1. Introduction
Worldwide, diabetes mellitus (DM) is among the major disorders presenting significant threat to the human population with high vulnerability among persons over 60 years and pregnant women, where it presents adverse consequences during first-time pregnancy (1–4). The disease condition is a global issue with prevalent records in developing and developed countries, including the United Kingdom (UK) (2), United States of America (USA) (1), Southeast Asian regions (5, 6), and Nigeria (7). The situation of DM among persons in advanced ages particularly in developing nations, such as Nigeria, is more critical due to limited access to diabetes care services, ignorance of the disease, poor diet, and lifestyle. The onset of DM is characterized by the body’s inability to tolerate carbohydrate (3). Surprisingly, the adverse effect of DM extends to the unborn babies with notable neonatal challenges and deformities (1, 4). The manifestation of DM is correlated with demographic variables of gender, age, marital status, education, tobacco intake, and alcohol consumption (8, 9). Inadequate knowledge of DM is a potential limitation to its prevention, resulting in high mortality and morbidity in the population. The quality of DM knowledge among different population cohorts is very poor (10–12), thus, indicating more complicated and dissatisfying reports if drastic measures are neglected (1–9).
Considering the epidemiological reports regarding DM with its pronounced poor knowledge status, preferences are given to educational interventions with emphasis on the potential risk factors, signs and symptoms, management, treatment, and prevention. The present study considered a valid intervention called “Education-Based Diabetes Intervention (EBDI), as an essential tool to improve the quality of DM-related knowledge, thereby preventing DM occurrences, and for possible management of DM condition in the elderly population. The EBDI is structurally designed through expert validation and authentication, to enhance elderly peoples’ knowledge relating to DM. The content of EBDI is constructively validated to improve DM knowledge based on established principles and philosophical assumptions and also in accordance with high-profile published studies with significant similarities (13–16). The extent of DM control, management, prevention, treatment and coping depends majorly on the quality of DM knowledge (17–19). In addition, care support and professional assistance are essential in complying with monitoring of glucose level, dietary intake, and physical exercises among patients (20). Studies quantifying the effectiveness of interventions on DM knowledge particularly in Nigeria are lacking as evidenced in literature reviewed. Therefore, this study basically evaluated the effectiveness of Education-Based Diabetes Intervention (EBDI) on diabetes-related knowledge (DRK) among persons over 60 years. It also determined the significant differences within study groups and demographic variables of the participants.
2. Materials and methods
2.1. Research design
An experimental research design employing pre- and post-test measures involving intervention and control groups was adopted. All the participants were involved in the two interval assessments. Those in the control group were not exposed to the content of the intervention package.
2.2. Participants and recruitment procedures
A total of 820 persons over 60 years were recruited from the six major geopolitical zones that formed Nigeria during the months of February 2023 and June 2023. Using different media platforms and printed materials, awareness regarding the study to the prospective participants was disseminated in all the zones. The state pension offices in the sampled zones served as the point of contact since the majority of the prospective study participants were retirees from state civil service. With the consent of the participants fully demonstrated in writing, eligible participants were successfully recruited. The participants were equally availed with the opportunity to withdraw from the study at will. Individuals who were below 60 years of age and those who did not sign the consent forms were completely excluded from the study. In accordance with scholarly recommendation (21), individuals who met the eligibility requirements were allocated randomly into one of the groups by the researchers. The content of the EBDI was successfully administered to the eligible persons in the intervention group in a duration of 45 min per session, once in a week for 4 weeks. Two main intervals of assessments were carried out: (a) pretest – which was observed at the beginning of the intervention, and (b) post-test – which was done at the end of the intervention. All the eligible participants were involved in the two interval assessments. The content of EBDI was written in very simple English language for easy comprehension and clarity. The intervention exercise was implemented in six different venues as agreed by the participants and the investigators. The participants in different groups were assessed independently (in-time and in-intervals) by the investigators in order to eliminate all forms of bias. The quantitative scores were blinded and handled separately until the end of all the statistical procedures.
2.3. Instrument for data collection
Data collection was done using a “Diabetes-Related Knowledge Questionnaire (DRKQ)” demonstrating a reliability index of 0.82. The DRKQ was adapted (22). The content of DRKQ covered the meaning of diabetes, predisposing factors, dietary knowledge, diabetes management, control and treatment, as well as adverse health effects. In a multiple-choice response options of 4 in each statement in the DRKQ, a correct answer was indicated and thus attracting a point. The range of scores was zero to 15 (9), implying that below 60% reflected poor knowledge, while 60% and above represented high knowledge. The study explored the participants’ demographic variables such as gender, alcohol consumption, chronological age, tobacco intake, marital status, and educational level.
