INTRODUCTION:

Diabetes mellitus or ‘Madhumeham’ has been known for centuries as a disease related to sweetness. Person with diabetes have too much sugar in blood and urine. However, there is no need to worry, since diabetes can be kept under control with certain changes in the life style-food intake, exercise and regular intake of prescribed medicines. Even though more than 30 million people all over the world are affected with diabetes not all are well informed about the nature of their disease.¹

Demographic transition combined with urbanization and industrialization has resulted in drastic changes in lifestyles globally but the impact is felt more in developing countries because of their more rapid pace of growth. One of the consequences of this transition is a change in disease patterns with communicable diseases being replaced by non-communicable or life style related diseases like diabetes, obesity, cardiovascular diseases and cancer.²

The management of diabetes poses a challenge to the medical and nursing staff as well as to the patients themselves. Since diabetes is a chronic disease, most diabetic patients need to continue their treatment for the rest of their lives. The emphasis is usually therefore, on the control of the condition through a tight schedule of blood glucose and urine sugar monitoring, medication and adjustment to dietary modification. Such a chronic condition requires competent self-care, which can be developed from a thorough understanding of the disease process and the management challenges by the patient and family members. This recommends the need for some form of diabetes education and counseling for the patient and family members. Educating and supporting diabetic patients in managing their daily lives are important goals of diabetic patient’s care.³

Both forms of diabetes ultimately lead to high blood sugar levels, a condition called hyperglycemia. Over long period of time, hyperglycemia damages the retina of the eye, the kidney, the nerves, and the blood vessels. Damage to the retina from diabetes (diabetic retinopathy) is a leading cause of blindness. Damage to the kidney from diabetes (diabetic nephropathy) is leading cause of kidney failure. Damage to the nerves from diabetes (diabetic neuropathy) is leading cause of foot and leg amputation. Damage to the nerves in the autonomic nervous system can lead to paralysis of the stomach (gastro paresis), chronic diarrhea, and an inability to control heart rate and blood pressure with posture changes.⁴

NEED FOR THE STUDY :

We are in the midst of an epidemic of diabetes mellitus and India is considered as the capital of the world of diabetics. This is because one fifth of the world's diabetic populations (285 million) are Indians. At the recently concluded IDF conference, it was mentioned that India has about 58 million diabetics and China lags behind at 43 million! These numbers are expected to increase another 50 per cent in next 20 years or so. For every diabetic patient that is diagnosed in a population, there is one undiagnosed patient. However, an important fact is often overlooked that nearly 50 per cent patients are asymptomatic. Awareness about this disease will promote patients and the public at high risk to go for a regular follow up. Diabetic complications generally develop after 12-15 years of diabetes. Around 15-25 per cent patients are unfortunate enough to have varying degree of complications at the time of diagnosis. This is explained by the fact that when the diagnosis of diabetes is made, the patient has already had some degree of glucose intolerance for an average of six to eight years. These complications lead to organ dysfunction and damage.⁵

India harbors the largest number of diabetic patients in the world. Poor awareness and practices are some of the important variables influencing the development and progression of diabetes and its complications, which are largely preventable. Preventive strategies need to be formulated based on the factors contributing to the development and progression of diabetes. Knowledge, attitude and practice among diabetics from backward areas of the country like Bijapur, Bidar, Kolar, Gulbarga and Karnataka state are not readily available.⁶

The heath workers play an important role in the treatment of diabetes mellitus and patients as well. Since diabetes is a chronic disease, most diabetic patients need to continue their treatment for the rest of their lives. The emphasis is usually therefore on the control of the condition through a tight schedule.⁸Diabetes mellitus is the leading cause of heart disease, stroke, adult blindness and non traumatic lower limb amputations. People with diabetes mellitus have at least two fold risks in development of coronary artery disease and more than 65% have hypertension.⁹Diabetic retinopathy is the most common cause of blindness in adults between 30-65 years of age in developed countries. Diabetic Neuropathy is a relatively early and common complication in diabetic patients. Diabetic Neuropathy accounts for approximately 14 % of all the deaths in Diabetic patients and some 25% of those developing diabetes under the age of 30 die from renal failure due to diabetic nephropathy.⁷

