A study of knowledge and practices in prevention of type 2 diabetes mellitus among

Bhilai steel plant employees

Sukanta Kumar Behera*, Rashmi Rekha Behera**, Harshad Thakur#

* School of Health System Studies, Tata Institute of Social Sciences, Mumbai- 400088, India.
** JLN Hospital, Bhilai Steel Plant, Bhilai, Chhattisgarh. India. #Centre for Public Health,
School of Health Systems Studies, Deonar, Mumbai.400088. India.

Corresponding Author:

Dr. Sukanta Kumar Behera,

School of Health System Studies, Tata Institute of Social Sciences, Mumbai- 400088, India.
E-mail: sukantabehere41@gmail.com

Abstract
Background: Preventive practices of type 2 diabetes mellitus are poor; in spite of good
knowledge. Proper education, awareness and healthful behaviour practices can prevent type 2
diabetes mellitus and its risk and complications.

Objectives: To study the knowledge on different aspects of diabetes mellitus and preventive
practices for type 2 diabetes mellitus among the employees of Bhilai steel plant.

Methods: A multi-staged sampling was done and 213 employees between 34 to 45 years of
age were interviewed. Out of 138 departments, 22 departments were selected for interview. A
structured interview method was conducted by pre-tested questionnaire on knowledge and
preventive practices of type 2 diabetes mellitus. SPSS 16 version was used to analyse the
data.

Results: The knowledge about type 2 diabetes mellitus was average. The knowledge of
associated risk factors seemed poor. There was significant knowledge difference between
genders: on lack of exercise, genetic association and dietary pattern. The lifestyle practices
for prevention of type 2 diabetes were poor.

Conclusion: The overall knowledge about type 2 diabetes mellitus and preventive practices
was average. The overall actual life style practices were poor.
Introduction

Diabetes mellitus (DM) is one of the most challenging health problems of 21st century and is
now a global epidemic with devastating humanitarian, social and economic consequences
[1,2]. Type 2 diabetes mellitus is the commonest form of diabetes and accounts for over 90%
of diabetes mellitus [3]. The Finnish Diabetes Prevention Study showed that lifestyle
intervention could reduce diabetes mellitus [4]. Through proper education and awareness,
many complications and co-morbidities can be reduced in diabetic population [5]. Smoking
and alcohol increase the risk of cardiovascular complications [6]. The cornerstones of
treatment of type 2 diabetes mellitus are to integrate healthful behaviours in nutrition,
exercise, and weight management [7]. A study from Pakistan highlighted that education and
awareness programmes can improve the knowledge of patients and change their attitude [8].
A study in Singapore showed that people getting health education on diabetes had better
knowledge on signs and symptoms of diabetes mellitus [9].

The most age-specific middle age group in a prosperous urban population; in a public sector
like Bhilai steel plant, Chhattisgarh (India) is more vulnerable to lifestyle diseases like type 2
diabetes mellitus. There was no study from available sources anywhere in India on
knowledge of type 2 diabetes mellitus and lifestyle practices of all employed population.

The objectives were to study the knowledge about diabetes mellitus and its preventive
practices (physical activities, dietary, smoking and alcohol habits).

Methods

The study design was a cross-sectional survey. It was done by a pretested structured
interview questionnaire method among the employees of Bhilai steel plant; Chhattisgarh from
15th May to 10th June 2011. There were approximately 24665 employees of a total 31247 as
per official records as on 31st March 2011, after excluding employees of mines and medical.
The employees were approximately 12600 after excluding the employees below 34 and above
49 years. The employees of work areas e.g. Rail mill, Plate mill, Blast Furnace are involved
in physical activities and in non work areas like Personnel, Finance departments do sedentary
activities. There were 90 work areas and 48 non-work area departments in total. The work
area employees work 8-hourly. Forty-six work-intensive areas were excluded from the
sampling. From 44 available work areas, 8 areas and out of a total 48 non work areas, 14
areas were selected by simple random sampling for the study. Each shift: whether 1st or
general shift had employees strength of approximately 45 to 55. A total of 9 to 10 employees
in the age group of 34 to 49 years from 1st shift (6 am to 2pm) of work areas and general
shift (9 am to 5 pm) of non-work areas were purposively interviewed. From each sampled
non-work areas 4 to 5 females and 4 to 5 males were purposively interviewed, till the desired
subjects of 9-10 was reached. The female employees in work areas were very less, whereas in
a few departments in non-work areas like information technology and education; the females
were more in numbers than males; so 7 to 8 females and 2-3 males were interviewed. The
rationale to select more non-work areas than the work areas: to cover more of females in non-
work areas to have overall ratio of males to females 2:1. Moreover the employees in non-
work areas are at more risk of developing type 2 diabetes mellitus due to sedentary lifestyle;
and assessment of their knowledge was important for developing future programmes. A total
of 213 employees were interviewed. The limitation of the study was that close-ended
questions might have been guessed by the educated study population. The written
permissions were obtained from departmental heads and consent was taken from each
interviewee.

