KNOWLEDGE AND COMPLIANCE OF TYPE 2 DIABETIC PATIENTS

REGARDING THEIR TREATMENT REGIMEN

______________

A Thesis
Presented to
the Faculty of the Graduate Studies
College of Nursing
University of Northern Philippines
Tamag, Vigan City

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In Partial Fulfillment
of the Requirements for the Degree
Master of Arts in Nursing

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by
ETHEL FLORES
2014

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TABLE OF CONTENTS
Page
CHAPTER
I.

THE PROBLEM
Introduction

..

Statement of the Problem ...

Scope and Delimitation of the Study .

Theoretical Framework ..

Conceptual Framework ..

17

Operational Definition of Terms

17

Assumptions ..

19

Hypothesis .

20

Methodology 20
Research Design 20
Population .. 20
Data Gathering Instrument . 21
Data Gathering Procedure .. 21
Statistical Treatment of Data . 21
Questionnaire ... 22

Chapter I
THE PROBLEM
Introduction
The rising of diabetes mellitus is a serious problem worldwide. Therefore, the
need for an effective management of diabetes is one of the major challenges faced by our
government not only the public sector but also the private entities worldwide.
As cited by Reparejo (2014), Dr. Gyu-Gan (2013), a diabetes specialist and
immediate past president of Diabetes Philippines, said that every 10 seconds, one person
dies due of diabetes-related complications. She added that this year alone, diabetes will
cause over four million deaths worldwide. In 2010, there were 285 million people
worldwide with diabetes. By 2030, the number of people with diabetes is estimated to
rise to 438 million, an increase of over 50 percent in 20 years. Almost 80 percent of
diabetes in the world live in developing countries. One of every five Filipinos could
potentially have diabetes mellitus or pre-diabetes.
Diabetes affects the lives of 9.7 percent of the adult population in the Philippines.
During the press conference, Fr. Danilo F. Baldemor, a diabetologist and immediate past
president of the Philippine Association of Diabetes Educators (PADE), said that the
number tends to double if we add the 12.5% of Filipinos who are at risk to diabetes with
impaired glucose tolerance (IGT). Combined, one out every five Filipino adults or
approximately 11 million has either pre-diabetes or diabetes. As the rate of diabetes cases
increases in the country, there will be some 6.16 million diabetic Filipinos by 2030.
In Baguio City, Dr. Francisco Pizarro, a diabetologist said that there is a noted
increase in diabetic cases. From the less than 50 new cases a year when they started

screening in 1988, it increased to about 150 to 200 a year by 2000. The increasing trend
continued over the years and present data indicates about 250 to 300 new cases a year. He
also said that though diabetes is mostly prevalent among adults, it was also noted now
that diabetes clients are getting younger and even becoming prevalent among teenagers,
mostly due to obesity and sedentary lifestyle. He added that Filipinos should not be wary
but work together instead for the prevention of diabetes, which though a noncommunicable disease, is also a dreadful disease.
During the course of clinical trials conducted among Diabetes Mellitus Type 2 in
Baguio City, the study coordinator noted that the management of the condition among
clients was very poor as indicated by controlled blood sugar level among subjects being
screened for the study. Out of 10 clients screened, only 1 client was randomized or
enrolled in the clinical trial. Clients who were enrolled in the studies received free
services like specialist consultation, nutritional counseling, oral hypoglycemic
medications which includes the study drugs, insulin, glucose monitoring kit, lab services,
and an allowance of 500 pesos for each schedules visits. Clients largely benefitted from
clinical trials and they were monitored closely. There was a great improvement on their
blood sugar level during the study.
In addition, Dr. Elizabeth Paz-Pacheco, former president of the Philippine
Society of Endocrinology and Metabolism said that in order to curb the trend and
minimize the ill effects of diabetes, everyone must work on prevention and proper
management of cases. Pacheco underscored the importance of getting blood sugar as
normal as possible for the majority of clients who are newly diagnosed, younger and who

