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Year : 2020  |  Volume : 7  |  Issue : 1  |  Page : 21-26

Diabetic retinopathy-related knowledge level among the omani population

Department of Optometry, College of Health Sciences, Al Buraimi, Oman

Date of Submission09-Apr-2020
Date of Acceptance02-Sep-2020
Date of Web Publication31-Dec-2020

Correspondence Address:
Dr. Gopi Suresh Vankudre
University of Buraimi, Al Buraimi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/bijo.bijo_3_20

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Background: An annual report published by the Ministry of Oman stated the diabetes mellitus (DM) prevalence of 15.7% among the patients attending a nutritional clinic. This estimate is higher than the prevalence rate of 12.3% that was reported in the national survey done in 2008. The Omani population having sight-threatening diabetic retinopathy (DR) ranges from 14.5% to 42.2%. Many factors can lead to the burden of DR, such as nonawareness or nonserious approach toward eye care.
Materials and Methods: This cross-sectional questionnaire-based study included 232 participants through a convenient sampling technique. It used a semi-structured interview method to secure the participant responses for evaluating their DR-related knowledge.
Statistical Analysis Used: The significance of the association for knowledge among the different study variables was analyzed by applying the Chi-square test and Fisher exact test. One-way analysis of variance was used to compare the knowledge level between participants with different sociodemographic backgrounds.
Results: 91.4% of the study population with nonmedical background are aware of ocular complication of diabetes. Condition-linked knowledge adequacy was associated with gender (P < 0.013), personal (P < 0.00) or family history (P < 0.017) of diabetes, and area of residence (P < 0.012). Only 0.61% of the general population had excellent knowledge about DR, whereas 58.28% of the study participants had a poor, and 22.09% had very poor knowledge about the condition.
Conclusions: Majority of the study participants are aware of ocular complications due to DM. However, variations were observed for the condition-related knowledge level, its prevention, diagnostic treatment, and managerial options in case of visual impairment.

Keywords: Diabetic retinopathies, diabetic retinopathy-related awareness, diabetic retinopathy-related knowledge

How to cite this article:
Vankudre GS, Ismail G, Al Maamari NS. Diabetic retinopathy-related knowledge level among the omani population. Albasar Int J Ophthalmol 2020;7:21-6

How to cite this URL:
Vankudre GS, Ismail G, Al Maamari NS. Diabetic retinopathy-related knowledge level among the omani population. Albasar Int J Ophthalmol [serial online] 2020 [cited 2023 Sep 30];7:21-6. Available from: https://www.bijojournal.org/text.asp?2020/7/1/21/305761

  Introduction Top

Diabetes mellitus (DM) is categorized as a noncommunicable disease with the global DM prevalence of 422 million.[1] Moreover, this burden is projected to increase up to 592 million by the year 2035.[2] Diabetic retinopathy (DR) is associated with the complication of DM, leading to irreversible visual impairment[2] contributing 2.6% of the global blindness. DR can be categorized as avoidable blindness,[1] and Oman has a risk for the increased incidence of DR.[3]

An annual report published by the Ministry of Oman (2016) stated that the prevalence of DM among the patients attending a nutritional clinic was 15.7%[4] that is higher than the prevalence of 12.3% observed in the national health survey conducted in 2008.[5] Most of the DR knowledge studies are done among the participants having DM. However, as many cases could be prediabetic, along with diabetics, it is also important for the at-risk population to know about the condition and the need for a regular ocular eye examination. Considering these public health issues, the National Health System has taken preventive as well as curative measures.[4]

The Omani population having sight-threatening DR ranges from 14.5% to 42.2%.[6] Importantly, the noncompliance with the ocular examination among the affected individuals is an issue, increasing the magnitude of blindness associated with the condition.[7] Hence, the at-risk population needs to know about preventive, curative, and other managerial options for the conditions having irreversible vision loss.[8] In addition, nonawareness about the availability of optical and nonoptical low vision devices keeps the condition-related visually impaired individual at a deprived stage.