More than 1.1 billion people seem to be vulnerable to type 2 diabetes, a disease of high blood sugar brought obesity, stress and genes often culminating in blindness, amputation in India. It has considerable medical and financial impact. 27 million out of 150 million diabetic in the world live in India. According to WHO estimate the number may rise to 57.5 million by 2025. Hyderabad with 16.6% diabetics followed by Chennai with 13.3% in the highest incidence. Looking at the region wise prevalence ,the prevalence of diabetes in southern parts of India, was found to be higher-13.3% among Chennai residents,11.7% Kolkata, northern India 11.6% (Delhi) and western India 9.3% (Mumbai).⁸

A literature search of knowledge about diabetes in developing countries yielded very few studies actually dealing with the awareness of diabetes among people with the disease. On the basis of literature it is clear that knowledge and attitude of patients regarding diabetic complications is inadequate. Therefore considering all the above factors the investigator felt that there is a need to improve the knowledge and attitude on complications of diabetes mellitus.

STATEMENT OF PROBLEM:

“A study to assess the knowledge and attitude on complications of diabetes mellitus among the diabetic patients in selected hospitals at Bijapur, Karnataka, with a view to develop self instructional module.”

OBJECTIVES OF THE STUDY:

1) To assess the level of knowledge on complications of diabetes mellitus among diabetic patients.

2) To assess the level of attitude towards the complications of diabetes mellitus among the diabetic patients.

3) To develop and provide self instructional module of knowledge on complications of diabetes mellitus.

4) To find the association between level of knowledge and attitude on complications of diabetes mellitus with selected socio- demographic variables.

OPERATIONAL DEFINITIONS:

1) Knowledge :-In this study, it refers to the awareness of diabetic patients on meaning and complications of diabetes mellitus.

2) Attitude : -In this study, it refers to the opinion , belief or response of diabetic patients regarding complications of diabetes mellitus.

3) Diabetes Mellitus: -In this study, it refers to a clinical syndrome characterized by hyperglycemia due to absolute or relative deficiency of insulin secreation or usage of the type I and II.

4) Diabetic patients: -In this study diabetic patient, refers to the patients who are suffering from diabetes of type I and II and are in both outpatient department and in patient department of the hospitals at Bijapur.

5) Complication of diabetes mellitus:-In this study complication of diabetes mellitus refers to the diabetic foot, diabetic retinopathy, diabetic nephropathy, diabetic neuropathy, gastro paresis.

6) Self Instructional Module: -In this study self instructional module refers to the indent to provide basic information on complications of diabetes mellitus as prepared by the investigator.

ASSUMPTIONS:

1. One of the most prevalent and costly chronic health condition is diabetes mellitus, the cost of treating diabetes and its complications is a significant economic burden.

2. The patient will have good knowledge on complications of diabetes mellitus.

3. The patient will have positive attitude towards complications of diabetes mellitus.

DELIMITATIONS:

The study is limited to:

1. The patients who have diabetes mellitus.

2. The patients of selected hospitals at Bijapur , Karnataka.

3. The study is limited to 60 samples of diabetic patients.

Review of literature:

1) Studies related to the knowledge and attitude on complications of diabetes mellitus.

A cross sectional survey done using the structured questionnaire to assess knowledge of diabetes its treatment and complications among diabetic patients. The sample size was 101 patients attending the integrated medical college, Ludhiana. There were 67 males (66.3%) and 34 females (33.7% in the study population. In this study 90 patients had type 2 diabetes and 11 had type 1 diabetes, 50.5% thought that diabetes to be incurable. 46.5% patients thought that diabetes could be prevented. 71.3% patients did not know the risk factors involved in the development of diabetes. The knowledge concerning the prevention of diabetes complications was partial with only 63.3% of the diabetes taking care of their feet through regular washing. Diabetes is the most common cause of non traumatic lower limb amputations. Only 57.4% of the patients however knew that the feet are affected in diabetes. Only 64.4% of the subjects know that diabetes affects heart and 26.7 % of the patients did not know that diabetes affects the kidneys. Patients’ knowledge regarding the treatment and complications of diabetes showed serious deficiencies more so among women even though most had been diabetic for years. This study recommended to provide knowledge on treatment and complications of diabetes¹²

A study was conducted to assess knowledge, attitude and practice of type 2 diabetic patients. Out of 300 patients 46 % of patients knew the pathophysiology of diabetes. Nearly 50% knew the complications of diabetes. An Encouraging finding was most believed in self care. This recommends for the education of patients regarding diabetes mellitus and its complications.¹¹