have a longer life ahead of them. She added that lifestyle change and adherence to
medication must be observed to prevent complications of diabetes (Dar, 2012). In
December 2010, the Aquino Health Agenda: Achieving Universal Health Care for All
Filipinos was signed. The agenda is seen as the governments continuing effort towards
reform. The overall goal of the agenda is to ensure the achievement of the health system
goals of better health outcomes, sustained health financing and a responsive health
system by ensuring that all Filipinos, especially the disadvantaged group in the spirit of
solidarity, have equitable access to affordable health care (Philippine Health Care
Delivery System, 2012).
The Department of Health (DOH) is the executive department of the Philippine
government hospital responsible for ensuring access to basic public health services by all
Filipinos through the provision of quality health care and the regulation of all health
services and products. On April 14, 2004, DOH organized a committee named as
Philippine Coalition for the Prevention and Control of Non-Communicable Diseases
(PCPCNCD). PCPNCD is working together with the diabetes specialty groups that are
members of the coalition in the creation of common and more acceptable guidelines for
the treatment and management of clients who already have diabetes. Among these
diabetes organizations are the Philippine Diabetes Association (PDA), the Philippine
Association of Diabetes Educators (PADE), the Institute for Studies on Diabetes
Foundation Incorporated and the Philippine Center for Diabetes Education Foundation
Incorporated.

The DOH added that helping the disadvantaged and the vulnerable groups starts
with diabetes education and increasing awareness about the disease. Through proper
education and information, people with diabetes, even the disadvantaged (the elderly,
children and ethnic groups) and the economically-challenged ones can live near normal
lives and be productive individuals.
Yet in spite of the many efforts of the government and other concerned nongovernment organizations to help diabetic clients, many are not aware. Therefore, they
are not availing these services. There are also few studies conducted on diabetes in spite
of the growing population affected by the disease. The researcher is therefore motivated
to conduct a study on the knowledge and compliance of the clients diagnosed with Type
2 diabetes mellitus to their treatment regimen. Identifying their level of awareness on the
management regimen for diabetes provides awareness on their needs and concerns that
need to be addressed by health care providers. It involves their active participation in
order to maintain optimum level of health. It is a way of preventing further
complications that many arise from uncontrolled diabetes.
In addition, the results of this study is hoped to provide the health care providers
on what are the implemented programs established by the government that will help
manage the condition of their clients. On the other hand, this study will also serve as an
evaluation tool on how effective are the services being rendered to reduce the mortality
and morbidity of diabetes and what are the possible factors affecting the management of
the condition. Hence, allowing them to modify some of their strategies in a method that is
cost effective but not compromising the health of clients.

Statement of the Problem

The study focuses on the knowledge and compliance of Type 2 diabetic patients
to their treatment regimen.
Specifically, it aims to answer the following questions:
1. What is the profile of the respondents in terms of:
A. Socio-demographic profile factors
a. age,
b. gender,
c. civil status,
d. educational attainment,
e. occupation, and
f. monthly family income
B. Health-related factors
a. duration of illness, and
b. family history of DM
2. What is the level of knowledge of the respondent on the DM along
a. disease process
b. signs and symptoms
c. management and treatment
3. What is the extent of compliance on treatment regimen of the respondents in
terms of:
a. diet modification,
b. medication, and

c. follow-up check up
4. Is there a significant relationship between the level of knowledge of the
respondents and their socio-demographic profile and health-related factors?
5. Is there a significant relationship between the extent of compliance to treatment
regimen and the following:
a. socio-demographic profile,
b. health-related factors, and
c. level of knowledge
Scope and Delimitation
The study seeks to determine the knowledge and compliance of Type 2 Diabetes
Mellitus patients to treatment regimen.
The independent variables of the study include the following: Profile of the
respondents along socio-demographic factors like age, gender, civil status, educational
attainment, occupation and monthly family income; health-related factors such as
duration of illness, family history of DM while the dependent variables will be the level
of knowledge of DM along disease process, signs and symptoms and management
regimen.
The respondents of the study will include 300 Type 2 Diabetes Mellitus patients
who visits the diabetic clinic every month in the out-patient department of Baguio
General Hospital and Medical Center. Slovins fomula will be used to determine the
sample size and the respondents will be chosen through purposive sampling

