Relationship between knowledge, attitude, practice, patient-level, and clinic-level factors of diabetic kidney disease among type 2 diabetes mellitus patients

Rosedi, Anas (2025) Relationship between knowledge, attitude, practice, patient-level, and clinic-level factors of diabetic kidney disease among type 2 diabetes mellitus patients. PhD thesis, Universiti Sains Malaysia.

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Abstract

Background: DKD was recognized as a major complication of Type 2 Diabetes Mellitus (T2DM), significantly contributing to the growing burden of chronic kidney disease (CKD) in Malaysia. Although the influence of Knowledge, Attitude, and Practice (KAP) on CKD prevention was well-documented, validated tools to measure these aspects specifically for DKD prevention among T2DM patients were limited. Using the Chronic Care Model as the framework, this study examined the patient-level and clinic-level factors associated with DKD and the relationship between KAP toward DKD. Objective: The objectives were to validate the Malay-translated KAP DKD prevention scale, measure poor KAP levels among T2DM patients in Kelantan, identify factors associated with poor KAP, and assess the relationship between KAP and DKD, considering both patient- and clinic-level factors. Methodology: The study was conducted in two phases. Phase 1 focused on validating the Malay-translated KAP DKD prevention scale for reliability and relevance. Content validity was established by an expert panel of six specialists in family medicine, public health, nephrology, and internal medicine. Items with a Content Validity Index (I-CVI) below 0.83 were removed. A pilot group of 10 T2DM patients evaluated item clarity and comprehensibility, which led to further refinement based on Face Validity Index (FVI) scores. Construct validity was assessed using Two-Parameter Logistic Item Response Theory (2PL-IRT) for the Analysis (CFA) for the Attitude and Practice domains. This phase included 260 participants selected systematically from KRK HPUSM clinics in Kubang Kerian. Phase 2 aimed to determine KAP levels and identify factors associated with poor KAP DKD prevention among T2DM patients across Kelantan, as well as to explore the relationship between KAP levels and DKD. This cross-sectional study included 600 T2DM patients from multiple clinics. Data collected included patient-level variables and clinic-level variables. Multilevel binary logistic regression was used to assess the associations between KAP and DKD, accounting for individual and clinic-level factors. Results: The validated KAP DKD prevention scale demonstrated strong psychometric properties. The Knowledge domain showed unidimensionality and adequate discriminant indices, while the Attitude and Practice domains achieved satisfactory fit indices after model refinement. Composite reliability using Raykov’s Rho confirmed internal consistency. Among participants, 77% had poor knowledge, 58.2% had poor attitudes, and 50.78% had poor practices regarding DKD prevention. Key associated factors of poor knowledge included being single, widowed, or divorced, having lower education, and having diabetic complications, while unemployed participants had lower odds of poor knowledge. Poor attitudes were associated with lower education and unemployment, and poor practices were linked to lower education, ethnicity, and poor attitudes. For DKD factors, participants not working had nearly twice the odds of DKD compared to those working. Microalbuminuria, macroalbuminuria, and persistent albuminuria significantly increased the odds of DKD, as did serum creatinine levels and diabetic foot ulcers. Among KAP domains, only practice was significantly associated with DKD, with poor practice linked to a lower likelihood of DKD. Knowledge domain and Confirmatory Factor Analysis (CFA) for the Attitude and Practice domains. This phase included 260 participants selected systematically from KRK HPUSM clinics in Kubang Kerian. Phase 2 aimed to determine KAP levels and identify factors associated with poor KAP DKD prevention among T2DM patients across Kelantan, as well as to explore the relationship between KAP levels and DKD. This cross-sectional study included 600 T2DM patients from multiple clinics. Data collected included patient-level variables and clinic-level variables. Multilevel binary logistic regression was used to assess the associations between KAP and DKD, accounting for individual and clinic-level factors. Results: The validated KAP DKD prevention scale demonstrated strong psychometric properties. The Knowledge domain showed unidimensionality and adequate discriminant indices, while the Attitude and Practice domains achieved satisfactory fit indices after model refinement. Composite reliability using Raykov’s Rho confirmed internal consistency. Among participants, 77% had poor knowledge, 58.2% had poor attitudes, and 50.78% had poor practices regarding DKD prevention. Key associated factors of poor knowledge included being single, widowed, or divorced, having lower education, and having diabetic complications, while unemployed participants had lower odds of poor knowledge. Poor attitudes were associated with lower education and unemployment, and poor practices were linked to lower education, ethnicity, and poor attitudes. For DKD factors, participants not working had nearly twice the odds of DKD compared to those working. Microalbuminuria, macroalbuminuria, and persistent albuminuria significantly increased the odds of DKD, as did serum creatinine levels and diabetic foot ulcers. Among KAP domains, only practice was significantly associated with DKD, with poor practice linked to a lower likelihood of DKD.

Item Type:	Thesis (PhD)
Uncontrolled Keywords:	diabetes mellitus
Subjects:	R Medicine R Medicine > RC Internal medicine > RC648-665 Diseases of the endocrine glands. Clinical endocrinology
Divisions:	Kampus Kesihatan (Health Campus) > Pusat Pengajian Sains Perubatan (School of Medical Sciences) > Thesis
Depositing User:	Mr Abdul Hadi Mohammad
Date Deposited:	16 Feb 2026 07:41
Last Modified:	24 Feb 2026 01:44
URI:	http://eprints.usm.my/id/eprint/63603

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