In order to reduce the burden of the condition, preventive measures are implemented in Oman through the health promotional activities such as teaching healthy lifestyle providing medicines and basic diagnostic or monitoring tools, free of cost to the Primary Health Care Centers and or to the affected individuals.[6] Events such as World Sight Day were conducted that focused on raising eye health awareness about “blindness and visual impairment.”[9] As can be observed through the literature review, in many individuals, the condition remains undetected till it becomes severe.[11] Apart from the lack of diagnostic eye health facilities, the nondetection of the DR could be attributed to the poor knowledge of the diabetic individuals related to the condition. There are limited studies within the region evaluating the knowledge level among the different components related to DR condition; therefore, the study aims to assess the community's current knowledge level related to condition, treatment, and rehabilitative services. This evidence can provide a baseline for enhancing the DR-related health promotional policies and interventions.

  Materials and Methods Top

This was questionnaire-based study. The study was conducted from September 2017 to September 2018. Only the native Omani participants were selected using convenient sampling technique. The sample size of 250 was calculated using 10% of the nonresponse, confidence interval of 95%, and the study power of 90%. We also assumed the prevalence of poor knowledge as 40% that is observed in one of the condition-related previous studies done within the region.?[7] The study included the native Omani population with any age above 18 years, gender, as well as different socioeconomic and educational backgrounds. Nonwilling Participants that are not willing to take part in the study and participants that are unable to respond to the research questions were excluded from the study. The questionnaire that was used as a study tool was also validated for ensuring its acceptability on the sociocultural grounds.

This study used a semi-structured interview method to collect the participant responses for analyzing the participant's knowledge toward DR on the components of the condition itself, diagnostic and treatment and rehabilitation options, and their source of information. The questionnaire was prepared through a thorough literature review.[1],[2],[3],[6],[7],[8],[9],[10],[11],[12] It included the randomly selected study population from 11 provinces of Oman. The data collection was done from March 2018 to September 2018. Two field investigators were trained to conduct the interview. They collected the patient responses using hard copies of the questionnaire. The field investigator translated the questions in local language for the participants that are unable to respond to the questions interviewed in the English language. Arabic language expert translated the English version of the questionnaire. The Arabic version was again translated in the English version to ensure translational validity. The model answers related to the knowledge component of the questionnaire were also validated using the same approach. Subject expert agreement of a minimum of 80% for each questionnaire item was considered as valid. The questionnaire was not exposed to the study participants during the conduct of an interview. Further questionnaire modifications were done after a pilot study on twenty participants. Cronbach's alpha of 5% was used for assessing the internal (95% confidence interval) validity. The questionnaire was not exposed to the study participants. The initial component of the questionnaire collected the information about demographics and the diabetic profile of the candidate. Participants, family as well as self-history for DM, duration, and type of DM were also collected. This diabetic profile of the participant was self-declared by the participant.

Only participants without medical background were further investigated on the level of knowledge about DR. The questionnaire consisted of 18 open- as well as close-ended questions. Each appropriate answer in the knowledge section was given a score of 1, however there was no negative marking for incorrect responses. These scores were then converted to percentage scores for further analysis.

Participant's responses were collected using a questionnaire in hard copies. They were further documented in soft copies, using Microsoft Excel 2013. The data were stored in two different computers separately and were reviewed for accuracy. Only the researcher, research guide, and university level Research and Ethics Committee had access to the soft as well as hard copies of the data.

The The IBM Statistical Package for Social Sciences (SPSS) version 21 (International Business Machines Corporation, United States) was used to conduct the data analysis. The participant's demographic profile was analyzed using descriptive statistics. One-way analysis of variance was used to compare the knowledge scores within different sociodemographic groups.

Association between adequacies of diabetic retinopathy-related knowledge with respect to the different study variables

Chi-square and Fisher's exact tests were applied to identify the association between the adequacies of DR-related knowledge with respect to the sociodemographic profiles of the individuals. Percentage knowledge score of equal to or more than 50% is considered adequate and <50% is considered inadequate for this analysis. Percentage knowledge score was further classified to evaluate the depth of knowledge. The scores <25%, =25% <50%, =50% <75%, and =75% are categorized as very poor, poor, good, and good knowledge, respectively.

The study followed the ethical principles as per the Declaration of Helsinki. It received approval from the College of Health Sciences, Research and Ethics Committee of a university in Oman. And informed verbal consent was also obtained from all the study participants. They were also told of their right to withdraw from the study at any phase during the study conduct. The study did not collect any personally identifiable information.

