A study of knowledge, attitude and practice in diabetic retinopathy among patients attending a primary health care centre

Malavika Geethadevi, Bindu Thampi, Joosadima Antony, Remya Raghavan, Rekha R. Sasidharan, Ajith Mohan


Background: Diabetic retinopathy is a major cause of preventable blindness. Sufficient knowledge about the disease can prevent sight threatening complications. Aim of this study is to evaluate the knowledge and its influence on attitude and practice in diabetic retinopathy among patients attending a primary health centre.

Methods: A knowledge attitude practice questionnaire was prepared and pretested in a sample group of representative population. The response was analyzed as to whether the questions were understood or not. Social workers were trained in administering questionnaire. Diabetic patients were given questionnaires at primary health centre and filled in the presence of social workers.

Results: Out of 324 patients 60.8% had no knowledge of diabetic retinopathy compared to 39.19% who had knowledge (p <0.001). Knowledge was more in age <40 years (82.60%) and least in 51-60 years (29.34%) (p<0.001) and more among females (38.59%) than males (61.4%). Knowledge was significantly higher among upper socioeconomic group (77.8%). About 83.46% in knowledge group had right attitude which was significantly higher than non knowledge group (32.48%) (p<0.001).  42.51% in knowledge group had practice of visiting ophthalmologist for eye check-up which was significantly higher than non knowledge group (13.19%) (p<0.001).

Conclusions: The attitude and practice of diabetic retinopathy was statistically significant in knowledge group compared to those who had no knowledge of diabetic retinopathy. Improving knowledge about diabetic retinopathy through awareness campaigns can increase attitude and practice. Early detection can help in preventing sight threatening complications of diabetic retinopathy.


Attitude, Diabetic retinopathy, Knowledge, Practice, Primary health centre

Full Text:



International Diabetes Federation. IDF Diabetes Atlas, 7th ed. Brussels, Belgium: International Diabetes Federation;2015.

Yau JWY, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012;35(3):556-64.

Resnikoff S, Pascolini D, Etya’ale D, Kocur I, Pararajasegaram R, Pokharel GP, et al. Global data on visual impairment in the year 2002. Bull World Health Organ. 2004;82(11):844-51.

Rema M, Deepa R, Mohan V. Prevalence of retinopathy at diagnosis among type 2 diabetic patients attending a diabetic centre in South India. Br J Ophthalmol. 2000;84:1058-60.

Rema M, Premkumar S, Anitha B, Deepa R, Pradeepa R, Mohan V. Prevalence of diabetic retinopathy in urban India: The Chennai Urban Rural Epidemiology Study (CURES) eye study, I. Invest Ophthalmol Vis Sci. 2005;46:2328-33.

Raman R, Rani PK, Reddi Rachepalle S, Gnanamoorthy P, Uthra S, Kumaramanickavel G, et al. Prevalence of diabetic retinopathy in India: Sankara Nethralaya diabetic retinopathy epidemiology and molecular genetics study report 2. Ophthalmology. 2009;116:311-18.

Jonas JB, Nangia V, Khare A, Matin A, Bhojwani K, Kulkarni M, et al. Prevalence and associated factors of diabetic retinopathy in rural central India. Diabetes Care. 2013;36:e69.

Klein R, Klein B, Moss S. The Wisconsin Epidemiological Study of Diabetic Retinopathy: a review. Diabetes Meta Review. 1989;5:5559-5570.

Padmaja KR, Rajiv R, Pradeep GP, Swati A, Kumaramanickavel G, Sharma T. Use of eye care services by people with diabetes-South India experience. British J Ophtahlmology. 2005.

Aswathy S, Lohidas V, Nimitha P, Anish TS, Tinu N, Brian O. Prevalence and Social Determinants of Type 2 Diabetes in a Coastal Area of Kerala, India. J Endocrinol Diab. 2017;4(3):1-5.

Rani PK, Raman R, Subramani S, Perumal G, Kumaramanickavel G, Sharma T. Knowledge of diabetes and diabetic retinopathy among rural population in India and the influence of knowledge of diabetic retinopathy on attitude and practice. Rural Remote Health. 2008;8(3):838.

Dandona R, Dandona L, John RK, McCarty CA, Rao GN. Awareness of eye diseases in an urban population in Southern India. Bull World Health Organ. 2001;79(2):96-102

Hussain R, Rajesh B, Giridhar A, Gopalakrishnan M, Sadasivan S, James J, et al. Knowledge and awareness about diabetes mellitus and diabetic retinopathy in suburban population of a South Indian state and its practice among the patients with diabetes mellitus: A population-based study. Indian J Ophthalmol. 2016;64(4):272-6.

Williams MV, Baker DW, Parker RM, Nurss JR. Relationship of functional health literacy to patients' knowledge of their chronic disease. A study of patients with hypertension and diabetes. Archives Inter Med. 1998;158:166-172.

Rothman RL, Malone R, Bryant B. The spoken knowledge in low literacy in diabetes scale. The Diabetes Educator. 2005;31:215-224.

Al Zarea BK. Knowledge, attitude and practice of diabetic retinopathy amongst the diabetic patients of Aljouf and hail province of Saudi Arabia. JCDR. 2016;10(5):NC05-NC08.

Ovenseri-Ogbomo GO, Abokyi S, Koffuor GA, Abokyi E. Knowledge of diabetes and its associated ocular manifestations by diabetic patients: A study at Korle-Bu Teaching Hospital, Ghana. Niger Med J. 2013;54(4):217-23.

Mwangi MW, Githinji GG, Githinji FW. Knowledge and awareness of diabetic retinopathy amongst diabetic patients in Kenyatta national hospital, Kenya. Int J Humanit Soc Sci. 2011;1(21):140-46.

Mahesh G, Elias A, Sandhya N, Giridhar A, Saikumar SJ, Sankaranarayanan, et al. Chengamanad diabetic retinopathy awareness study (CDRAS) Kerala J Ophthalmol. 2006;28:14-21.

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 Jul;11(7):NC01-NC07.