47

CHAPTER 4

Data analysis and discussion

4.1 INTRODUCTION

This chapter presents the data and a discussion of the findings. A quantitative, descriptive survey design
was used to collect data from subjects. Two questionnaires, one for diabetic patients and the other for
family members of diabetic patients, were administered to subjects by the researcher personally. The study
was conducted at Nkhensani Hospital and Giyani Health Centre, falling under the Lowveld region, Mopani
District in the Limpopo Province. A convenient sample was selected from the two health care services. The
sample consisted of 32 diabetic patients and 32 family members living with and caring for diabetic patients.
The data was gathered over a six-month period. Data was analysed through the computer program, SPSS.
Descriptive statistics in terms of percentages were used. The research results are presented in the form of
percentages, bar graphs, pie diagrams and frequency counts.

4.2 PURPOSE OF THE STUDY

The purpose of the study was to determine the knowledge of patients and family members regarding
diabetes mellitus and its treatment regimen. The researcher was interested in finding out what the cause of
non-compliance with the diabetes treatment regimen could be. Once the cause is determined it may be
rectified and culture specific health education and nursing care may be provided, thereby improving
adherence to the treatment regimen and the quality of patient care.

4.3 RESEARCH OBJECTIVES

The objectives of this study were to

• identify the patients’ and their family members’ knowledge of diabetes mellitus and its treatment
regimen
• identify the views of patients and their family members towards diabetes mellitus and its treatment
regimen
48
4.4 DATA PRESENTATION AND DISCUSSION

The data is presented in descriptive statistics through frequency counts and percentages, illustrated in pie
diagrams and bar graphs.

4.4.1 Section A: Demographic characteristics of participants

This section describes the demography of the participants in terms of age, gender, educational status,
income and where they live. The results of the diabetic patients will be given first, followed by the results of
the family members.

4.4.1.1 Age of patients

The patients’ ages ranged from 16 to older than 41 years. A total of 30 (93.8%) were aged 21 and older
(see figure 4.1). According to Black and Matassarin-Jacobs (1993:1775), diabetes mellitus affects mostly
adults from the age of 21 to 74 years.

25,0%

6,3%
6,3%

62,5%

16-20 years 21-30 years

31-40 years 41 years and older

Figure 4.1
Age of patients

4.4.1.2 Gender of patients

In the study, 17 (53.1%) of the patients were males and 15 (46.9%) were females (figure 4.2).
49

53.1%

46,9%

Male Female

Figure 4.2
Gender of patients

4.4.1.3 Level of education of patients

According to figure 4.3, 21 (65.7%) of the patients had reached grade 8 and above, and only 11 (34.3%)
had not reached grade 8. Therefore the majority can read and write, which means that they would be able
to understand the importance of adhering to the treatment regimen once it has been explained to them
properly.

34,4%
12,5%

18,7%

34,4%

Std 0-5 Std 6-8

Std 9-10 Tersiary education

Figure 4.3
Educational level of patients
50
4.4.1.4 Income of patients

Figure 4.4 indicates that the majority of the patients 25 (78.1%) had a monthly income in the form of a
salary or pension grant and 7 (21.9%) had no income. The income varied from R100 to more than R2100
per month, and most patients fell into the higher category of income. New Fast-acting Insulin (1997:30)
reported that expenses contribute towards diabetic patients’ frustration because their diet differs to that of
the family.

15,6%
21,9%

18,8%

9,4%
34,4%

No income R100-R500 per month

R600-R1000 per month R1100-R2000 per month
R2100 + per month

Figure 4.4
Income of patients

4.4.1.5 Living areas of patients

The majority of the patients in the sample 18 (56.2%), stay in the township and only 14 (43.8%) stay at the
villages. Therefore most patients are near the hospital and the health centre, which means that health care
support is readily available and accessible.

4.4.1.6 Age of family members

The age of participants who were involved in the study ranged from 16 to older than 41 years, and of the 32
subjects, 28 (87.5%) were aged 21 years and older. Only 4 (12.5%) were between 16 and 21 years of age.
Therefore, family members who were staying with diabetic patients in this study were mostly adults (see
figure 4.5). This indicates the possibility that patients may receive responsible support from adult family
members living with them.
51

34,4% 6,3%

12,5%

46,9%

16-20 years 21-30 years

31-40 years 41 years and older

Figure 4.5
Age of family members

4.4.1.7 Gender of family members

Figure 4.6 indicates that 24 (75%) of family members were females and only 8 (25%) were males. This
indicates that females are in the majority of those caring for their loved ones. It is well known that females
are more nurturing and caring than males, and therefore more inclined to find themselves in caring
situations.

25,0%

75,0%

Male Female

Figure 4.6
Gender of family members
52
4.4.1.8 Level of education of family members

Figure 4.7 indicates that a small portion, 9 (28.1%), of the family members had not reached standard 8
(grade 10) and the majority, 23 (71.9%), had reached from grade 8 to tertiary education. This may indicate
that the majority of family members are able to read and write, which increases the possibility that they
would understand that the adherence to a treatment regimen would benefit the patient.

15,6% 28,1%

25,0%

31,3%

Std 0-5 Std 6-8

Std 9-10 Tersiary education

Figure 4.7
Educational level of family members

4.4.1.9 Income of family members

On average 19 (59.4%) of the family members had a monthly income in the form of a salary or pension
grant. The remaining 13 (40.6%) had no income (see figure 4.8). This implies that in the majority of cases
included in the sample it would be possible to purchase the correct food for the diabetic patients.
53

40,6%

18,8%

3,1%
31,3%
6,3%

No income R100-R500 per month

R600-R1000 per month R1100-R2000 per month
R2100 + per month

Figure 4.8
Income of family members

4.4.1.10 Area where family members live

A high percentage, 19 (59.4%) of the family members stay in the township and 13 (40.6%) stay in the
villages. This correlates with the distance travelled to a health service, as the majority indicated that they
travelled less than 5 km to access a health service.

