Evaluations of knowledge, skills and practices of insulin storage and injection handling techniques of diabetic patients in Ethiopian primary hospitals

Abstract

Background Insulin is an effective therapeutic agent in the management of diabetes, but also sensitive to the external environment. Consequently, diabetic patients’ adherence to insulin delivery recommendations is critical for better effectiveness. Patients’ lack of knowledge, skill and irrational practices towards appropriate insulin delivery techniques may end up in therapeutic failure and increase costs of therapy. The aim of this study was to evaluate patients’ knowledge, skills and practices of insulin storage and injection techniques. Methods An interview-based cross-sectional study was conducted through purposive selection of participants in Northwest Ethiopian primary hospitals from March 1 to May 30, 2019. Levels of knowledge were assessed with right or wrong responses, while practice was measured by using a 4-point Likert scale structured questionnaire collected via face-to-face interviews. Likewise, a five-point observational (demonstration) techniques checklist employed to assess patients’ skills. Results Among 194 patients approached, 166 participants completed the survey giving a response rate of 85.6%. More than half of the respondents (54.8%) were males and the mean age (±SD) was 38.5 ± 13.8 years. The overall patients’ median knowledge and practice levels on insulin storage and handling techniques were moderately adequate (64.3%) and fair (55.4%), respectively. In patients’ skill assessments, 94.6% correctly showed injection sites, 70% indicated injection site rotations, and 60.75% practiced injection site rotations. Education (P < 0.001), duration of insulin therapy (P = 0.008), and duration of diabetes (P = 0.014) had significant impact on knowledge level. Education (P < 0.001), occupation (P < 0.001), duration of insulin therapy (P = 0.001), duration of diabetes (P = 0.036) and patients’ knowledge level (P < 0.001) were found to have a significant effects on the patients’ practice levels. A Mann-Whitney U test also disclosed that residency, ways to get insulin and mocked injection technique during the first training had significant effects on patients’ knowledge levels. Conclusion The current study revealed that patients had moderately adequate knowledge and fair practice levels on insulin storage and handling techniques. However, patients missed important insulin administration skills. This study highlights the need of regular public health education so as to enhance the patients’ knowledge, skill and practice levels on insulin handling techniques.

Insulin Knowledge, Handling, and Storage among Diabetic Pilgrims during the Hajj Mass Gathering

“…In our study, pilgrims had just above average knowledge regarding insulin storage, and only 8.6% were deemed to have a good level of knowledge. These results are in line with numerous other studies reporting that diabetic patients lack appropriate knowledge and practice regarding insulin therapy, including storage, handling, and disposal of the medication and its associated consumables [ 25 – 27 ]. Using a similar cut of criteria for good knowledge as ours (knowledge score > 0.75), studies from India and Ethiopia reported that only 4% and 31.3% of participants, respectively, had good knowledge regarding insulin therapy [ 25 , 26 ].…”

“…These results are in line with numerous other studies reporting that diabetic patients lack appropriate knowledge and practice regarding insulin therapy, including storage, handling, and disposal of the medication and its associated consumables [ 25 – 27 ]. Using a similar cut of criteria for good knowledge as ours (knowledge score > 0.75), studies from India and Ethiopia reported that only 4% and 31.3% of participants, respectively, had good knowledge regarding insulin therapy [ 25 , 26 ]. Our results are concerning given that lack of insulin knowledge and inappropriate storage of the medication have been linked to poor glycemic control among diabetic patients [ 11 , 12 ].…”

“…Similarly, being educated enabled patients to understand and practice the written, oral, and any other means and directions and instructions of storage and handling better than illiterates. Level of education and insulin therapy duration were reported to have a significant effect on knowledge of insulin storage and handling among diabetic patients in other settings [ 25 , 28 ]. Also, patients' education has been reported to increase their knowledge of diabetes and its management and to have a positive effect on metabolic control and patients' outcome [ 29 , 30 ].…”

Medication Handling and Storage among Pilgrims during the Hajj Mass Gathering

“…Level of education, having an underlying health condition, and receiving health education on mediation storage were independently associated with good knowledge. Level of education is associated with better knowledge of medications, their handling and storage [23][24][25][26]. Being educated enables patients to understand and practice the written and oral guidelines and instructions of medication use, storage and handling better than those who are illiterate.…”

“…Only 28.2% of pilgrims accessed information on medication storage from the medication label in the current study. Studies have shown that not all medication users consult the medication label or the package insert for information [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. In one study among Hajj pilgrims, only 54.2% reported that they do read the information on medications' labels before using them.…”