  Results Top

Demographic and diabetic profile of the participants

A total of 250 candidates were contacted through convenient sampling technique, of which 232 participants volunteered to participate in the study. Out of the total study population, 91 were male and 141 were female. Participant's demographic and diabetic profile is presented in [Table 1]. Out of 232 participants, 14.7% of the participants had a history of DM and 74.1% of the participants had a family history of DM. The mean duration of having DM among the diabetic population was 7.27 (standard deviation [SD] = 7.5) years. The mean age of the study participants was 31.124 (SD = 12.02). Out of the total 232 participants, 29.74% (n = 69) of the participants were from medical background and 70.26% (n = 163) of the participants were from nonmedical background. The further analysis on knowledge score is done among the participants with nonmedical background to avoid knowledge biases. The mean province size was calculated for all the 11 provinces of Oman.[13] The population size more than or equal to 252134.5 is considered as high population size or otherwise low. Muscat, Al Batinah North, Al-Dakhiliyah, and Al Batinah South are categorized as having high population size with the population size of 775,878, 483,582, 326,651, and 289,008, respectively.[13] Dhofar, Ash Sharqiyah South, Ash Sharqiyah North, Al Dhahirah, Al-Buraimi, Al-Wusta, and Musandam are categorized as having a low population with the population size of 249,729, 188,032, 162,482, 151,664, 72,917, 42,111, and 31,425, respectively [Table 1].[13]
Table 1: Demographic and diabetic profile of the participants without medical background

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Knowledge about diabetic retinopathy among the study participants

One hundred and forty-nine (91.4%) of the total study population with nonmedical background were aware of the ocular effects of DM. Participants aware of ocular complications associated with DM were further investigated to assess the knowledge level regarding DR.

The mean percentage knowledge score was 35.913 (SD = 17.659, 0.00–75.00).

As shown in [Table 2], there was a significant effect of gender, demographic location, and personal or family history of DM on DR-related knowledge score at P < 0.05. However, there was no statistically significant effect of self or parental educational level on their condition-related knowledge score [Table 2].
Table 2: The effect of participant's sociodemographic profile on their diabetic retinopathY-related knowledge score

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Participants had the lowest knowledge level regarding the rehabilitative services (18.61%) [Table 3].
Table 3: Percentile scores for the different components of knowledge related to diabetic retinopathy

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Source of information among study participants

General health professionals (25%) were the main sources to gain information about DR. Radio (0.75%) was the least followed information platform [Figure 1].
Figure 1: Source of information among the study population (in %)

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  Discussion Top

The aim of this study was to evaluate the knowledge level among the components of the disease itself, preventive, managerial, and rehabilitative options within the study population with different age and socioeconomic and educational levels. About 14.7% of this study population had DM, whereas the studies done by Al Zarea[2] and Srinivasan et al. (2017)[10] included only the diabetic population.

In this study, only 29.5% of the study population had adequate knowledge about DR. The study done by Srinivasan et al. (2017)[10] observed 42% of their study population having good knowledge of DM. A study done by Al Zarea among the diabetic population in Saudi Arabia observed that 75.62% of the study participants knew about the ocular complications of DM and 73.80% mentioned the need of timely ocular examination.[2] This higher knowledge prevalence in these later studies could be attributed to the prevalent diabetic condition within the population. The other reason for the observed variation in knowledge among the concerned population could also be because of the different assessment tools used in these studies. Hence, there is a need to use an evidence-based, valid, and common study tool[12] to ensure the comparability of the study outcomes. 'The knowledge about diabetic retinopathy related treatment and rehabilitative options are observed to be less within the study with the scores of 22.63% and 18.61%, respectively. These areas should be focused while enhancing the overall knowledge level about the disease. Interestingly, individuals residing in the provinces having low population size had higher knowledge compared to the individuals residing in the provinces with the higher population size. This could be attributed to the lower burden on the health professionals allowing enough chair time for providing the health education to the community. Similar to the other studies,[2],[11] the knowledge level among these study participants having self or family history of DM was significantly higher.