A questionnaire checklist formulated by the researcher and content to be validated

by experts will be used in gathering data. The data gathered will be analyzed and
interpreted using frequency, percentage, mean, and bivariate correlation analysis.
Theoretical Framework
The study adopted the principles and theory on the health promotion model as
proposed Nola J. Pender. According to her, health is up to the person. It was designed to
be a complementary counterpart to models of health protection. Health promotion is
directed at increasing a clients level of well-being. The health promotion model
describes the multi-dimensional nature of persons as they interact within their
environment to pursue health. The model focuses on following three areas: individual
characteristics and experiences, behavior-specific cognitions and affect and behavior
outcomes. The set of variables for behavioral specific knowledge and affect have
important motivational significance. These variables can be modified through nursing
actions.
Health promoting behavior is the desired behavioral outcome and is the end point
in the HPM. Health promoting behavior should result in improved health, enhanced
functional ability and better quality of life at all stages of development. This model is
based on the idea that human beings are rational, and will seek their advantage in health.
But the nature of this rationality is tightly bounded by things like self-esteem, perceived
advantages of healthy behavior, psychological states and previous behavior. As for the
medical profession in general, the main purpose here is not merely to cure disease but to
promote healthy lifestyles and choices that affect the health of individuals. The
significance here is that the medical profession is really not the main ingredient in living

a healthy lifestyle. They might be an important part, but always serve a secondary role to
the rational choices of healthy living. The significance here is that the medical profession
is really not the main ingredient in living a healthy lifestyle. They might be an important
part, but always serve a secondary role to the basic rational choices of healthy living. The
health profession, in other words, is useless individuals reform their own lives and
perception of what is healthy.
The Health Promotion Model of Pender is based on the following theoretical
propositions. Prior behavior and inherited and acquired characteristics influenced beliefs,
affect, and enactment of health-promoting behavior. Persons commit to engaging in
behaviors from which they anticipate deriving personally valued benefits. Perceived
barriers can constrain commitment to action, a mediator of behavior as well as actual
behavior. Perceived competence of self-efficacy to execute a given behavior increases the
likelihood of commitment to action and actual performance to the behavior. Greater
perceived self-efficacy results in fewer perceived barriers to a specific health behavior.
Moreover, positive affect toward a behavior results in greater perceived selfefficacy, which can in turn, result in increased positive effect. When positive emotions or
affect are associated with a behavior, the probability of commitment and action is
increased. Persons are more likely to commit to and engage in health-promoting
behaviors when significant other model the behavior, expect the behavior to occur, and
provide assistance and support to enable the behavior. Families, peers, and health care
providers are important sources of interpersonal influence that can increase or decrease
commitment to and engagement in health-promoting behavior. Situational influences in
the external environment can increase or decrease commitment to or participation in

health-promoting behavior. The greater the commitments to a specific plan of action, the
more likely health-promoting behaviors are to be maintained overtime. Commitment to a
plan of action is less likely to result in the desired behavior when competing demands
over which persons have little control require immediate attention. Commitment to a plan
of action is less likely to result in the desired behavior when other actions are more
attractive and thus preferred over the target behavior. Persons can modify cognitions,
affect, and the interpersonal and physical environments to create incentives for health
actions.
In relation to diabetes, there are clients behavior in the past which predisposes
them to develop their condition which includes sedentary lifestyle, unhealthy habits,
vices and many more. Personal views, socio-cultural and psychological factors affect
their level of awareness on the available services rendered on how to effectively manage
it. This theory emphasizes the importance of clients committing themselves to an
established action plan which includes the programs and strategies formulated by DOH
and other support groups in the management and control for Diabetes Mellitus Type 2.
Health promoting behavior is the desired outcome and it is the end point in diabetic
management. It should results in improved health, enhanced functional ability and better
quality of life. The health care providers play an important part in health promotion and
education but always serve a secondary role to the basic rational choices of healthy
living for the clients. The commitment of clients can greatly influence the outcome of the
planned interventions and action.

10

Healthy Lifestyle Programs

The management regimen of Diabetes Mellitus Type 2 is derived from a
standardized method developed by Department of Health (DOH). As defined by
Lippincott (2001), Diabetes Mellitus Type 2 formerly known as non-insulin dependent
diabetes mellitus (NIDDM) is caused by combination of insulin resistance and relative
insulin deficiency. The usual presentation is slow and often insidious with symptoms of
fatigue, weight gain, poor wound healing, and recurrent infection. It is primarily found in
adults over 30 years of age.
The Department of Health provided standardized method of managing diabetes
aside from the mentioned treatment accepted worldwide. The action framework has seven
action areas as follows: (1) Environmental interventions; (2) Lifestyle interventions;
(3) Clinical interventions; (4) Advocacy; (5) Research, surveillance, monitoring and
evaluation; (6) Networking and coalition building; and (7) Strengthening of health
system. The strategies and accomplishments includes the development of clinical practice
guidelines on diabetes and other non-communicable diseases (NCDs), promotion and
advocacy through conduction of healthy lifestyle to the max campaign-this advocacy
focuses on clear health priorities such as consumption of healthy diet, promoting physical
activity, curbing the use of tobacco, alcohol and illegal drugs, proper weight and stress
management, early detection and control of hypertension and lastly, coalition building
also known as healthy lifestyle coalition, the DOH encourages the fast food establishment
to offer healthier food choices by reducing the fat, sugar and salt content as well as transfatty acids in the food they serve.

