (rural Islamabad). J Pak Med Assoc 2009, 59: 798–801.PubMedGoogle Scholar
- Gagliardino J, González C, Caporale J: The diabetes-related attitudes of health care professionals and persons with diabetes in Argentina. Public Health 2007, 22: 304–307.Google Scholar
- Moodley LM, Rambiritch V: An assessment of the level of knowledge about diabetes mellitus among diabetic patients in a primary healthcare setting. SA Fam Pract 2007, 49: 16–18.Google Scholar
- Al Shafee MA, Al-Shukali S, Rizvi SG, Farsi AL, Khan MA, Ganguly SS, Afifi M, Al Adawi S: Knowledge and perception of diabetes in semi-urban Omani population. BMC Pub Health 2008, 8: 249. 10.1186/1471-2458-8-249View ArticleGoogle Scholar
- Beeny LJ, Dunn SM: Knowledge improvement and metabolic control in diabetes education: approaching the limits? Patient Educ Couns 1990, 16: 217–229. 10.1016/0738-3991(90)90071-RView ArticleGoogle Scholar
- Pegg A, Fitzgerald F, Wise D, Singh BM, Wise PH: A community-based study of diabetes related skills and knowledge in elderly people with insulin-requiring diabetes. Diabet Med 1991, 8: 778–781. 10.1111/j.1464-5491.1991.tb01700.xPubMedView ArticleGoogle Scholar
- West JD, Goldberg KL: Diabetes self-care knowledge among outpatients at a veterans affairs medical center. Am J Health–system Pharm 2002, 59: 849–852.Google Scholar
- Harrison TA, Hindorff LA, Kim H, Wines RC, Bowen DJ, McGrath BB, Edwards KL: Family history of diabetes as a potential public health too. Am J Prep Med 2003, 24: 152–159. 10.1016/S0749-3797(02)00588-3View ArticleGoogle Scholar
- Harwell TS, Dettori N, Flook BN, Priest L, Williamson DF, Helgerson SD, Gohdes D: Preventing type 2 diabetes: perceptions about risk and prevention in a population-based sample of adults’ ≥ 45 years of age. Diabetes Care 2001, 24: 2007–2008. 10.2337/diacare.24.11.2007PubMedView ArticleGoogle Scholar
- Pierce M, Ridout D, Harding D, Keen H, Bradley C: More good than harm: a randomized controlled trial of the effect of education about familial risk of diabetes on psychological outcomes. Br J Gen Pract 2000, 50: 867–871.PubMedPubMed CentralGoogle Scholar
- Chutto MA, Qadr HR, Abro HA: Awareness of diabetes mellitus and its complications in diabetic patients. Suppl Med 2009, 15: 156–159.Google Scholar
- Sallis JF, Hovell MF, Hofstetter CR, Faucher P, Elder JP, Blanchard J, Caspersen CJ, Powell KE, Christenson GM: A multivariate study of determinants of vigorous exercise in a community sample. Prev Med 1989, 18: 20–34. 10.1016/0091-7435(89)90051-0PubMedView ArticleGoogle Scholar
- Courneya KS, McAuley E: Are there different determinants of the frequency, intensity, and duration of physical activity? Behavior Med 1994, 20: 84–90. 10.1080/08964289.1994.9934621View ArticleGoogle Scholar
- Godin G, Shephard RJ: Psychosocial factors influencing intentions to exercise of young students from grades 7 to 9. Res Quart Exer Sport 1986, 57: 41–52. 10.1080/02701367.1986.10605387View ArticleGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.