General health professionals (25%) were the main sources of information about DR among the study participants. Radio (0.75%) was the least followed informational platform. Various sources should be used to create awareness among the community. In a study done by Srinivasan et al. (2017), doctors (71.4%) contributed significantly to providing DR-related health information.[10] It is necessary to identify the source that carries a major impact and should be used to percolate the information about the condition. These study findings provide a baseline indicating poor DR knowledge level among study participants, however the results cannot be generalized to the population. The reviewers of the “Eye Health Care Program in Oman” have recommended the improvements in the managerial and rehabilitative services related to DR.[6] Reviewing advocacy and preparing the DR health promotional policies involving all stakeholders in decision-making, target-oriented health interventions with monitoring support can be useful. An integrated approach involving the community-primary, secondary, and tertiary level health centers can be useful in reducing the burden of blindness due to DR.

  Conclusions Top

Majority of the study participants are aware of ocular complications due to DM. However, variations were observed for the condition-related knowledge level, its prevention, diagnostic treatment, and managerial options in case of visual impairment.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest

  References Top

World Health Organization. WHO Nepal Tackles Diabetic Retinopathy. World Health Organization; 2017. Available from: http://www.who.int/blindness/feature-story-Nepal/en/[Last accessed on 2019 May 30].  Back to cited text no. 1
Al Zarea BK. Knowledge, attitude and practice of diabetic retinopathy amongst the diabetic patients of AlJouf and hail province of Saudi Arabia. J Clin Diagn Res 2016;10:NC05-8.  Back to cited text no. 2
Khandekar R. Screening and public health strategies for diabetic retinopathy in the Eastern Mediterranean region. Middle East Afr J Ophthalmol 2012;19:178-84.  Back to cited text no. 3
[PUBMED]  [Full text]  
Ministry of Health Oman. Health Domains. Ch. 8. Ministry of Health; 2013.p. 8. Available from: https://internal.moh.gov.om/documents/274609/275098/CH08Y12.pdf/1156f97d-e9e3-40f3-84ec-a9004c264c11. [Last accessed on 2019 Jan 09].  Back to cited text no. 5
Khandekar RB, Al-Lawati JA. Epidemiology of diabetic retinopathy in Oman: Two decades of research. Oman J Ophthalmol 2015;8:1-2.  Back to cited text no. 6
[PUBMED]  [Full text]  
Khandekar R, Shah S, Al Lawatti J. Retinal examination of diabetic patients: Knowledge, attitudes and practices of physicians in Oman. East Mediterr Health J 2008;14:850-7.  Back to cited text no. 7
Mazhar K, Varma R, Choudhury F, McKean-Cowdin R, Shtir CJ, Azen SP, et al. Severity of diabetic retinopathy and health-related quality of life: The Los Angeles Latino Eye study. Ophthalmology 2011;118:649-55.  Back to cited text no. 8
Arden GB, Ramsey DJ. Diabetic retinopathy and a novel treatment based on the biophysics of rod photoreceptors and dark adaptation. InWebvision: the Organization of the Retina and Visual System [internet] 2015 Jul 14. University of Utah Health Sciences Center.  Back to cited text no. 9
Srinivasan NK, John D, Rebekah G, Kujur ES, Paul P, John SS. Diabetes and diabetic retinopathy: Knowledge, attitude, practice (KAP) among diabetic patients in a tertiary eye care centre. J Clin Diagn Res 2017;11:NC01-NC07.  Back to cited text no. 10
National Eye Institute. What You Should Know | National Eye Institute. What You Should Know. Available from: https://nei.nih.gov/diabetes/content/english/know2. [Last accessed on 2019 Jan 09].  Back to cited text no. 11
Ismaile S, Alhosban F, Almoajel A, Albarrak A, Househ M. Knowledge, attitude and practice tools for health education among diabetic patients. Stud Health Technol Inform 2017;238:250-2.  Back to cited text no. 12
Ministry of Foreign Affairs. Governorates of Sultanate of Oman; 2013. Available from: https://www.mofa.gov.om?p=1063&lang=en. [Last accessed on 2019 Jan 09].  Back to cited text no. 13


  [Figure 1]

  [Table 1], [Table 2], [Table 3]


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