4.4.1.11 Summary of demographic data

The demographic data of the diabetic patients and the family members included in the sample reveals that
the majority are educated adults who receive an income, and live near the available health services. They
therefore have the capacity and means to adhere to the diabetes mellitus treatment regimen.

4.4.2 Section B: Knowledge and views on diabetes melitus

This section of the questionnaire revealed the knowledge, beliefs and attitudes of subjects towards
diabetes mellitus and its treatment.

4.4.2.1 Explanation of the term Diabetes Mellitus

The majority of patients 20 (62.5%) could not explain diabetes mellitus. They said diabetes is diabetes or is
high blood or sugar in blood, a condition where you feel tired or a chronic condition that is incurable. Only
54
12 (37.5%) of them explained diabetes as high blood sugar due to lack of insulin. A total of 14 (43.8%) of
the family members explained diabetes by indicating a relationship between high blood sugar and lack of
insulin. The remaining 18 (56.2%) responded by saying that diabetes mellitus is diabetes, a disease where
injuries don’t heal, is sugar in the blood, or is a disease where you sweat a lot. According to Bain (2001:4),
both patients and family should be given an explanation of the diagnosis, and recognition of diabetes
symptoms.

4.4.2.2 Diabetes Mellitus can be cured

Subjects were asked to indicate whether diabetes mellitus can be cured or not. Many diabetic patients 20
(62.5%) reported that diabetes mellitus can be cured and only 12 (37.5%) indicated that diabetes mellitus
cannot be cured (figure 4.9). A high percentage 20 (62.5%) of family members indicated that diabetes
mellitus can be cured and 12 (37.5%) indicated that it cannot be cured. This indicates that the majority of
patients and family members are not well informed and are not aware that diabetes is an incurable chronic
disease. Richardson, Adner and Nordstrom (2001:759) indicate that a diagnosis of diabetes mellitus implies
a major change in the way of life and that the person has to cope with the disease for the rest of his/her life.

100
90
80
70 62.5 62.5
60
50
37.5 37.5
40
30
20
10
0
Yes Never

Patient Family members

Figure 4.9
Diabetes Mellitus can be cured

4.4.2.3 Withdrawing sugar treats diabetes

On average 20 (62.5%) of patients disagreed that withdrawing sugar can treat diabetes, 5 (15.6%) were
unsure and 7 (21.9%) agreed that withdrawing sugar can treat diabetes (figure 4.10). The majority of family
members 22 (68.8%) disagreed with the statement, 3 (9.4%) were unsure and the remaining 7 (21.9%)
55
agreed. It is alarming to find once again a lack of essential knowledge about the disease among both
patients and family members. It may indicate that essential information was not given to patients and family
members. According to Cleaver and Pallourios (1994:181), diabetic patients eat whatever is available at
social gatherings and therefore their blood glucose level is not controlled.

100
90
80
68.8
70 62.5
60
50
40
30
21.9 21.9
20 15.6
9.4
10
0
Agree Unsure Disagree

Patient Family members

Figure 4.10
Withdrawing sugar

4.4.2.4 Once sugar is normal, stop treatment

Figure 4.11 indicates that 27 (84.4%) of the patients did not agree with the statement which says that once
sugar is normal, treatment should be stopped, 3 (9.3%) were unsure and only 2 (6.3%) agreed with the
statement. Family members revealed the same percentage of those who did not agree with the statement
as that of patients 27 (84.4%). Again, 3 (9.3%) of them were not sure about the statement, and only 2
(6.3%) of the family members agreed that once sugar is normal treatment should be stopped. It is not
acceptable that there are patients and family members who think that treatment can be stopped once the
blood sugar is normal. This implies that they do not realise that diabetes is a chronic disease. According to
Bain (2001:4), patients and family members should be reassured about the continuity of care.
56

100
90 84.4 84.4
80
70
60
50
40
30
20
9.3 9.3
10 6.3 6.3
0
Agree Unsure Disagree

Patient Family members

Figure 4.11
Normal sugar – stop treatment

4.4.2.5 Causes of diabetes mellitus

“Name the causes of diabetes mellitus”, was the question directed at patients and family members.
According to the results 20 (62.5%) of the patients mentioned that eating sugar is the cause of diabetes
mellitus whereas 12 (37.5%) indicated that heredity and failure of the pancreas to secrete insulin is the
cause of diabetes mellitus. Family members responded in the following manner: 21 (68%) indicated that
nature, loss of power, sweating, drinking alcohol, eating starchy and fatty foods as well as problems are the
causes of diabetes mellitus and 11 (32%) of family members indicated that heredity is the cause of
diabetes mellitus. According to Smeltzer and Bare (1992:1025), the possible causes of diabetes mellitus
include genetic, immunologic and environmental factors, age, obesity, family history and ethnic group.
Royle and Walsh (1992:596) add that viral infections may cause IDDM. It appears that patients and family
members do not fully understand the causes of diabetes. The majority of patients in the sample apparently
do not know the real causes of diabetes mellitus whereas most of the family members mentioned a few
related causes.

4.4.2.6 Programmes attended

According to figure 4.12, 19 (59.4%) of patients reported that they had never attended organised
programmes and 13 (46.6%) had attended such programmes. Family members had a high percentage 27
(84.4%) of those who had never attended the programmes whereas 5 (15.6%) had attended. According to
findings by Chen-Yen and Fenske (1996:468), Gowers et al. (1995:995) and Keller in Cleaver and
Pallourios (1994:176), the type of support system the patient has, has an influence on the adherence to the
57
diabetic regimen. Thompson (1995:1401, 1415) defines a support system as an organised group of
individuals that encourages or assists. Attending programmes may assist diabetic patients to cope with the
disease as a result of the advice and support that they may get.