11

Some of the future plan/action include printing and dissemination of clinical

guidelines on diabetes-orientation/forum will be conducted among non-communicable
disease coordinators in community health department and hospitals to discuss details of
the clinical practice guidelines (CPG). The experts from diabetes societies will be invited
as speakers. There is a continuation of the conduction of promotion and advocacy
activities and partnership with specialty societies and other stakeholders on NCD
prevention and control including diabetes. Third, ensure implementation of diabetes
registry and finally, together with National Center for Health Promotion and other experts
on diabetes, develop various information-education materials on the prevention and
management of diabetes for dissemination to various clients.
Hence, the policies and guideline for the management of diabetes mellitus are
currently on going. The development of a uniformed guideline allows healthcare
providers to have a foundation of their planned action in the prevention, treatment and
control of the incidence of Diabetes Mellitus Type 2. Level of awareness on these
management strategies should be assessed not only for clients but also for healthcare
providers.
Mechanism
Components of Diabetes Self-Care Treatment
As a result of its major impact on public health and health care expenditures,
diabetes treatment has been a major goal of nationwide disease management programs,
and much attention has been given to the dissemination of treatment guidelines and
specific components of treatment. The goals of diabetes treatment are good metabolic
control, minimization of complications due to diabetes, control of co-occurring diseases

12

(i.e, hypertension, hyperlipidemia), and good quality of life. Treatment for diabetes
mellitus involves restoring blood glucose to or near normal levels in all patients. The
American Diabetes Association (ADA) recommends a treatment target for diabetes that
includes a glycosylated hemoglobin (HbA1c) level < 7% and a fasting plasma glucose
(FPG) of < 120 mg/dl. Treatment for type 2 diabetes is designed to maximize the effect
of endogenous insulin by decreasing insulin resistance. Significant patient involvement is
necessary to achieve treatment goals, and diabetes care is almost always carried out by
patients and their families. To maintain adequate glycemic control, patients typically
follow a self-care regimen involving frequent self-monitoring of blood glucose (SMBG),
dietary modifications, exercise, education, and medication administration. In addition, a
majority of diabetes self-care treatment regimens include activities toward the goal of
reducing diabetes mellitus-related complications (e.g., foot and eye care) and behaviors
targeting the reduction of cardiovascular risk factors (e.g., high fat diet, sedentary
lifestyle, smoking) (American Diabetes Association, 2006).
Dietary Modifications and Physical Activity.
Lifestyle modifications in the form of dietary change and the initiation of physical
activity are essential components of diabetes self-management, and are often a first-line
therapy for persons newly diagnosed with type 2 diabetes. Diets with moderate caloric
restriction (e.g., 250-500 calories less than daily intake), a reduction in saturated fats,
increase in fiber and vegetable consumption, and an increase in physical activity have
been recommended for patients with diabetes. A specific aim of dietary modification is a
reduction in body weight, because weight loss through proper diet and exercise results in
improved glycemic control and reductions in cardiovascular risk factors (e.g., blood

13

pressure, plasma lipid levels) and overall mortality. Several studies have shown that
specific dietary modifications, such as the increased consumption of whole grains and
reduced saturated fat intake, along with weight loss and increased physical activity, may
delay or prevent the onset of type 2 diabetes in high risk patients.
Self-monitoring of Blood Glucose.
Another important component to diabetes self-management is the self-monitoring
of blood glucose (SMBG) levels. Glycemic stability can be checked using a lancet and a
calibrated blood glucose monitor or by regular urine. New self-calibrating, continuous
blood-glucose monitoring systems that avoid regular blood sampling from the fingertip
are currently being tested for use in diabetes self-management. Regardless of method, if
used properly, SMBG gives an acceptably accurate reflection of immediate plasma
glucose levels. Results of SMBG are used to assess the efficacy of therapy as well as
provide information regarding necessary adjustments to nutritional therapy and
medication. The ADA recommends daily blood glucose monitoring by patients on insulin
therapy to prevent hypoglycemia or other related complications. Study results vary, but in
general, the evidence supports a positive effect of regular SMBG for improving glycemia,
particularly in individuals treated with insulin. While frequency of SMBG may range
from 1 to 4 checks per day, the clinical recommendation is for regular monitoring with
frequency depending on disease severity, treatment plan, instability of glycemia, and the
overall functioning of the patient (Saudek, Derr, & Kalyani, 2006).
In addition to SMBG, the measurement of HbA1c, a target indicator suggested by
the ADA, provides a stable and longer-term measurement of glycemic status. HbA1c
measures reflect a time weighted mean over the previous 120 days, and most accurately