A study to assess the knowledge and self care practices of diabetics in a resettlement colony of Chandigarh. A cross sectional survey was carried out 60 diabetics aged 20 years and above was identified. Their knowledge and practices regarding diet, genital hygiene, care of foot, wound, complications of diabetes and medications was assessed using a semi structured interview schedule. The results show that 60% opinion that diabetics should consume whatever is cooked in family. 48 diabetics knew that sweets and fatty foods should be avoided but only 18.3 were avoiding them. Genital hygiene was maintained by 51.7% and foot care was done by 63.3% through regular washing. Monitoring blood sugar was poor [46.7%], only 3 knew and were continuing self testing of urine. Oral anti–diabetic drug compliance rate was 62.9%. None of the patients on insulin injections knew about self therapy. Knowledge regarding diabetic complications was poor. Therefore the study was recommended that there is a need of providing knowledge on diabetes^.13

A descriptive research design was adapted to conduct the awareness programme on diabetes mellitus. The samples of 50 diabetic patients were selected randomly. Interview method was used to elicit the information. The results shows that 10 male patients were having major complications which may be chronic systemic or acute metabolic and also they do not know when they have to go for follow up. This makes to provide knowledge on complications of diabetes.¹⁴

A cross sectional descriptive survey included 1073 diabetic patients to explore skin care knowledge, attitude and practice among Pakistanis. The findings have shown that with 67% male subjects, only 14% had awareness about skin manifestations in diabetes. Majority of respondents did not know that people with diabetes are more vulnerable to skin disease. 43% preferred traditional healer go skin treatment and 18% did not know what to do. Respondents who were more anxious about skin care, they wanted to absorb information and make changes around their lifestyle. Patients having lack of knowledge about connection of diabetes mellitus with skin complications. This study was recommended the need of further intervention regarding diabetes and its complications.¹⁵

METHODOLOGY:

Research approach:

A research approach tells the researcher what data to be collected and how to analyze it. It also suggests possible conclusion to be drawn from the data. In view of the nature of the problem selected for the study and objectives to be accomplished, an evaluative research approach was considered as appropriate for the present study.

Research design:

Depending upon the purpose of the study research approach and variables to be studied. The descriptive survey design was adopted for this study. The following variables were used for this study-.

· Dependent variable – Knowledge and attitude on complications of diabetes mellitus.

· Independent variable –Self instructional module on complications of diabetes mellitus.

Setting of the study:

The investigator selected hospitals to conduct the study with adequate availability of the participants and feasibility in conducting the study. The hospitals selected were Mudhol hospital Bijapur, Government civil hospital Bijapur, Al-Nabi hospital Bijapur .

Population:

In the present study, population consisted of diabetic patients of selected hospitals, Bijapur.

Sample:

Sample consists of the population selected to participate in a research study. In the present study the sample consisted of 60 diabetic patients of selected hospitals, Bijapur.

Sampling technique:

Sampling refers to the process of selecting the portion of population to represent the entire population. In this study Purposive Sampling technique was used.

Criteria for sample selection:

The sampling frame structured by the researcher included Inclusion Criteria and Exclusion Criteria.

Development and description of the tool

Data collection is the gathering of information needed to address a research problem. Tools are the procedures or instruments used by the researcher to collect the data. In this present study self administered questionnaire was used for collecting the data after an extensive review of literature and discussion with experts; questionnaire was developed to assess the knowledge and attitude of diabetic patients on complications of diabetes mellitus. Data was collected by structured questionnaire. The tool used in the present study consisted of 4 parts:

Part I: Socio demographic data:

It contains 10 items for obtaining information regarding age, gender, religion, marital status, area of residence, education, duration of illness, frequency of health checkup, family history of diabetes, source of health information.

Part II: Structured knowledge questionnaire:

The structured knowledge questionnaire on complications of diabetes mellitus. Consists of 20 multiple choice questions. Each question has 3 incorrect responses and 1 correct answer. Score 1 was given for each correct response in a single question and score 0 was given for wrong answer. The resulting scores were ranked as follows: Adequate knowledge- > 75%. Moderately adequate knowledge- 50-74%, Inadequate knowledge-1- 49%

Part III: Structured Attitude Scale:

The structured Attitude Scale on complications of diabetes mellitus. Consists of 20 statements. Attitude Scale has both positive and negative statements and which has 5 points scale as strongly agree, agree, undecided, disagree and strongly disagree. The scoring was done in following ways;

Type of statement	Strongly Agree	Agree	Undecided	Disagree	Strongly Disagree
Positive statement	5	4	3	2	1
Negative statement	1	2	3	4	5

Part IV: Self instructional module. (SIM):

The self instructional module was developed by the investigator after reviewing the literature and by obtaining experts opinion. The SIM gives the basic information on complications of diabetes mellitus.

