Development of KAP questionnaire and data collection
The questionnaire used for the survey related to KAP were recognized
after review of similar questionnaires used in other
studies6,10and was modified by the authors and underwent content validation by a
peer group comprising two senior clinical pharmacists and one
endocrinologist. It was pre-tested on a group of 30 diabetic outpatients
to ensure that the questionnaire was unambiguous. The final
questionnaire had a total of 16 questions related to knowledge, 8
questions pertained to attitude, and 10-step checklists of practice
steps.
Knowledge was measured using 16 questions related to hypoglycemia and
insulin use. Example of questions covering knowledge was “What are
causes of hypoglycemia?” Answers were provided with multiple choices
and “Don’t know” followed by correct and incorrect responses to
further evaluate the responses. One point was offered for each correct
response and the total score was calculated. Score ranges of 0–8, 9-16
were considered as poor and good knowledge, respectively.
An attitude was assessed using eight 5-point Likert scale related to
patient’s opinion on insulin role. For example, “Insulin use helps to
prevent complications of diabetes.” Responses to above questions were
assessed with 5 categorical responses: (1) Strongly disagree, (2)
Disagree, (3) Neither agree nor disagree, (4) Agree, (5) Strongly agree.
The average scores of the attitude of each patient ranged above 3 point
were categorized as having positive attitudes.
Practice was assessed by using a 10-step checklist when demanding
patients to demonstrate how to inject with similar sample pens.
Pharmacists observed patients and each step was assessed in order to
evaluate the correct and incorrect practice. One point was offered for
each correct step and the total score was calculated. Score ranges of
0–5, 6-10 were considered as poor and good practice, respectively.
According to American Diabetes Association Guidelines
201918, FPG target
belongs to 80 - 130 mg/dL (4.4 – 7.2 mmol/L) and a HbA1C is
<7% (53 mmol/mol) for nonpregnant adult patients. Less
stringent HbA1C (<8%) and FPG (90 - 150 mg/dL) are
appropriate for patients with more complicated disease features or the
elderly.