100
90 84.4
80
70
59.4
60
50 46.6

40
30
20 15.6
10
0
Did not attend Attended

Patient Family members

Figure 4.12
Programmes attended

4.4.2.7 Warning signs of hypoglycaemia

That the following are warning signs for hypoglycaemia or low blood sugar, namely, sweating, hunger, and
faintness, was a statement to which 18 (56.3%) patients indicated that they knew the signs and 14 (43.8%)
that they were not sure. Half of family members, 16 (50%), knew the warning signs and 16 (50%) were not
sure (see figure 4.13). According to Bain (2001:4), patients, friends and family should be educated to
recognise symptoms of hypoglycaemia. It is extremely important that patients and family members know
these signs as immediate action is required to prevent the patient from falling into a coma.
58

100
90
80
70
60 56.3
50 50
50 43.8
40
30
20
10
0
Agree Unsure

Patient Family members

Figure 4.13
Recognition of warning signs of hypoglycaemia

4.4.2.8 Urine testing

Data indicates that a high percentage, 24 (75%) of patients, never tested their urine and only 8 (25%) were
testing their urine on a daily or monthly basis (see figure 4.14). Family members also reported a high
percentage of patients, 19 (59.4%), not going for urine testing. Only 13 (40.6%) of family members reported
that patients were testing their urine. Bain (2001:4) stresses the importance of teaching patients and family
about urine testing and that glucose in urine is correlated with hypoglycaemia.

100
90
80 75
70
59.4
60
50
40.6
40
30 25
20
10
0
Did not test urine Test urine

Patient Family members

Figure 4.14
Urine testing
59
4.4.2.9 Glucose monitoring

The results indicate that 18 (56.3%) of the patients never went to the clinic for glucose monitoring and 14
(43.8%) did visit the clinic for glucose monitoring. Among the family members 28 (87.5%) indicated they
never visited the clinic with patients for glucose monitoring and 4 (12.5%) did visit the clinic for glucose
monitoring of patients (figure 4.15). Bain (2001:4) says that blood glucose self-monitoring is important and
preferable to urine monitoring and that patients, friends and family should be instructed on how to do blood
glucose self-monitoring. If they do not have the equipment they should visit the clinic or hospital for testing.
Patients do not test their urine or blood. This supports the high rate of complications of diabetes mellitus
indicated by Smeltzer and Bare (1992:1060), as complications are aggravated by continuously elevated
blood sugar levels. Diabetic patients should monitor their blood glucose since it is preferred to urinalysis.
Urinalysis has a problem in that it may not warn the patient of impending hypoglycaemia (Coates
1994:264).

100
90 87.5

80
70
60 56.3
50 43.8
40
30
20 12.5
10
0
Never visit clinic Visit clinic

Patient Family members

Figure 4.15
Visit clinic for glucose monitoring

4.4.2.10 Medication

A total of 25 (78.1%) of the patients reported that they were taking treatment and 7 (21.8%) were not using
treatment but diet only. Of the family members 25 (78.1%) reported that patients were using treatment
whereas 7 (21.9%) reported that patients were not using treatment but diet only. Oral anti-diabetic drugs
and insulin treatment are introduced when a patient with type II diabetes mellitus cannot achieve
satisfactory metabolic control with his/her diet. The majority of the subjects are taking treatment, therefore
they have to monitor blood glucose, and yet the majority also indicated that they never test their urine and
most of them do not visit the clinic for glucose monitoring (4.4.2.8 and 4.4.2.9).
60
4.4.2.11 Name of medication

When asked about the medication they are using, patients responded in the following manner: 22 (67.2%)
said they used Dianol, Glucophage or Insulin, and 10 (32.8%) did not know the medication. Half of the
family member 16 (50%) indicated that Glucophage, Dianol or Insulin were used, 14 (44.8%) did not know
and 2 (5.2%) indicated that the diabetic patients were not taking treatment. This correlates with item 4.4.1.3
which indicates a smaller percentage of patients who did not reach grade 10, and thus cannot read and
write, which may account for their not knowing the name of the medication they are using.

4.4.2.12 The better treatment, injection or oral treatment

“Which is better, insulin injection or oral treatment?” This was a question directed to patients and family
members. According to the results, 12 (38.5%) of the patients indicated that oral treatment is the best
because it doesn’t cause loss of libido, and 7 (20.9%) regarded an injection as the best whereas 13
(40.6%) responded by saying that they do not know. Of family members 13 (40.6%) indicated that oral
treatment is the best, 6 (18.8%) said an injection is the best because it acts faster, whereas 13 (40.6%) did
not know which is the best. According to the researcher both oral medication and injection could be
beneficial when instructions are followed. Treatment is said to be the best when the desired results are
obtained. Both treatments are advantageous because they supplement each other if blood glucose fails to
respond to one drug (Smeltzer & Bare 1992:1022).