Preparation of the Blue Print:

A blue print is prepared with the construction of structured questionnaire based on which the items are developed. It depicted the distribution of items according to the content areas. Structured knowledge questionnaire includes three domains ie, Knowledge, Comprehension and Application.

Testing of the Tools:

Validity:

Validity refers to a complex concept, which broadly concerns the soundness of the study’s evidence that was, whether the findings were cogent, convincing and well grounded.

The prepared instrument along with the objectives, operational definitions , blue print and scoring key for validating the tool was submitted to ten experts which includes eight nurse educators, one statistician , and doctor, to establish content validity suggestions were taken and final valid tool was prepared.

Pilot Study:

The pilot study was a small-scale version, or the trail run study, conducted before actual study in different population with similar characteristics. Pilot study was conducted with a prior permission from the authority. The topic was explained and confidentiality was assured and the investigator collected data from six participants with the purpose of finding feasibility of the study before starting the main study. SIM was given on the same day after collecting the data. The tool and SIM were found to be reliable, feasible and practicable. Data analysis was done using descriptive and inferential statistics.

Reliability of the tool:

The reliability of the tool was established by split half method. The tool was administered to six subjects and the reliability of Split Half Test was found using Karl Pearson correlation co-efficient formula and the significance of the correlation was tested by using probable error. The r value was 0.86 for knowledge and attitude so the tool was found to be reliable. The tool was finalized with the concurrence of all experts.

Data collection process:

Prior to data collection permission was obtained from the concerned authorities. Every day on average 7-8 participants were selected by purposive sampling technique. The SIM was administered after each data collection.

Plan for data analysis:

The data is analyzed by both descriptive and inferential statistics on the basis of objectives and hypothesis of the study. To compare the data, master data sheet was prepared by the investigator.

Protection of human rights:

The proposed study was conducted after the approval of Dissertation committee of the college. Permission was obtained from the respected hospitals. The written consent of the participant was obtained before the data collection. Assurance was given to the participants regarding the confidentiality.

RESULTS:

Major findings of the study:

Finding related to Socio- Demographic Characteristics of Respondents.

On the basis of the findings the following conclusions were made. It was observed that the maximum number of subjects 26(43.3%) were in the age group of 40-49 years and 26(43.3%) were in the age group 50-59years (Grp.1). 37(61.6%) were males( Grp.2).19(31.60%) were in primary education( Grp.3).. , 40(66.6%) were Hindu( Grp.4) , 56(93.3%) were married( Grp.5), 56(93.3%) were married( Grp.6).,44(73.3%) were from urban area( Grp.7). , 34(56.66%) were in 1-3 year duration of illness (Grp.8)., 25(41.6%) frequency of health checkup was twice a year( Grp.9).,32(53.3%) have the family history of diabetes mellitus.. 32(53.3%) have the family history of diabetes mellitus. 30(50%) source of health information was friends and neighbours( Grp.10).

Section III: Assessment of Attitude on complications of diabetes mellitus among diabetic patients.

Table-3.1: Frequency distribution of Attitude on complications of diabetes mellitus among diabetic patients. n=60

Sl. No	Attitude	Score	No of Respondents
Sl. No	Attitude	Score	No (f)	%
1	Unfavourable attitude	1-49%	13	21.66
2	Favourable attitude	50-74%	31	51.66
3	Most favourable attitude	>75%	16	26.66

The table 3.1 depicts that the 21.66 % diabetic patients had unfavourable attitude, 51.66% had favourable attitude and 26.66 % had most favourable attitude on complications of diabetes mellitus.

Table – 3.2: Mean, SD and Mean percentage of Attitude on complications of diabetes mellitus among diabetic patients. n=60

Sl. No

Domain

Maximum Statement

Maximum

Score

Range

Mean

Standard

Deviation

Mean%

Attitude Score

100

34-92

60.06

6.9

60.16

The above table shows the maximum statements, maximum score, range, mean, standard deviation and means percentage of attitude experienced by the diabetic patients. The maximum statements and maximum score of attitude scale among diabetic patients were 20 and 100 respectively. The mean score, standard deviation and mean percentage of attitude are 60.06, 6.9 and 60.16 respectively.

