The role of primary health care in patient education for diabetes control.

The major components of diabetes management are dietary therapy, exercise and drug treatment. Therefore, education of people with diabetes is the cornerstone of management. The aim of the present work was to study the role of primary health care (PHC) in patient education for diabetes control in Alexandria. Accordingly, the knowledge and perception concerning diabetes and its management of all 88 PHC physicians and 104 nurses working in the two rural health centers and two randomly chosen urban health centers of Alexandria governorate were assessed by pre-designed self-administered questionnaire. All diabetic patients over 20 years of age attending the study health facilities over a period of two months were assessed for their knowledge and attitude concerning diabetes and self-management and asked about their degree of satisfaction with the provided PHC services by a pre-designed interview questionnaire. They amounted to 560 diabetic patients. The results revealed that the PHC physicians had sufficient knowledge about causes and complications of the disease, but insufficient knowledge about diagnosis and management, as only 10.2% & 4.5% of the physicians recognized the importance of regular exercise and patient education for diabetes management. Some misconceptions and false beliefs were observed among PHC nurses, as many of them considered diabetes a contagious disease or primarily caused by stress; that liver failure, hearing impairment and splenomegaly are among the complications of diabetes and that young age and immunodeficiency disorders are among the risk factors for developing diabetes. Moreover, most of them believed that the amount of carbohydrates given to diabetic patients should be reduced or even completely restricted; that vitamins are essential for all diabetic patients and that hot-water bottles are good for providing warmth to the diabetic feet. They also disagreed on the use of artificial sweeteners as sugar substitutes. Most of the diabetic patients had poor knowledge about diabetes and its management (85.7%) and a negative attitude towards self-management (61.6%) and only 23.6% of them were satisfied with the services provided by the PHC facilities for diabetes control. They were mainly dissatisfied with the role of PHC physicians in patient education. Some misconceptions and false beliefs were also recognized among diabetic patients. Many of them considered diabetes a contagious disease or primarily caused by stress. They didn't know the importance of regular exercise in diabetes control. They also believed in the efficacy of herbal therapy in diabetes control; that vitamins are essential for all people with diabetes; that water intake should be decreased when passing large amounts of urine, that anti-diabetic drugs should be stopped during associated illnesses and that patients on insulin treatment can't be shifted to oral drugs. Moreover, they believed that the amount of carbohydrates in diet should be reduced or even restricted and that the amount of proteins should not be reduced. They also refused the use of artificial sweeteners as sugar substitutes. Thus, it may be concluded that there is a serious gap in the provision of basic educational services to the majority of diabetic patients attending PHC facilities in Alexandria.