4.4.2.13 Body not functioning as before

Figure 4.16 depicts that 16 (50%) of the patients indicated that their body functioning had changed since
they started using the diabetic treatment, 15 (46.9%) said there was no change in their body functioning
and 1 (3.1%) was not sure whether body functioning had changed or not. The reasons given for affirmation
of a change in body function were indicated as weakness, feeling tired, dizziness, a tingling sensation and
loss of libido. The reasons given for the change in body functioning are alarming as they all indicate that
these patients’ diabetes is not well controlled – they are signs of low blood sugar. According to Andrews
and Boyle (1995:241), sexual dysfunction aggravates feelings of frustration. Family members did not
answer this question. Half of the patients experienced altered body image which might indicate
complications such as sexual dysfunction as indicated by Boyle and Andrews (1998).
61

100
90
80
70
60
50 46.9
50
40
30
20
10 3.1
0
Agree Unsure Disagree

Patient Family members

Figure 4.16
Body functioning

4.4.2.14 Meals

Figure 4.17 indicates that 7 (21.9%) of the patients said they eat twice, 21 (65.6%) eat thrice and 4 (12.5%)
eat four times per day. Of family members 1 (3.1%) said patients eat twice, 23 (71.9%) said they eat thrice
and 8 (25%) said four times per day. The majority of the patients eat according to Smeltzer and Bare
(1992:1028), who describe the recommended diet for diabetic patients and the importance of eating 3
meals per day and having snacks in between the meals in order to prevent hypoglycaemia.

100
90
80 71.9
70 65.6
60
50
40
30 25
21.9
20 12.5
10 3.1
0
Twice a day Three times a day Four times a day

Patient Family members

Figure 4.17
Meal times
62
4.4.2.15 Snacks

On average 17 (53.1%) of the patients reported that they carry snacks wherever they go to supplement
their blood sugar, and 15 (46.9%) indicated that they don’t carry snacks. Of family members 18 (54.7%)
reported that patients carry snacks and 14 (45.3%) reported that patients don’t carry snacks (figure 4.18).
According to Smeltzer and Bare (1992:1028), diabetic patients should have snacks in between their meals
to prevent hypoglycaemia, and to prevent them from eating full meals frequently which can lead to weight
gain. Adherence to the treatment regimen requires the patients to carry snacks with them.

100
90
80
70
60 53.1 54.7
50 46.9 45.3
40
30
20
10
0
Take snacks Do not take snacks

Patient Family members

Figure 4.18
Snacks for supplementing blood sugar

4.4.2.16 Nutrition counselling

Subjects were asked if they went for nutrition counselling following the diagnosis. Only 15 (46.9%) of the
patients indicated that they never went for counselling and 17 (53.1%) did. Almost half of the family
member 15 (46.9%) reported that they never went for nutrition counselling and 17 (53.1%) went (figure
4.19). It is a known fact that diabetic patients should consult a dietician for advice on their diet following
diagnosis. It is alarming that so many of the subjects did not have nutrition counselling, as the correct diet is
a very important part of the management of diabetes. This is supported by Savoca and Miller (2001:225)
who indicate that most people with diabetes mellitus fail to adhere to a healthy diet, which might be due to
failure to attend nutrition counselling offered by a dietician.
63

100
90
80
70 46.9

60 53.1 53.1
50 46.9

40
30
20
10
0
Not at all Go for councelling

Patient Family members

Figure 4.19
Nutrition counselling

4.4.2.17 Traditional healers know better how to treat diabetes

In response to this item 19 (59.4%) of the patients indicated that traditional healers don’t know better how
to treat diabetes mellitus, 11 (34.4%) were unsure and 2 (6.2%) indicated that traditional healers know
better than western doctors. Among the family members 20 (62.5%) indicated that traditional healers don’t
know better than doctors, 10 (31.3%) were unsure and 2 (6.2%) indicated that traditional healers know
better how to treat diabetes than doctors (figure 4.20). It is a known fact that patients use traditional
medication before they consult medical doctors (Setswe 1999:56) but the results indicate that the majority
of subjects in this study do not believe that traditional healers could provide better treatment.
64

100
90
80
70 62.5
59.4
60
50
40 34.4 31.3
30
20
10 6.2 6.2
0
Agree Unsure Disagree

Patient Family members

Figure 4.20
Traditional healers know how to treat diabetes

4.4.2.18 Visit to traditional healers

On average 10 (31.2%) of the patients indicated that they visited the traditional healers for treatment and
22 (68.8%) indicated that they never visited traditional healers, only 7 (21.9%) family members indicated
that patients visited traditional healers and 25 (78.1%) indicated that patients never went to traditional
healers for treatment (figure 4.21). Mulemfo (1995:341) indicates that men and women since the earliest
ages made use of plants from which they prepared certain remedies. These first experiences showed that
plants and animals effected the healing which was required of them, and as such they developed trust in
that curative source. Consequently, the use of medicinal plants has been accepted universally. The
responses to the two questions on traditional healers therefore indicate that the majority of subjects are
following one treatment regimen, the medical one. This is a positive aspect as it can then be envisaged that
the response to proper health education will be favourable.

100
90
78.1
80
68.8
70
60
50
40
31.2
30 21.9
20
10
0

Never Visited traditional healer

Patient Family members

Figure 4.21
Visit to traditional healer
65
4.4.2.19 Visit to a spiritual healer

More than half of the patients 17 (53.1%) indicated that they visited the spiritual healer, whereas 15
(46.9%) indicated that they never visited the spiritual healer. Only 9 (28.1%) of family members indicated
that patients visited the spiritual healer whereas 23 (71.9%) indicated that patients didn’t visit the spiritual
healer (figure 4.22). It is a known fact that patients visit spiritual healers when they are ill. Even the results
of this study indicate that quite a number of the subjects visited the spiritual healers. The fact that more
than half of the subjects visited a spiritual healer might indicate a need for psychological support or have
expectations that their diabetes may be cured. According to Bain (2001:3) several research studies indicate
that people suffering from chronic diseases, including diabetes, are more at risk of developing depression.
Some research results support the theory that depression may even cause diabetes. This implies that
diabetic patients might need additional moral support.