2.4. Statistical analysis
Statistical data were computed using SPSS statistics 22.0 version (23). Frequency counts, percentage scores, and independent chi-square statistics were used to establish the effectiveness of EBDI on DRK among persons over 60 years in Nigeria at a significance level against the probability value of less than 0.05. The ethical permit was received from Ethics Sub-Committee of the University of Nigeria, Nsukka, following the stipulated principles, guidelines, and regulations as established by the Declaration of Helsinki for conducting studies of this kind.
3. Results
A complete data analysis was done on 820 persons over 60 years who met the eligibility requirements for the study. The number of male participants (62%) was higher than that of the females (38%) in the intervention group, and that of male participants (46%) was lower than that of female participants (54%) in the non-intervention group, without statistical difference (p = 0.603 > 0.05). More than two-thirds (72%) of the participants consume alcohol in the treatment group while less than one-third (28%) do not; and approximately two-thirds (66%) of them consume alcohol in control group while slightly above one-third (34%) do not, with significant difference (p = 0.038 < 0.05). Only 43% of the participants were 70 years and above, and more than half (57%) were 60–70 years in the treatment group, without statistical difference (p = 0.109 > 0.05). Only 39% of them use tobacco, and approximately two-thirds (61%) do not in the intervention group; more than half of the participants (62%) took tobacco and only 38% of them did not take tobacco in the non-treatment group, with a difference (p-value = 0.026 < 0.05). Approximately three-quarters of the participants (73%) were married, only 27% of them were in other marital union in the intervention group; three quarters of the participants (75%) were married while only 25% were in other marital union in control group, with a difference (p = 0.010 < 0.05). Three-quarters of the participants (75%) had a university degree while only 25% had other degrees in the intervention group; only 38% of the participants had other degrees while more than half of them (62%) had university degrees in the non-treatment group, without statistical difference (p = 0.291 > 0.05). (Full details are presented in Table 1).
Table 1. Demographic information of the participants and significant differences (N = 820).
There was a significant difference in the study groups in DRK pretest measures (p < 0.001) while none existed in the groups in DRK post-test scores (p > 0.870). (Full details are presented in Table 2).
Table 2. Analysis of significant differences within study groups of the participants (N = 820).
4. Discussion
This study quantified the effectiveness of education-based intervention (EBDI) on the quality of knowledge relating to DM among persons over 60 years. The experimental approach adopted in the study intensified its strength as well as the statistical outcomes. Some significant implications are linked with our findings. For instance, reliable interventions are frameworks for knowledge acquisition and creating awareness regarding diseases. On the other hand, the findings filled the existing research gap in this area of study as the findings of the study can be referenced. Finally, the educational institutions, care providers, and policy-makers can leverage on the study outcomes in improving, modifying, and initiating other means or approaches in handling diabetes cases. In our study, the significant effect of EBDI on DRK among persons over 60 years was established. This was demonstrated on the statistical scores of individuals in the experimental group as varied with the participants in the conventional group as contained in the post-test assessments. Secondly, the significant effect of the intervention was proved when the statistical outcomes of pre- and post-test measures of the participants in the intervention group are set for comparison. The statistical differences in the percentage scores of the groups are justified and linked with the treatment given and thus its effect. Also, this finding is a clear indication that successful application of interventions on health complications that are peculiar to elderly persons would be very effective in deepening the etiology and possible mechanism for control, management, and prevention. A similar study justifies that disease management and prevention depends on one’s knowledge and understanding (9). Our findings are in accordance with other studies with huge similarities. A study of healthcare workers revealed effectiveness of a validated program on the sampled group (13). Also, a reliable study conducted on 215 people with Type 2 diabetes reported the significant effect of a validated program on the participants’ knowledge of diabetes (14). Also, a similar study involving 103 eligible participants revealed that diabetes education program was significantly effective on physical exercises of Type 2 diabetic patients (15). Similarly, a significant effect of educational intervention in attaining positive and quality health outcomes on diabetic patients was reported (24). Also, a similar significant effect was recorded (16). These outcomes are expected to form the basis for the development and validation of effective diabetes care centers for persons in all the geopolitical zones in Nigeria.
The strength of our study research lies primarily in the use of appropriate methodologies, population, and statistical approach while its weakness is demonstrated in the use of questionnaire for data collection which limited the responses to the structured items. Similar studies are recommended to allow for qualitative assessment of the participants. The quality of knowledge if properly assessed by allowing participants’ view and experiences would be more robust and convincingly presented for effective generalization. Also, further study that would encourage follow-up is recommended using the same population cohort.
5. Conclusion
The study concluded that EBDI is significantly effective on DRK of persons over 60 years in Nigeria. Therefore, the need for educational institutions and care providers to adopt reliable education-based intervention such as EBDI to maximize diabetes care to elderly population particularly in Nigeria becomes paramount.
Abbreviations
DRK, Diabetes Related Knowledge; DRKQ, Diabetes Related Knowledge Questionnaire; EBDI, Education-Based Diabetes Intervention.
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