14

reflect the previous 3-4 months of metabolic control. The ADA recommends routine
HbA1c testing two times per year in patients maintaining adequate control, and more
frequently among patients who have not maintained control or who have changed their
therapeutic regimen. The main value of HbA1c is its use as a predictor of diabetes
complications and the proven effect of improved control of HbA1c on complication risk.
A reasonable target value for HbA1c is less than 7%, and the ADA recommends that
therapy be reevaluated when HbA1c exceeds 8%.
Medication
While modifications to diet and exercise are an initial and conservative treatment
for type 2 diabetes, many patients require pharmacologic intervention to maintain
glycemic control. The medications for people with type 2 diabetes are classified into
those that increase endogenous insulin secretion, those that enhance the effectiveness of
insulin, or those that improve the sensitivity of peripheral tissues to insulin. Medications
come in the form of pills or injectable insulin, although inhalable insulin and newer
synthetic hormones (e.g., pramlintide) are currently being tested for approval in the
United States.
Diabetes self-management is obviously a multi-component regimen, with patients
possessing a great deal of influence on their own glycemic control, overall health, and
quality of life. Indeed, lack of participation in a variety of self-care behaviors contributes
to poor glucose control, leading to greater incidence of complications, morbidity, and
mortality. While other components are also important to the reduction in diabetes-related
complications (i.e., foot and eye care, smoking cessation), the current study focused on

15

the self-management behaviors described above (i.e., diet, physical activity, SMBG, and
medication), which have been shown to be most directly related to glycemic control.
Adherence to Diabetes Self-Care Regimen
To achieve the therapeutic goals of diabetes management, adherence to self-care
is crucial because most of diabetes care is carried out by patients and their families
(Toljamo & Hentinen, 2001). Self-care management is necessary for improved physical
functioning and reduction in diabetes-related complications, and day-to-day lifestyle
modifications as described above are needed to optimize lycemic control. While medical
management is a component of almost all treatment plans, patients may handle up to 95%
of their own care of this chronic disease. Therefore, promoting adherence to active selfcare is a major goal in diabetes education. Self-care in diabetes may involve complex
changes in basic behaviors or adherence to complicated, multi-component regimens.
Active self-care often consists of performing home blood glucose monitoring and
adjusting other treatment components to compensate for results, variation of nutrition in
response to daily needs, insulin dose adjustments to meet actual needs, and regular
exercise. Furthermore, patients must be responsible for making necessary adjustments to
their medication and dietary needs in the event of illness. It is inevitable that
successful self-care and optimal balance require motivation, support, and encouragement
by family, friends, and health care professionals.
Assessment of Adherence
The assessment of adherence to diabetes self-care is often difficult, whether due
to changing operational definitions, lack of patient behavior observations, or social

16

desirability bias in patients reporting of their self-care behaviors. In past decades, the
conceptualization of adherence has shifted from a focus on patients personality features,
attributing low adherence to a maladaptive personality style, to the procedural delivery of
medical treatment and the patients beliefs and commitment to engaging in health-related
behaviors. By the nature of self-care diabetes treatment, such procedural delivery is often
not observable by health care professionals. For example, patients who do not record the
timing of their insulin administration or the results of SMBG, regardless of their
participation in these behaviors, cannot be adequately assessed for treatment adherence.
Furthermore, observations of the outcomes of adherence (e.g., adequate glycemic control)
are often difficult to obtain in the form of blood or urine samples. One of the most
reliable measures of a patients stability of glycemic control, HbA1c, is typically
recommended only twice per year. Lastly, patients with low adherence may report an
excessively positive review of their own behaviors. Previous findings concerning selfmanagement and adherence to self-care among patients with diabetes vary greatly. A
literature review by Hentinen showed that adherence rates may range from 30 to 80%,
depending on the interventions and research methods used in the studies. In general,
patients with diabetes vary in their adherence to individual components of treatment.
Some research has questioned whether response to treatment is a reliable criterion for
adherence to regimen, due to the multi-component nature of treatment and other factors.
Adherence to one therapeutic recommendation does not indicate adherence to others, and
each treatment component is associated with unique barriers to adherence.