Table – 3.3: Correlation between knowledge and attitude on complications of diabetes mellitus among diabetic patients. n=60

Sl. No

Domain

Mean

Mean%

Correlation value

Knowledge

60.66

0.53

Attitude

60.06

6.93

60.16

The above table shows the mean score, standard deviation and means percentage for knowledge experienced and attitude experienced by diabetic patients. The mean score, standard deviation and mean percentage of knowledge experienced by the diabetic patients are, 60.66,10 and 64 respectively. Similarly the mean, standard deviation and mean percentage of attitude used by the diabetic patients are 60.06, 6.9 and 60.16 respectively. The correlation between the knowledge and attitude strategies was 0.53 which indicates p<0.05, statistically significant.

Section IV: Association of demographic variables with knowledge and attitude on complications of diabetes mellitus.

Association between knowledge and demographic variables among diabetic patients.

There was no significant association between knowledge on complications of diabetes mellitus with demographic variables such as age gender, religion, marital status, duration of illness, frequency of health checkup, family history of diabetes mellitus and source of health information.

There was association between knowledge on complications of diabetes mellitus with education and area of residence.

Association between Attitude and demographic variables:

There was no significant association between attitude on complications of diabetes mellitus with demographic variables such as age, gender, religion, area of resident, duration of illness, frequency of health checkup and source of health information.

There was significant association between attitude on complications of diabetes mellitus with demographic variables such as education, marital status and family history of diabetes mellitus.

DISCUSSION:

The present study was intended to a study to assess the knowledge and attitude on complications of diabetes mellitus among the diabetic patients in selected hospitals at Bijapur, Karnataka. In order to achieve these objectives, a descriptive survey approach was adopted. Purposive sampling technique was used to select the study samples. The data was collected from 60 diabetic patients in selected hospitals from civil hospital, Bijapur, Dr, Jilani Awati Al-Nabi hospital Bijapur, Dr.Sajid Ahmed, Mudhol Hospital Bijapur. Structured knowledge and attitude scale was used to collect the data.

Description of socio-demographic characteristics of the sample:

The characteristics of the demographic variables described in the terms of their frequency and percentage distribution which showed that, ; 43.3%(26) were in the age group of 40-49 years and 50-59years, 61.6% (37) of the subjects were males 31.6%(19) belonged to primary , 66.6%(40) subjects were Hindu, 93.3%(56) were married , 73.3% (44) of the subjects were from urban areas, 56.66%(34) were in 1-3 year duration of illness, 41.6%(25) respondants frequency of health checkup is twice a year , family history of diabetes mellitus 53.3%(32) were yes , 50%(30) of the subjects received information from their family and relatives.

Assessment of knowledge on complications of diabetes mellitus among diabetic patients.

The mean value of knowledge on complications of diabetes mellitus was 60.66 which fall in the level of moderately adequate knowledge. The findings contradicts with the findings of the another study on assessment of knowledge on diabetes its treatment and complications among diabetic patients from Ludhiana which stated that patients had moderately adequate knowledge .¹²The findings of this study are in contrast to the findings of another study that patients reported 50% of the knowledge on complications of diabetes mellitus. Encouraging findings most believed in self care.⁹Based on the present study findings revealed that 60.06 % of the patients had moderately adequate knowledge on complications of diabetes mellitus.

Assessment of attitude on complications of diabetes mellitus among the diabetic patients.

The mean value of attitude on complications of diabetes mellitus was 60.06 which fall in the level of favourable attitude and the maximum numbers of subjects 51.66% were in the level of favourable attitude Whereas the findings of this study were in contrast to the study showed that the 67% male subjects and only 14% had awareness about skin complications in diabetes. Majority of respondents believed in traditional healer of skin treatment.¹⁶ The findings of this study are in contrast to another study which reflected that 67% 0f patients do not consider cardiovascular disease to be serious complication of diabetes and believe that there is no effect on heart with diabetes mellitus.¹⁰

Association between knowledge on complications of diabetes mellitus with selected socio- demographic variables.

The findings of the study revealed that there was a significant association between patients knowledge with the selected demographic variables such as education and area of residence were significant at 0.05 levels. Whereas variables such as age gender, religion, marital status, duration of illness, frequency of health checkup, family history of diabetes mellitus and source of health information were found to be not significant at 0.05 level. Thus it can be interpreted that there was a significant association between knowledge with selected demographic variables.