100
90
80 71.9
70
60 53.1
50 46.9

40
28.1
30
20
10
0
Never Visit spirituall healer

Patient Family members

Figure 4.22
Visit to spiritual healer

4.4.2.20 Drinking boiled lemon leaves

“Drinking boiled lemon leaves helps to reduce high blood sugar” was a statement posed to patients and
family members. A high percentage, 24 (75%) of the patients were unsure as to whether boiled lemon
leaves reduced blood sugar or not.,3 (9.4%) indicated that boiled lemon leaves helped to reduce blood
sugar, and 5 (15.6%) didn’t agree with the statement. Only 1 (3.1%) family member agreed with the
statement, 10 (31.3%) indicated that drinking boiled lemon leaves doesn’t reduce blood sugar and 21
(65.6%) of family members were unsure. According to Helman (1994:50), dietary beliefs and practices are
sometimes difficult to discard, even when they are dangerous to health. Consumption of certain food or
66
drink may be encouraged by defining them as sacred or medicinal such as the belief that taking lemon juice
can treat “high blood”. The low percentage of subjects who believe that lemon leaves can reduce high
blood sugar may be an indication that this belief is not relevant to the culture of the subjects included in this
study.

4.4.2.21 Forbidden food

Subjects were requested in an open question to write down the food that diabetic patients should not eat.
The majority, 30 (93.7%), indicated that the forbidden food includes sugar, fat, alcohol and cold drinks and
2 (6.3%) mentioned banana and salt. A high percentage of family members, 25 (78.1%), mentioned cakes,
sugar and fat, and 7 (21.8%) did not know the food that should not be eaten by diabetic patients. The
results indicate that both patients and family members know the diet which is not supposed to be taken by
the patient. Smeltzer and Bare (1992:1028) described the recommended diet for diabetic patients as one
with low fat, boiled vegetables and meat, and carbohydrates like brown bread and maize meal.

4.4.2.22 Exercise

Subjects were requested to indicate whether diabetic patients perform exercises daily, twice a week, once
a week or not at all. Figure 4.23 shows that patients responded in the following manner: 25 (78.2%)
indicated that they exercise for 30 minutes by walking and 7 (21.8%) do not exercise. Amongst those who
exercise, the majority, 21 (65.6%), exercise daily, which is to their benefit. Only 2 (6.3%) indicated
exercising once and twice a week respectively. The majority of family members, 15 (46.9%), affirmed that
patients exercise daily whereas 5 (15.6%) indicated that they exercise twice a week with 1 (3.1%)
exercising once a week. A total of 11 (34.4%) indicated that patients do not exercise. In Bain (2001:15) and
Smeltzer and Bare (1992:1031) information on health promotion was reinforced such as good dietary
management and physical activity or exercise. Exercise is important because of its effect of lowering blood
glucose and reducing cardiovascular risk factors. Exercise lowers blood glucose by increasing the uptake
of glucose by the body muscles and improving insulin utilisation.
67

100
90
80
70 65.6
60
50 46.9
40 34.4
30 21.8
20 15.6
10 6.3 6.3
3.1
0
Not at all Every day Twice a week Once a week

Patient Family members

Figure 4.23
Walking for exercise

4.4.2.23 Experiencing sexual problems

In response to this question 16 (50%) patients indicated that they experience sexual problems, 12 (38%)
didn’t experience sexual problems and 4 (12%) were unsure. A small percentage of family members, 12
(37.5%), indicated that patients experience sexual problems, 5 (15.6%) indicated that patients didn’t
experience sexual problems and 15 (46.9%) were unsure as to whether diabetic patients experience sexual
problems or not (figure 4.24). According to Smeltzer and Bare (1992:1062), diabetic patients suffer from
autonomic neuropathy, and the main effects of autonomic neuropathy include urinary and sexual
dysfunction. According to The Viagra Boom (1998:22), this can be alleviated by hot baths, rubbing in some
ointments which the author did not give examples of, and intra-penile injection therapy.

100
90
80
70
60
50
50 46.9
37.5 38
40
30
20 15.6
12
10
0

Agree Unsure Disagree

Patient Family members

Figure 4.24
Experiencing sexual problems
68
4.4.2.24 Examples of sexual problems experienced

Half of the total number of patients, 16 (50%), indicated that they experience lack of sex urge (libido) and
the penis doesn’t erect. The remaining 16 (50%) indicated that they don’t experience sexual problems. For
the family members, 12 (38%) mentioned that diabetic patients experienced lack of sex urge (libido) and 20
(62%) didn’t know whether patients experience sexual problems or not. Smeltzer and Bare (1992) indicate
that diabetic patients suffer from autonomic neuropathy and the main effects of this neuropathy includes
sexual and urinary dysfunction such as lack of sex urge and incontinence, for example, impotence (inability
of the penis to become rigid and sustain an erection) and retrograde ejaculation (normal erection and
orgasm occurs but no ejaculation as the seminal fluid is propelled backwards through the posterior urethra
and into the urinary bladder).

4.4.2.25 Sexual educational programmes

“Information on sexual problems should be included in the educational programmes” was a statement
posed to both the patients and family members. The majority of the patients, 29 (90.6%), agreed that
information on sexual problems should be included in the educational programmes, 1 (3.1%) disagreed
with the statement and 2 (6.3%) were not sure as to whether information on sexual problems should be
included or not. Of family members, 24 (75%) indicated that information on sexual problems should be
included in the educational programs, 1 (3.1%) disagreed with the statement and 7 (21.9%) were not sure
(figure 4.25). According to Boyle and Andrews (1989), diabetic patients and their family members should be
educated about sexual dysfunction and its management. Education on sexual problems appears to be an
important aspect of health education to be given to diabetics as indicated by both patients and family
members.