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Conceptual Framework
The figure below illustrates the direction of the study.
Independent Variables

Dependent Variables

Level of knowledge on DM
along:
a. disease process
b. signs and symptoms
c. management and
treatment

Socio-demographic profile:
a. age,
b. gender,
c. civil status,
d. educational attainment,
e. occupation,
f. monthly family income

Extent of compliance on
treatment regimen:
a. diet modification
b. medication
c. follow-up check-up

Health-related factors:
a. duration of illness,
b. family history of DM,

Figure 1
Paradigm of the study
Operational Definition of Terms
The researcher defined the following terms according to the conceptual and
operational use in the study.
Level of Knowledge. It is an adjective denoting degree of knowledge or
perception of a situation or fact regarding Diabetes Mellitus Type 2 as confirmed by
clients and health care providers without necessarily implying understanding.

18

Disease Process. It refers to the development of a certain disease in an individual.

Particularly it covers the series on how it deviated from the normal physiological function
affecting the individual.
Signs and Symptoms. It is defined as the manifestation of an illness either
experienced or observed by the affected person.
Management and Treatment. A plan or a regulated course for Diabetes Mellitus
Type 2 such as a diet, exercise, or treatment that is designed to give a good result and
maintain or improve the health of the clients.
Extent of Compliance. It refers to the degree of constancy and accuracy with
which the patient follows a prescribed regimen, as distinguished from adherence and
maintenance.
Diet modification. It is defined as the changes in the daily dietary intake of the
patients with diabetes mellitus as part of their treatment regimen in order to prevent
complications that may arise from the disease progression.
Medication. These are the drugs given to the patients in order to treat or alleviate
the symptoms of the disease.
Follow up Check-up . It refers to act of patients following up with their trusted
doctors to monitor their condition and sometimes undergo reexaminations to make
necessary changes in their treatment regimes.
Age. This term refers to the length of time of existence of the respondents from
birth to the time of the conduct of the study.

19

Gender. It refers to either of the two category as being male or female

Civil Status. It refers to the marital status of the respondents whether they are
married, single, or widow.
Educational Attainment. This refers to the level of formal education the
respondents have reached until the conduct of the study.
Occupation. This refers to the role of the respondents in the home which is either
working or non-working.
Monthly family income. This term refers to the monthly earnings of the family
spent for the needs of their needs.
Health Related Factors. These refers to predisposing factors related to health
that contributes to the development of diabetes mellitus in an individual.
Duration of Illness. It is defined as the length or period of time that the
individual had the disease starting from the time when he/she was diagnosed mellitus or
started to manifest the signs and symptoms of diabetes mellitus.
Family History of DM. This is an essential part of a patients medical history in
which he/she is asked about the health of members of the immediate family in a series of
specific questions to discover any disorders to which the patient may be particularly
vulnerable specifically to diabetes mellitus.
Assumptions
The study will be guided by the following assumptions:
1. The answers of the respondents to the gathering instrument are honest and
correct.
2. The questionnaire checklist to be used in gathering data is valid and reliable.

20

Hypothesis
To researcher posited the following hypothesis
1. There is no significant relationship between the level of knowledge of the
respondents and their socio-demographic profile and health-related factors.
2. There is no significant relationship between the extent of compliance to treatment
regimen and the following:
d. socio-demographic profile,
e. health-related factors, and
f. level of knowledge
Methodology.
This section present the research design, population and sample, data gathering
instrument, data gathering procedure, and statistical treatment of data.
Research Design. The researcher will make use of the descriptive survey method
of research with the use of the questionnaire-checklist as the main instrument in gathering
the needed data for the study.
This study will be supplemented by actual by actual experiences, personal
experience, readings, published books and printed materials as source of information for
the study.
Population. The respondents of the study will include 300 Type 2 Diabetes
Mellitus respondents from out-patient department of Baguio General Hospital and
Medical Center. Sample size will be determined using the Slovins formula will be used
to determine the respondents. The distribution of the respondents is presented in Table 1.