Association between attitudes on complications of diabetes mellitus with selected socio- demographic variables

The findings of the study revealed that there is a significant association between patients attitude with the selected demographic variables such as education, marital status and family history of diabetes mellitus. The age, gender, religion, area of resident, duration of illness, frequency of health checkup and source of health information were found to be not significant at 0.05 level. Thus it can be interpreted that there was a significant association between attitudes with selected demographic variables.

CONCLUSION:

On the basis of the findings the following conclusions were made.It was observed that the maximum number of subjects 26(43.3%) were in the age group of 40-49 years and 26(43.3%) were in the age group 50-59years. 37(61.6%) were males., 19(31.60%) were in primary education. , 40(66.6%) were Hindu. , 56(93.3%) were married. 56(93.3%) were married,44(73.3%) were from urban area. , 34(56.66%) were in 1-3 year duration of illness, 25(41.6%) frequency of health checkup was twice a year,32(53.3%) have the family history of diabetes mellitus. 32(53.3%) have the family history of diabetes mellitus. 30(50%) source of health information was friends and neighbours.

The findings of the study revealed that there was a significant association between knowledge on complications of diabetes mellitus with selected sociodemographic variables such as education and area of residence were significant at 0.05 levels. Whereas variables such as age, gender, religion, marital status, duration of illness, frequency of health checkup, family history of diabetes mellitus and source of health information were found to be not significant at 0.05 level. Thus it can be interpreted that there was a significant association between knowledge on complications of diabetes mellitus

The findings of the study revealed that there was a significant association between attitude on complications of diabetes mellitus with demographic variables such as education, marital status and family history of diabetes mellitus were significant at 0.05 level. Whereas variables such as age, gender, religion, area of resident, duration of illness, frequency of health checkup and source of health information were found to be not significant at 0.05 levels. Thus it can be interpreted that there is a significant association between attitudes of diabetic patient with selected demographic variables.

Nursing Implications:

The findings of the study have various implications in different areas of nursing that is nursing practice, nursing education, nursing administration and nursing research.

Nursing Practice:

· In the hospital , nurses play the most important role in providing health care. Before nurses can effectively intervene the patient’s family, needs of family members, assessment of the knowledge and improve the attitude was the essential to keep in mind. The present study has been carried out by the investigator to find out the knowledge and attitude of diabetic patients.

· Activities based on the study outcomes, anticipate the goals and implement the need based interventions.

· Psychological support and providing reassurance was one of the nurse’s responsibilities. This study assesses the knowledge and attitude of diabetic patients on complications of diabetes mellitus. Nurses need to understand the patients and the role they play when providing care to the patient.

Nursing Education:

· Nursing curriculum should incorporate a vast section on the knowledge and attitude adopted by the patients. Nurses should be taught on how to deal with the diabetic patients.

· Nursing education should emphasize on preparing prospective nurses to assess and identify the diabetes mellitus in the patients and to take necessary interventions to reassure them.

Nursing Administration:

· Nursing administrators should create public awareness on complications of diabetes mellitus and the need for immediate care

· Nursing administrators are responsible in arranging a health education program which helps the vulnerable population in preventing and understanding the complications of diabetes mellitus.

· The administrator should organize continuing education program for nursing personal regarding complications of diabetes mellitus.

Nursing Research:

· Extensive research studies can be undertaken in different fields to quantify the magnitude of knowledge and attitude in diabetic patients .

· This study revealed that there were moderate knowledge levels among the patients and positive attitude which needs further research to explore it.

Limitations of the study:

· The tool should be tested for reliability for larger population.

· Long-term follow up could not be carried out due to time constraints.

RECOMMENDATIONS:

Based on the findings of the present study, few recommendations are offered for the further study.

· A quasi-experimental study can be conducted to assess the effectiveness of SIM.

· A study can be undertaken to compare the knowledge and attitude in people without diabetes mellitus.

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Received on 25.07.2015 Modified on 26.07.2015

Asian J. Nur. Edu. and Research. 2016; 6(2): 171-182

DOI: 10.5958/2349-2996.2016.00032.X

Sl. No	Knowledge	Score	No of Respondents
Sl. No	Knowledge	Score	No (f)	%
1	Inadequate	1-49%	11	18.3
2	Moderately adequate	50-74%	34	56.6
3	Adequate	>75%	15	25