[[alternative]]The Relationship between Diabetes Knowledge, Social Support and Self-Care Activities of Diabetes in Kiribati

[[abstract]]Diabetes type 2 has been a growing concern globally. It is predicted that 300 million people worldwide will be affected by diabetes by 2025 whereby two third of all cases affected are from low middle income countries like Kiribati. Kiribati has been facing the impact of diabetes where showed that 58% are non-communicable diseases related deaths. About 28% of the population has diabetes. More than 100 individuals with diabetes undergo operation each year due to diabetes complications whereby 58 individuals undergo limb amputation due to gangrenous wounds. However, the relevant issue has never been explored in Kiribati. The purpose of this study was to explore the relationship between diabetes knowledge, social support and self-care activities of patients with diabetes in Kiribati. Another purpose was to explore how diabetes knowledge and social support contribute to patients’ self-care activities in Kiribati. This was a cross-sectional and descriptive correlational study. A convenient sampling employed of 138 individuals with diabetes attending the diabetic clinic at the Tungaru Central Hospital, referral hospital in Kiribati and two other clinics on south Tarawa; Bairiki and Temanoku clinics. A self-administered questionnaire was used in data collection between the periods from July, 2013 to September, 2013. Data were analyzed using Statistical Package for Social Sciences (SPSS) software version 18.0. One-way ANOVA, t-tests, Pearson product moment correlation and multiple linear regression analysis were used for the study. The findings of this investigation showed the mean age of participants was 51.64 (SD=8.8) and range between 25 – 75 years. Religion showed 43% was Catholics while Kiribati Protestant Church (KPC) was 45% and other churches were 11%. The disease duration of diabetes showed average of 7.96 (SD=6.4) and range between 0.08-32 years. Diabetes knowledge average total score was 19.09 (SD=4.22). Social support revealed social support total score was 3.74 (converted score were 74.79). The social support sub-scores revealed a range from 3.35 – 4.20 (converted score were 58.74 – 79.89). The findings showed that the self-care activities total score (SCA-TMS) showed an average of 2.9 days per week and the subscales of self-care range between 5.4 days per week to 0.7 day per week. Univariate analysis was performed between demographic characteristics, medical factors, diabetes knowledge and social support and self-care activities and subscales and the results showed the following were significant: Demographic and medical factors found significant were age, religion, employment status and disease duration. Age was associated with diet self-care (r=0.21, p=0.01), and foot-care self-care (r=0.21, p=0.01). Religion was found associated with foot-care self-care (F=4.36, p=0.02) Post hoc test showed Catholics mean score > KPC. Employment status was associated with diet self-care (t= -2.57, p=0.01). Disease duration was related with physical activity (r= -0.18, p=0.04). Univariate analysis was done between the variables such as diabetes knowledge, social support and self-care activities and sub-dimensions and the results showed that these were the only significant: social support and several subscales were found significant include social support total mean score (MOS-TMS), emotional informational support, tangible support, and affectionate support. Social support total mean score was associated with self-care total mean score (r=0.17, p=0.045) and physical activity self-care (r=0.22, r=0.01). Emotional informational support was related to physical activity self-care (r=0.28, p=0.001). Tangible support was associated with blood glucose monitoring self-care (r=0.17, p=0.049). Affectionate support was associated with three self-care activities include self-care total mean score (r=0.21, p=0.01), diet self-care (r=0.17, p=0.04) and foot-care self-care (r=0.19, p=0.03). Diabetes knowledge was found to have no association with self-care activities total score and subscales. The predictors of self-care activities was tested using the multiple linear regression and the result showed that religion and social support total mean score were significant predictors of overall self-care activities (F(2,135) = 4.11, p=0.02). In conclusion factors including age, religion, employment status, disease duration and social support need to be incorporated when planning and implementing strategies in enhancing self-care behaviours of patient diabetes. There is a need to duplicate the study in the rural areas of Kiribati to compare results