100
90.6
90
80 75
70
60
50
40
30
21.9
20
10 6.3 3.1 3.1
0
Agree Unsure Disagree

Patient Family members

Figure 4.25
Need for education on sexual problems
69
4.4.2.26 Feet examination

Only 19 (59.4%) patients said they examine their feet whereas 13 (40.6%) said they don’t. A high
percentage of family members, 30 (93.7%), indicated that diabetic patients examine their feet and 2 (6.3%)
of them indicated that diabetic patients do not examine their feet (figure 4.26). In Long-term Complications
([sa]:36), New Fast-acting Insulin (1997:50) and Recognition and Management… ([sa]:34), patients and
their family members are advised on foot care, and patients further advised to inspect their feet daily for
redness, blisters, calluses or ulceration as they won’t experience pain and pressure sensation due to
sensory neuropathy. Early detection may result in wound healing, although in patients with peripheral
vascular disease, foot ulcers may not heal because of the decreased ability of oxygen, nutrients and
antibiotics to reach the injured tissue (Smeltzer & Bare 1996:1061).

100 93.7
90
80
70
59.4
60
50
40.6
40
30
20
10 6.3
0
Never Examine feet

Patient Family members

Figure 4.26
Feet examination
4.4.2.27 Visit to the podiatrist

The majority of patients, 30 (93.8%), reported that they never visited the podiatrist for examination of their
feet and 2 (6.2%) did visit the podiatrist. This concurs with the high number of family members, 27 (84.4%),
who mentioned that patients never visited the podiatrist and 5 (15.6%) mentioned that they do visit the
podiatrist (figure 4.27). According to New Fast-acting Insulin (1997:50), Sanders (1995:10) and Smeltzer
and Bare (1992:1062, 1063, 1068), diabetic patients should be advised on foot care to prevent some of the
infections and to have their feet examined at least every six weeks by a podiatrist. It is necessary to prevent
gangrene or foot ulcers as they may not heal in patients with peripheral vascular disease because of the
decreased supply of oxygen, nutrients and antibiotics to the injured tissue.
70

100 93.8
90 84.4
80
70
60
50
40
30
20 15.6
10 6.2
0
Never Visit podiatrist

Patient Family members

Figure 4.27
Visit to the podiatrist

4.4.2.28 Shoe type

A total of 19 (58.4%) of the patients mentioned that they should wear any shoes, including open shoes
(sandals), whereas 13 (41.6%) said they should wear loose fitting leather shoes. The majority of family
members, 20 (62.5%), mentioned that tight shoes, black sandals, and any shoe that fits the patient could
be worn whereas 12 (37.5%) indicated well fitting leather shoes as the correct shoes.

In Diabetes Education (1998::22), Long-term Complications ([sa]:36), New Fast-acting Insulin (1997:50),
Recognition and Management … ([sa]:34) and Sanders (1995:10), diabetic patients and family members
have been advised on foot care and wearing well fitting closed-toe shoes. The percentage of patients and
family members who do not know what type of shoes should be worn by diabetics is alarming.

4.4.2.29 Reasons for wearing the above shoes

With reference to the reason for supporting the above answers, 14 (44.8%) of the patients said the reason
for wearing well fitting shoes was prevention of trauma, to avoid hindering circulation and to prevent
infection, and 18 (55.2%) said they don’t know the reason for wearing such shoes. A small number of
family members, 8 (25.6%), mentioned prevention of trauma as their reason, and 24 (74.4%) indicated that
they don’t know the reason for wearing such shoes. It is apparent that the majority of patients and family
members do not know the reasons for wearing specific shoes. This implies that they have not received
adequate health education.
71
4.4.2.30 Low salt diet

Subjects were asked if a low salt diet reduces high blood pressure to which 16 (50%) of the patients agreed
that low salt diet reduces high blood pressure and 16 (50%) disagreed. The majority of 21 (65.6%) of the
family members agreed that low salt diet reduces high blood pressure and 11 (34.4%) disagreed.
According to Smeltzer and Bare (1992:1028), the recommended diet for a diabetic patient comprises of
herbs and special salt for hypertensive patients as these reduce the accumulation of fluids in the body
caused by the intake of general salt. According to the results, patients and family members know that a low
salt diet reduces high blood pressure. It appears that all the patients and family members are not
adequately informed about the role of salt in the diet.

4.4.2.31 Visit to ophthalmologist

The subjects had to indicate how often the diabetic patients visit the ophthalmologist. Responses to this
question are summarised in figure 4.28. Half of the patients, 16 (50%), reported that they never visited the
ophthalmologist and 16 (50%) did. The majority of family members, 22 (68.8%), indicated that diabetic
patients never visited the ophthalmologist and 10 (31,2%) indicated that the patients did. It is indicated in
Campbell et al (1997:69), Long-term Complications [sa]:36 and Smeltzer and Bare (1992:1059) that
diabetic retinopathy is caused by damage to the sensitive blood vessels in the eyes, and that annual eye
examinations should be done on all diabetic patients and they should be referred to an optometrist or
ophthalmologist. According to Kritzinger (1990) in Coates (1994:268), regular monitoring of diabetic
patients’ vision for signs of retinopathy is essential as they will not benefit fully from treatment once they
already experience loss of vision. It is alarming to realise that such a large proportion of the subjects
included in the study do not visit the ophthalmologist. The reason for this needs to be clarified, whether it is
lack of knowledge or lack of money.
72

100
90
80
68.8
70
60
50 50
50
40
31.2
30
20
10
0

Never Visit ophtalmologist

Patient Family members

Figure 4.28
Visit to the ophthalmologist

4.4.2.32 Diabetic patients lose jobs and status

“People affected by diabetes mellitus should lose their jobs and status” was the statement directed to
patients and family members. Responses to this question were summarised in figure 4.29 where 2 (6.3%)
of the patients were unsure as to whether they should lose their jobs and status or not. The majority, 30
(93.8%), disagreed with the statement. The majority of family members, 29 (90.6%), disagreed that the
patients should lose their jobs and status, whereas 2 (6.3%) were unsure and 1 (3.1%) agreed that they
should lose their jobs. It is apparent that neither the patients nor the family members regard diabetes
mellitus as a disabling disease.

