Shushami, Ahmad Hanis Ahmad
(2020)
Health needs among older person with diabetes in Penang : a mixed method study.
Masters thesis, Universiti Sains Malaysia.
Abstract
Background
Both population aging and increasing prevalence of diabetes leads to a longer duration of having diabetes. The longer the duration of disease, the higher risk of developing complication, causing disability, and eventually reducing the quality of life. With the reduction of quality of life, health need will arise. Majority of the literature on health need among elderly with diabetes describe needs related to the services. Evidence on physical, psychological, and social health dimensions are limited. Three other dimensions which are financial, environment and spiritual have not been investigated. In addition, evidence on health service heed that is based of patient’s expressed need were also lacking. It is important to fulfil these dimensions to improve quality of life, for healthy aging and to build evidence for policy on elderly with diabetes
Method
This is a mixed method study, with sequential explanatory design conducted between October 2018 to August 2020. The two-phase design began with a quantitative cross-sectional health survey, followed by qualitative interviews using phenomenology approach. The quantitative part was conducted between April 2019 and August 2019. While the qualitative part was followed simultaneously between end of August 2019 and April 2020. The survey study identified the health need and the related factors using 13-Item need for care scale developed by WHO, involving 417 randomly selected samples from government health facility in Penang, Malaysia. The scores are summarized into single mean, ranges from 1 to 5. The Phase two study used in-depth
interview, exploring the health need among those who have high to low health need based on the significant factors identified in the health survey. The 15 respondents were purposively selected samples, a subset from the phase one study
Result
For the phase one study, the health need was measured by the respondent’s need for care score. The mean (SD) of overall need for care was low, 1.66 (0.66). This study found that there is significant positive linear relationship between age group, perceive distance to health facility, transport to health facility, living arrangement and disability, towards need for care. There is also significant negative linear negative relationship between Income source and need for care, [F (11,405) = 11.01, p < 0.001], with an R2 of 0.37. From the in-depth interview, disability mediates health need of the elderly through restriction in activity in daily living and loss of social network. Income mediates their health needs through better ability to face financial crisis, affordability to pay for personal need, and ability to be independent. Transport to health facility mediates health needs through the compliance to appointments and gives self-determination over decision for transport. Living arrangement mediates health needs through availability of established social network, by satisfying the elder’s preference for privacy and their routine activity, and familiarity with neighbourhood environment. Home ownership mediates health needs through the peace of mind it gives and their ability to give support to others. Lastly, perceive distance to health facility also mediates health needs because it determines by their ability to attend health facility unaccompanied, and by satisfaction of the service
Conclusion
The health needs of elderly with diabetes in Malaysia is complex. The way how disability, income, transport, home ownership and perceive distance influence health needs consist of complex interaction between economic status, physical, social, psychological and environment of the elderly. All these factors intertwined with one another in shaping the health of the elderly.
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