Published: 2018-05-25

Perceived severity of diabetes and associated factors among patients attending a referral hospital in Port Harcourt, Nigeria

Roseline Onu, Seye Babatunde


Background: Nigeria has recorded a rising profile of diabetes in recent times due to urbanization and transition to westernized lifestyles. Perceived severity, the extent to which people deem their ailment to be severe, is an attitudinal construct that partly explains how likely people would modify their health behaviours. The study aimed to determine the level and associated factors influencing perceived severity among type 2 diabetes patients in Port Harcourt, Nigeria.

Methods: A cross-sectional study was conducted among 119 adults at the University of Port Harcourt Teaching Hospital. They responded to a structured interviewer-administered questionnaire that included a 7-item scale on perceived severity, and socio-demographic and medical-related characteristics.

Results: The mean age was 56.84 ± 11.51 years; 42.0% were males and 58.0% females. Mean diabetes duration was 7.60±5.58 years and 48.7% reported hypertension as a co-morbidity. About half (56.3%) had low Perceived Severity Score (mean score<3) versus 43.7% with high Perceived Severity Score (c2=3.782, p=0.052). Sex, employment status, religion, duration of diabetes and presence of co-morbidity appeared to show an inverse relationship with perceived severity, however there was no valid association (p>0.05).

Conclusions: This study revealed an equal prevalence of low and high perceived severity of diabetes. Findings suggested that an unemployed Christian female with over 5 years’ diabetes history and no co-existing illness was likely to have a low perceived severity. We recommend further studies to examine other attitudinal constructs, beyond perceived severity, for better understanding of beliefs underpinning the health behavior of diabetes patients in different settings.


Associated factors, diabetes, Port harcourt, Perceived severity, Nigeria

Full Text:



Danaei G, Finucane M, Lu Y, Singh G, Cowan M, Paciorek C, et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet 2011; 378(9785):31-40.

World Health Organization. Global status report on Non Communicable diseases 2010. Geneva: World Health Organization; 2013.

Chinenye S, Young E. State of Diabetes Care in Nigeria: A Review. Niger Health J. 2011;11(4):101-6.

Ogbera AO, Ekpebegh C. Diabetes mellitus in Nigeria: The past, present and future. World J Diabetes. 2014;5(6):905-11.

Fasanmade OA, Dagogo-Jack S. Diabetes Care in Nigeria. Annals Global Health. 2015;81(6):821-9.

Chinenye S, Onyemelukwe GC, Johnson TO. Diabetes advocacy and care in Nigeria. Port Harcourt, Nigeria: Diabetes Association of Nigeria; 2014.

Nwafor A, Owhoji A. Prevalence of diabetes mellitus among Nigerians in Port Harcourt correlates with socio-economic status. J Appl Sci Environ Mgt. 2001;5(1):75-7.

Nyenwe EA, Odia OJ, Ihekwaba AE, Ojule A, Babatunde S. Type 2 diabetes in adult Nigerians: a study of its prevalence and risk factors in Port Harcourt, Nigeria. Diabetes Res Clin Pract. 2003;62(3):177-85.

Unachukwu C, Babatunde S, Ihekwaba AE. Diabetes, Hand and Foot Ulcers: a hospital-based cross-sectional study in Port Harcourt, Nigeria. Diabetes Res Clin Pract. 2007;75(2):148-52.

Wettlaufer A. In the mind's eye: the visual impulse in Diderot, Baudelaire and Ruskin. Amsterdam; New York: Rodopi; 2003:257.

Miles A. Perceived Severity. In: Gerrard M, McCaul K, Etcheverry PE, eds. Constructs and measures for health behavior. Rockville, USA: Division of Cancer Control and Population Sciences, National Cancer Institute, 2008. Available at: Accessed on 19 July 2017.

Skinner CS, Tiro J, Champion VL. The Health Belief Model. In: Glanz K, Rimer BK, Viswanath K, eds. Health Behavior and Health Education: Theory, Research, and Practice. San Francisco, CA: Jossey-Bass; 2008.

Adejoh SO. Diabetes knowledge, health belief, and diabetes management among the Igala, Nigeria. SAGE Open. 2014;4(2):1-8.

Park KA, Kim JG, Kim BW, Kam S, Kim KY, Ha SW, Hyun ST. Factors that affect medication adherence in elderly patients with Diabetes Mellitus. Korean Diabetes J. 2010;34(1):55-65.

Sharifabad MAM, Tonekaboni NR. Perceived severity and susceptibility of diabetes complications and its relation to self-care behaviors among diabetic patients. Armaghane Danesh. 2007;12(3):59-68.

Ayele K, Tesfa B, Abebe L, Tilahun T, Girma E. Self care behavior among patients with diabetes in Harari, Eastern Ethiopia: the health belief model perspective. PLoS ONE. 2012;7(4):e35515.

Daniel M, Messer LC. Perceptions of disease severity and barriers to self-care predict glycemic control in Aboriginal persons with type 2 diabetes mellitus. Chronic Dis Can. 2002;23(4):130-8.

Mayega RW, Etajak S, Rutebemberwa E, Tomson G, Kiguli J. Change means sacrificing a good life: perceptions about severity of type 2 diabetes and preventive lifestyles among people afflicted or at high risk of type 2 diabetes in Iganga Uganda. BMC Public Health. 2014;14:864.

Ogbera A, Adeyemi‐Doro A. Emotional distress is associated with poor self care in type 2 diabetes mellitus. J Diabetes. 2011;3(4):348-52.

Agbir TM, Audu MD, Adebowale TO, Goar SG. Depression among medical outpatients with diabetes: A cross-sectional study at Jos University Teaching Hospital, Jos, Nigeria. Ann Afr Med. 2010;9(1):5-10.

Nkporbu AK, Stanley PC, Ohaeri J. Pattern and prevalence of psychiatric comorbidity in patients with essential hypertension in Port Harcourt, Nigeria. Am J Psychiatr Neurosci. 2016;4(1):5-12.

Alogna M. Perception of severity of disease and health locus of control in compliant and noncompliant diabetic patients. Diabetes Care. 1980;3(4):533-4.

Fisher L, Glasgow RE, Mullan JT, Skaff MM, Polonsky WH. Development of a Brief Diabetes Distress Screening Instrument. Ann Fam Med. 2008;6(3):246-52.

Given GW, Given BA, Gallin RS, Condon JW. Development of scales to measure beliefs of diabetic patients. Res Nurs Health. 198;6(3):127-41.

Tan MY. The relationship of heath beliefs and complication prevention behaviors of Chinese individuals with type 2 diabetes mellitus. Diabetes Res Clin Pract. 2004;66:71-7.

Kartal A1, Ozsoy SA. Validity and reliability study of the Turkish version of Health Belief Model Scale in diabetic patients. Int J Nurs Stud. 2007;44(8):1447-58.

Mohebi S, Azadbakht L, Feizi A, Sharifirad G, Kargar M. Structural role of perceived benefits and barriers to self-care in patients with diabetes. J Educ Health Promot. 2013;2:37.

Mollem ED, Snoek FJ, Heine RJ. Assessment of perceived barriers in self-care of insulin-requiring diabetic patients. Patient Educ Couns. 1996;29(3):277-81.

Nagelkerk J, Reick K, Meengs L. Perceived barriers and effective strategies to diabetes self management. J Adv Nurs. 2006;54:151-8.