100 93.8 90.6

90
80
70
60
50
40
30
20
10 6.3 6.3
3.1
0
Agree Unsure Disagree

Patient Family members

Figure 4.29
Loosing jobs and status
73
4.4.2.33 Reasons for losing or not losing your job

Subjects were requested to give the reasons why they think that diabetic patients should lose their jobs and
status or why they think they shouldn’t. Almost aal of the patients, 29 (90,6%) indicated that they mustn’t
lose their jobs as they won’t have money to buy food. They also indicated that they must work in order to
get money for better treatment, and 3 (9.4%) indicated that they must be treated but not expelled from
work. A total of 21 (65.6%) of family members supported the sentiment that patients must not lose their jobs
and the reasons given were, ‘they must be able to buy food, won’t have money to support their families if
expelled’, whereas 11 (36%) indicated that they must not lose their jobs as diabetes can be controlled.
Others said it depends on the employer whether to expel the employee or not and lastly they indicated that
patients can fall while working due to poor eyesight. It appears that money is needed for food and better
treatment, that patients realise that treatment is essential, and therefore if they don’t have a job they will not
be able to afford treatment.

4.4.2.34 Emotional experience

Subjects were requested to describe their reaction when they first heard that they have diabetes. Only 4
(12.5%) of the patients accepted their condition whereas the majority 28 (87.5%) denied it, felt tired, were
hurt, were depressed, and some were shocked. This corresponds with the response of family members
where only a small percentage indicated that patients accepted it at once, and 18 (56.2%) reported that
patients acted in various ways such as ‘didn’t accept’, ‘felt tired’, ‘were not happy’, ‘were hurt’, ‘didn’t tell
anybody’. A small percentage, 6 (18.7%), reported that they don’t remember how the patients reacted
when they were informed that they have diabetes mellitus.

Generally, people don’t accept that they have chronic, life-threatening diseases but instead they develop
depression. The reason why patients visit spiritual healers may be because they need psychological
support. Bain (2001:3) also indicates that 21-24% of diabetics had one episode of depression before their
diagnosis of diabetes mellitus, and patients who are depressed are less likely to control their blood sugar
level.

4.4.2.35 Fear

Subjects were asked what their greatest fear about diabetes was. Only 6 (18.8%) of the patients indicated
that they don’t have fear whereas 26 (81.2%) indicated that they fear death; becoming blind; falling and
getting injured; that blood sugar will be low and it will be difficult to raise it; and divorce. Of family members
12 (37.5%) indicated that they don’t have fear and 18 (56.2%) said they fear death of their relative, that the
74
patient can lose a limb and also fear hyper- or hypoglycaemia. The remaining 2 (6.3%) responded by
saying that they don’t know what their greatest fear is. The majority of patients indicating fear depict
emotional turmoil and uncertainty. It also relates to the previous question about emotional experiences
which indicate negative emotions such as unhappiness and depression. The responses from the majority of
the family members indicating fear imply that family members and also in need of psychological support
when caring for diabetic patients.

4.4.2.36 Effects of living with and management of diabetes

Patients and family members were asked to describe the effects of living with and treating diabetes. The
majority of patients indicated that it was stressful to live with diabetes, because of the responsibility to take
medication on time, the inability to satisfy their partners’ sexual needs and lastly the special diet they have
to adhere to. The majority of the family members responded by saying that it is difficult to live with a
diabetic patient as he does not eat everything, it is difficult when there is no money to pay doctors, the
patient can die any time, and it is traumatic as you don’t satisfy your partner’s sexual needs and this causes
stress.

Only a few of the family members indicated that there is no difference between living with a diabetic patient
and a non-diabetic patient.

4.4.2.37 Money interferes with diabetes control

“Lack of money interferes with the control of diabetes” was a statement posed to patients and family
members. A total of 24 (75%) patients agreed that a lack of money does interfere with the control of
diabetes whereas 8 (25%) were unsure. The majority of family members, 23 (71.9%), also indicated that a
lack of money interferes with the control of diabetes and 8 (25%) disagreed with the statement whereas 1
(3.1%) was unsure (figure 4.30). According to Baumann et al (2002:191), the morbidity from diabetics is
more severe in low income groups, and less than half of adults with type II diabetes in their study achieved
a blood glucose level of less than 7mmol/L. This indicates the negative effects of lack of control of diabetes,
which may be due to lack of money.
75

100
90
80 75
71.9
70
60
50
40
30 25 25
20
10 3.1
0

Agree Unsure Disagree

Patient Family members

Figure 4.30
Lack of money interferes with diabetes control

4.4.2.38 Reason to support the above statement

A high percentage of patients 25 (78.1%) indicated that they won’t be able to reach the clinic or hospital for
a check up, and won’t have money to buy food, whereas 7 (21.9%) responded by saying that lack of money
does not interfere with the control of blood sugar. The response of family members was that 24 (75%) said
patients won’t be able to reach the clinic if they don’t have money and that they won’t be able to buy food
and only 7 (21.9%) indicated that lack of money does not interfere with the control whereas 1 (3.1%)
indicated that he/she doesn’t know whether lack of money interferes with the control or not.

The responses to these two questions are alarming in the sense that external factors such as financial
restraints can interfere with diabetes control, and could therefore lead to complications setting in, in spite of
sufficient knowledge and willingness to adhere to the treatment regime.