21

Distribution of Respondents
Type 2 DM Patients (Population)

Sample Size

450

212

Data Gathering Instrument. A structured questionnaire will be used for the

study. Part I will be on the personal information which contained the age, sex and date of
diagnosis for type 2 DM patients. Part II will determine the level of awareness and
frequency of the services and programs of DOH and other support groups for type 2 DM
clients which is categorized into the following: (a) Healthy Lifestyle Programs of DOH
and other support groups; (b) Established mechanism to reduce the socio-economic
impact on affected individuals and family; and (c) coordinated health system with DOH
and non-government organizations.
Data Gathering Procedure. The researcher will sought the permission from the
head of the DM in the out-patient department of the Baguio General Hospital and
Medical Center. Afterwards, the questionnaire will be floated to client who satisfied the
stated criteria in this study.
Statistical Treatment of Data. The data to be gathered will be treated with the
following statistical tools:
1. Frequency and percentage to determine the distribution and describe the
socio-demographic profile of the respondents in terms of age and gender.
2. Mean was to describe the knowledge and compliance of the respondents to
their treatment regimen.
3. Bivariate correlation analysis to determine the relationship between the profile
of the respondents and their knowledge on the healthy lifestyle programs of
DOH and other support groups to prevent Diabetes Mellitus Type 2 and its
complications?

22

SAMPLE QUESTIONNAIRE
Instruction: Please put a check mark (/) on the appropriate column that
corresponds to your answer.
Profile:
a.
b.
c.
d.
e.
f.

Age: _________________
Gender: Female ( __ ) Male ( ___ )
Civil Status: _________________
Educational Attainment: _________________
Occupation: _________________
Monthly Family Income: _________________

Part I. Knowledge on Type 2 Diabetes Mellitus

Instruction: Please check the appropriate box that corresponds to you
answer
3 Very Knowledgeable (VK)
2 Moderately Knowledgeable (MA)
1 - Not Knowledgeable (NK)
KNOWLEDGE ON DIABETES MELLITUS
A. Disease Process
1. Genetic (Hereditary ) and obesity are risk factors for DM
2. Inability of the pancreas to make and release insulin
3. The sugar stays in the bloodstream because it is not used
by the body
4. The sugar travels to the bodys organs causing damage
B. Signs and Symptoms
1. High blood sugar
2. High Blood Pressure
3. Frequent urination
4. Frequent thirsting
5. Frequent sweating
6. Tiredness
7. Blurry vision and dizziness
8. Slow healing wounds or cuts
9. Frequent infections
10. Numbness or tingling in the lips, hands, and feet
C. Management and Treatment
1. Lifestyle modification
a. At least 150 minutes of moderate-intensity aerobic
physical activity throughout the week (walk or cycling
for 15-30 minutes every day) as prescribed

VK MK NK
(3) (2) (1)

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b. At least 75 minutes of vigorous-intensity aerobic

physical activity throughout the week (run, jog, swim,
dance) as prescribed
c. Proper weight and stress management
2. Self-monitoring of blood glucose
a. Keeps record of self-monitoring results
b. Regularly monitors blood sugar
c. Aware of the normal range for blood sugar
Part II. Compliance on the treatment of DM
Instruction: Please check the appropriate box that corresponds to your
answer
3 Very Compliant (VC)
2 Moderately Compliant (MC)
1 - Not Compliant (NC)
COMPLIANCE ON THE TREATMENT OF DM
1. Diet Modification for diabetic clients
a. Carbohydrates counting, carb counting, estimated 45-60
grams of carbohydrates at a meal (1 cup of rice every meal)
b. Creating an imaginary line on your plate and selecting the
foods with non-starchy vegetables and having smaller
portions of starchy foods and meats.
c. Intake of foods with low glucose index which includes whole
grain breads and cereals (like barley, whole meat bread) and
grown rice as recommended by DOH.
d. Vegan diet like eating soy produce and a mix of vegetables,
fruits, dried beans and legumes (like kidney beans and lentils
e. Avoids excessive salt intake
f. Uses artificial sweeteners in moderation
2. Medication
a. Religious and on time administration of medications
b. Administers insulin injection properly
c. Administers correct dose of insulin
3. Follow up check-up
a. Undergoes the following tests regularly:
1.a. Hemoglobin A1c
1.b Creatinine and BUN levels
1.c Cholesterol levels
b. Feet and lower extremities check
c. Checks eyes for possible retinopathy
d. Blood Pressure check

VC MC NC
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