Comparative Assessment of Knowledge, Attitude, and Practice of Insulin Use in a Public Versus Private Hospital in Kenya

Abstract

Introduction: Diabetes is a leading cause of death globally, and insulin is essential in its management. The knowledge, attitude, and practice (KAP) regarding insulin use and pens in Kenya's public and faith-based sectors among patients and prescribers are not well studied. Objectives: This study aimed to compare the KAP of insulin use and pens among diabetics and prescribers at Kenyatta National Hospital (KNH) and Presbyterian Church of East Africa Kikuyu Hospital (PKH). Methodology: A dual-site, cross-sectional study was conducted using questionnaires. The sample size, determined by Cochran’s formula, included 300 diabetics interviewed through consecutive sampling at the diabetic clinics' pharmacies in KNH and PKH over three months between May and July 2023. All eligible insulin prescribers were also included. Ethical approval and a research license were obtained. Clinical data and data on KAP were collected. The data was coded and cleaned. Descriptive and inferential analyses were performed with a significance level set at 0.05. Logistic regression was used to assess predictors of good insulin use knowledge and practice. Results: Both facilities demonstrated good knowledge and practice, with notable differences in body mass index, occupation, family history of diabetes, and history of diabetes complications. Better knowledge and practice were reported in PKH among diabetics. Logistic regression revealed the facility of care as the best predictor for both knowledge and practice on insulin. In PKH, patients were nearly twice as knowledgeable about and used insulin pens more frequently than in KNH. Almost all PKH patients primed their pens before use. Patients in both facilities rarely changed insulin needles from the pen. Physicians in both facilities showed good KAP toward insulin pens. Conclusion: Better KAP on insulin use and adoption of insulin pens was demonstrated by PKH. Both facilities need to improve training on insulin needle replacement