4.4.2.39 Diabetes mellitus is a punishment

“People suffering from diabetes mellitus are being punished by God” was a statement posed to patients
and family members. A minority, 5 (15.6%) of the patients agreed that suffering from diabetes mellitus is a
punishment from God and 9 (28.1%) were unsure, whereas 18 (56.3%) disagreed with the statement. Only
3 (9.4%) of the family members agreed that suffering from diabetes mellitus is a punishment from God, 6
76
(18.8%) were unsure and 23 (71.9%) disagreed. It appears that diabetes mellitus is not a disease which is
generally associated with religious beliefs and viewed as some form of punishment.

4.4.2.40 Diabetic patient is a burden

“A person with diabetes mellitus is a burden to his/her family.” The responses to this statement included 11
(34.4%) of the patients who regarded a diabetic patient as a burden to his/her family, 4 (12.5%) were
unsure and 17 (53.1%) disagreed. Only 6 (18.8%) of family members agreed that diabetic patients are a
burden to their families, 5 (15.6%) were unsure and 21 (65.6%) disagreed (figure 4.31). Donohoe et al
(2000:582) and Ruth (1999:419) indicate that the chronic complications of diabetes place an enormous
burden on health care resources, with foot ulceration representing a major cause of bed occupancy for
people with diabetes who undergo non-traumatic lower limb amputation. If it places a burden on health care
resources, it places a burden on society and therefore on individuals. According to the above results the
patients tend to regard themselves as a burden to the family to a greater extent than the family members
who are less inclined to consider them as a burden.

100
90
80
70 65.6
60 53.1
50
40 34.4
30
18.8
20 12.5 15.6
10
0
Agree Unsure Disagree

Patient Family members

Figure 4.31
A diabetic is a burden to the family

4.4.2.41 Reasons for diabetic patients being a burden to the family

A total of 17 (53.1%) patients indicated that a diabetic patient is not a burden because he/she can do
everything for him/herself and diabetes is like other diseases. The reasons given by the 11 (35.2%) patients
who said they are a burden included that they need care and a special diet and family members are not
happy with them. The 4 (12.8%) patients who were unsure whether they are a burden or not did not give
77
reasons. The majority, 23 (71.9%) family members said the diabetic patient is not a burden because they
can do everything for themselves and only 6 (18.8%) said they are a burden the reasons being that money
is needed to transport them for treatment and for buying food. The 3 (9.4%) who indicated that they were
unsure whether the patient is a burden or not did not give reasons. From the responses it appears that
while the patient can still care for himself/herself both the patient and family members do not regard the
diabetic as a burden. However, the need for a special diet and regular visits to the clinic/hospital have
financial implications which result in the patient being regarded as a burden.

4.4.2.42 Distance from the nearest clinic/hospital

“How far is the nearest clinic/hospital where treatment is collected?’’ was the question posed to subjects.
Almost half, 15 (46.9%), of the patients said they walk less than 5 km from where they stay, 10 (31.3%)
indicated less than 10 km, 4 (12.5%) said less than 20 km and only 3 (9.3%) live further than 20 km from
the clinic. Family members’ responses included 13 (40.6%) who reported that patients live less than 5 km
from the clinic, 10 (31.3%) said less than 10 km, 6 (18.8%) indicated less than 20 km and 3 (9.3%)
indicated 20 km and more (figure 4.32). Therefore the health services appear to be accessible to most
individuals.

100
90
80
70
60
50 46.9
40.6
40
31.3 31.3
30
18.8
20 12.5 9.3 9.3
10
0

1-5 kilometer 6-10 kilometer 11-20 kilimeter 20 kilimeter +

Patient Family members

Figure 4.32
Distance to the nearest clinic/hospital
78
4.4.2.43 Transport used

Patients and family members were asked about the mode of transport they used to reach the clinic/hospital.
The findings showed that the majority of patients used some form of transport as 13 (40.6%) patients
reported that they use a bus, 8 (25%) use cars, and 1 (3.1%) said he/she uses a bicycle. The remaining 10
(31.3%) indicated that they walk to reach the clinic or hospital (figure 4.33). The family members’ responses
included 10 (31.2%) who use a bus, 9 (28.1%) use a car, 1 (3.1%) uses a bicycle and 12 (37.5%) walk to
the clinic or hospital.

100
90
80
70
60
50
40.6
40 37.5
31.3 31.2
30 25 28.1

20
10 3.1 3.1
0
Feet Bicycle Car Bus

Patient Family members

Figure 4.33
Type of transport used

4.4.2.44 With whom does the patient stay at home

In response to this question 3 (9.4%) patients reported that they stay alone, 21 (65.6%) stay with their
spouses, 5 (15.6%) with their parents and 3 (9.4%) with their relatives. The family members’ responses
included 2 (6.3%) who reported that diabetic patients stay alone and 21 (65.6%) indicated that they stay
with their spouses, 7 (21.8%) reported that they stay with their parents and 2 (6.3%) stay with their relatives
(figure 4.34). This indicates that the majority of diabetic patients in the sample as reported by patients and
family members do not stay alone and therefore have a support system available. According to findings of
Chen-Yen W and Fenske (1996), Gowers et al (1995) and Keller in Cleaver and Pallourios (1994), patients
whose families are supportive follow the recommended diet or a diabetic regimen.
79

100
90
80
70 65.6 65.6
60
50
40
30 21.8
20 15.6
9.4
6.3 9.4 6.3
10
0

Alone Wife/husband Parents Relatives

Patient Family members

Figure 4.34
Persons with whom diabetics stay at home

4.5 CONCLUSION

In this chapter the researcher presented the data systematically and chronologically according to the items
in the questionnaires. The purpose of the study was laid out together with the research objectives. Data
was analysed using a computer program called SPSS. Descriptive statistics in terms of percentages were
used and pie diagrams and bar graphs were added to summarise the results. The results were supported
by references to the literature where applicable. In the next chapter, a summary of the findings, conclusions
and recommendations will be discussed.