The first part of data collection was on basic socio-economic personal information. The
sections on knowledge and practices had different sets of questions. The height was measured
in centimetres without footwear and weight in kilograms with standard instruments. Data
entry and data analysis were done using SPPS version 16. All descriptive statistics were used
to study the characteristics of the subjects. To compare with proportion, chi-square test was
used and p < 0.05 was considered statistically significant.
Results

Characteristics of the study population- Of the 213 subjects, 135 (63.4%) were males and 78
(36.6%) were females. 72 male subjects (53.3%) worked in work areas and 63 (46.7%) in
non-work areas. Out of 78 female subjects, 7 (9%) worked in work areas and 71 (91%) in
non-work areas. Average age for males was 44.46 4.11 years and for females was 42.69
4.65 years. Average BMI for males was 25.82 3.49 kg/m2 and 25.29 3.88 kg/ m2 for
females. The mean family income for male employees was Rs. 45007 28537 and 40680
28777 for females. The ratios of male to female and non-work to work areas were
approximately 2:1. Diabetes mellitus was noted in 29 (13.7%) subjects. 83 respondents
(38.96%) had either single or both parents suffering from diabetes; while 89 (41.8%) gave
history of any of the family members suffering from diabetes mellitus.

Ninety per cent of subjects were graduates; 49% were post-graduates and professionals
(engineers, technocrats, administrators and managers). Every tenth person (n=21, 9.9%)
respondents had secondary or below level of education while three females were illiterate.
36.4% respondents had a family income of less than Rs.30,000 per month, while 61.5%, had
family income of more than Rs. 30,000 per month (Table 1).

Table 2 outlines the respondents among males and females about the knowledge about the
disease, its signs and symptoms, causes, diagnosis, treatment and preventive practices. The
knowledge of respondents varied from 59% to 78.2% on various aspects of diabetes, except
that type 2 diabetes was the commonest type (20.8%), predisposition to skin and genital
infections (25.5%), lack of exercises can lead to diabetes (48.6%). Female respondents did
have slightly better response rates regarding Diabetes can be prevented and family history
of diabetes as associated with causation of diabetes while males had better knowledge that
lack of exercise can cause diabetes and in avoiding sweets and fatty food to prevent
diabetes (Table 2). The knowledge about preventive practices also ranged from 51.6% to
80.8%, excepting the need to control weight and avoid smoking/alcohol.
Almost half of the employees (53.5%) stated to do regular exercises. Most of employees
(87%) use vehicles for going to duty. After duty hours only one out ten were doing gardening.
Two out of ten (19.2%) had eating habits of unhealthy junk food almost every day to
alternate days. On the habits of eating healthy diets like vegetables and salads, two out of
three (66%) took healthy food regularly. One out of three (31%) males smoked and similar
percent males consumed alcohol (Table 3).
Discussion

The mean BMI of the study population falls in the standard definition of overweight; over 25
kg/m2. The overall education and income level of the population were very good. The most
basic knowledge about increase sugar level in diabetes mellitus was at 77% in spite of good
level of education as compared to 83% in a study in Singapore [9]. The level of knowledge
about diabetes among the employees was average as compared to many other studies, where
the level of knowledge was good and was proportionate to education. Very few (20%) knew
about the commonest type of diabetes mellitus similar to Singapore Study [9]. The
knowledge of diabetes being a preventable disease was quite good at 59%; with significantly
better knowledge among females.

