Association between quality of diabetes care and health related quality of life and psychological distress among people with type 2 diabetes

Abstract

Introduction: Due to the poor quality of diabetes care in most countries, this study was performed aimed to evaluate the quality of care in type II diabetic patients and its relation to quality of life and psychological distress. Methods: The present study was carried out using a cross-sectional method. Study population included more than 7,600 type II diabetic patients and, a total of 300 people who referred to diabetes clinic of Imam Khomeini Hospital, and had the study inclusion criteria, were selected using a convenience sampling method between July-2013 and June-2014. Demographic and indicators of the quality of care data were collected by two interviewers, using a structured questionnaire and checklist developed by the researchers. Care status of each patient was evaluated according to a quality of care scoring systeminto three categories: ≤ 10, 15- 20,>20, and based on America Diabetes Association criteria. In second part the 26-item questionnaire of quality of life (WHQOL-BREF) and Kessler psychological distress scale (K10) were employed in order to assess the quality of life and mental health status among study participants. In addition, K10 was translated into Persian by backward-forward method. Content and Concurrent validity of K10 were evaluated; the reliability and stability evaluated by Cronbach’s alpha and test-retest method (ICC). Data analysis was performed using descriptive and analytical statistical methods. Analytical tests such as t-test, Mann-Whitney, chi square test, Fisher's exact test and Monte Carlo; ANOVA, powerful Welch test, Kruskal-Wallis, Pearson and Spearman correlation were also used to analyze the data by SPSS v.20. Results: In this study, 72.3% of patients were women and the mean age of the patients was 54.13±9.13... About one-third of patients (29.7%) had a quality care score ≤ 10, half of them (51%) had a score between 15-20, and only19.35% had a score >20. There was an association between HbA1c, FBS, diastolic blood pressure, cholesterol and LDL with a quality of care score which was statistically significant ( p<0.05). The highest score of quality of life was related to the environment domain (57.10±10.52) and the lowest to the dimension of social health (45.68±17.25). There was a significant difference between men and women only in terms of psychological health and the score of women was lower than men. Sex, care score, HbA1C, treatment methods and comorbidities, had significant effect on some dimension of the quality of life. Based on The k10 questionnaire 12.59% had severe mental disorder. The level of family income, education, care score, BMI, HbA1C, lipid profile, insulin therapy, kidney and renal complications had an significant effect on increase of mental disorders in diabetic patients. The total average content validity ratio (CVR) and content validity index (CVI) were 0.88 and 0.95; correlation between K10 and GHQ- 12 was significant (r = 0.63, P < 0.001), hence, the content and concurrent validity of K10 Persian version was confirmed. Reliability was confirmed by Cronbach's alpha = 0.84 and ICC = 0.77, respectively. Conclusion: It seems that, using the scoring system could be a quick and easy way to check the quality of diabetes care. As well as the correlation were observed between demographic factors and determinants of quality of care. Relationship between quality of care and quality of life was observed only in psychological dimension and the relationship between the quality of care and psychological distress were not observed. The Persian version of K10 was valid and reliable for evaluation of mental health status among patients with type 2 diabetes.