Knowledge about diabetes: The signs and symptoms like increased tiredness, increased
passing of urine, decreased healing of wounds were good at par with Singapore study [9].
The knowledge of skin, genital infections was poor and only 25% knew about it. It is an area
of concern; where as in Singapore study, 62% in the general population had knowledge of
urinary tract infections [9]. Fifty per cent of general population in Singapore study had
education below polytechnic / University; whereas the employees of Bhilai steel plant, it was
much better with 90% above with graduation. The knowledge of obesity being a cause of
developing diabetes was only at 60%; in spite of such high education level. Obesity may be
seen as a sign of prosperity and very good health. The knowledge on risk of type 2 diabetes
association with obesity, lack of exercise, genetic relationship were lacking among the
employees: as all the above risks are included in Indian Diabetes Risk Score (IDRS) [10].
Moreover, all the employees fall in risk group as far as age is considered. The average
knowledge of signs and symptoms about the causes of type 2 diabetes mellitus among the
employees will hamper the detection of the disease and screening process. Typically in type 2
diabetes, patients report very late for interventions as seen in many studies. The increased
awareness and knowledge on the signs and symptoms will help in earlier reporting and
detection of the disease. Shera showed in Pakistan that proper education and awareness can
change the attitude [8].

Knowledge of preventive practices: Just little over half of the employees stated about the
positive role of exercise and diet control as treatment modalities in diabetes. Of the
knowledge on unhealthy diet e.g. fatty food and sweets; males had significantly better
knowledge (p=0.038). Similarly on the knowledge of healthy diet like vegetables and salads
was significantly less among females, is a matter of concern: as in Indian context the females
usually look after cooking and kitchen. Although the knowledge of regular exercises on
prevention of diabetes was good, the importance of weight control and weight reduction was
average. It is imperative to educate the employees on the dire consequences of overweight.
The knowledge of type 2 diabetes mellitus as a lifestyle disease was lacking among the study
population. The poor knowledge on consumption of alcohol and smoking habits can have
long-term implications in prevention of type 2 diabetes mellitus. Sixty per cent felt regular
exercise is a part of diabetes management programme; whereas 80% felt it to be, a preventive
measure for development of diabetes. There are a lot of gaps in the above findings; which
need to be studied further; more so because people in this study were not aware of the
importance of exercise, which is one of the primary pillars for management of diabetes. This
study also highlights the fact that education alone is not a criterion to have better knowledge.
Considering very high level of education among the study population; the level of knowledge
on the treatment, diagnosis, preventive practices was not very high. In educated populations,
70-80% respondents are expected to have knowledge about life-style diseases, specially
diabetes, more so in India, which has a sizeable burden of diabetes. The lack of knowledge
and awareness in turn affects the practices. The knowledge deficit on diagnosis and treatment
modalities need to be studied further to find the gaps, in spite of 40% having family history of
diabetes. Comprehensive health education and awareness programmes will help in imparting
knowledge and awareness on prevention of type 2 diabetes mellitus. A good association
between knowledge and practice as has been reported earlier [11].

Practices in prevention of diabetes: Means of transport is mainly by vehicles; hardly anybody

is involved in any physical activity after duty hours and half of employees do not exercise.
The practice of taking unhealthy junk food was quite regular among the employees. Similarly
one third of the study population do not regularly take healthy diet like vegetables and salads.
Unhealthy eating habits and avoidance of healthy diet are believed to be major risks in Asians
in developing type 2 diabetes mellitus at an earlier age. The knowledge about the preventive
practices of type 2 diabetes mellitus among the employees of Bhilai steel plant was not at all
encouraging and the preventive practices on lifestyle were poor.

It is imperative that high levels of education among individuals is transformed to knowledge

about diabetes, which will in turn result in adoption of better practices in order to reduce the
burden of diabetes and its attendant complications.

Key Points

The knowledge on preventive aspects of type 2 diabetes mellitus was average and poor
practices of healthy lifestyle need to be improved by awareness programmes.
Good level of education alone may not be enough for acquiring knowledge and practices
regarding diabetes.
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shorty (Noun)

An attractive young female, especially: a girl who is "down", who is counted among close
male friends and sometimes loose sexually; or, one's "girl", one's "boo"; or, a girl that a male
does not know but wishes to meet.