Quality of life of people with non communicable diseases

Introduction

Knowledge on disease management, lifestyle, and health care facilities available will have direct impact on their Quality of Life. Quality of services provided will enhance quality of life of the people especially with chronic noncommunicable diseases. A research on people's perception towards their quality of life becomes an essential tool to enhance quality of care. ¹

Gholami A, Azini M, Borji A, Shirazi F, Sharafi Z, Zarei E conducted a cross sectional study to evaluate QOL in type 2 diabetic patients among 1847 people of Iran by using Iranian version of WHO QOL BREF scale. Mean age of subjects were 59.65± 12.3 years and majority were females. Overall Cronbach's alpha was 0.93, total mean score was 12.18. The lowest score was found in psychological domain [11.93] and highest in social domain [12.66].Backward multiple regression model showed that education, marital status and household income were significantly associated with all domains of WHOQOL BREF [p<0.05]. Study concluded that QOL of patients were moderate to low, so international programmes were necessary to improve QOL. ²

By reviewing the literature and researcher's personal experience it was felt to assess the quality of life of people living with non-communicable diseases. The aim of the study is to determine the quality of life of people at selected villages. This descriptive survey will help to enhance the quality of care and strengthen or develop new strategies; which will enhance the quality of life of the community.

Purpose of the study was to identify the quality of life of people living with non-communicable diseases. The study will be helpful to provide need based care and to develop strategies to improve quality of life of community.

Objectives of the study were to assess quality of life of people living with non-communicable diseases as measured by WHO QOL BREF scale and to find association between quality of life of people living with noncommunicable diseases and selected variables.

In the present study subjects with asthma, hypertension, diabetes mellitus and both hypertension and diabetes mellitus are selected to assess quality of life.

Materials and Methods

A descriptive survey was done among 200 people with asthma, hypertension, diabetes mellitus and both hypertension and diabetes mellitus within 30-80 years of age.

Subjects were selected from Athrady and Hirebettu villages through purposive sampling technique.

A demographic proforma was used to identify the basic information regarding subjects, which includes 15 items such as age, gender, education, occupation, marital status, religion, monthly family income, preferable health centre, frequency of visits to clinic, type of clinic, diseases and type of health insurance.

WHO Quality of Life BREF scale is a standardized tool consists of 26 items comprised in 4 domains such as physical, psychological, social and environmental. This tool produces four domain scores and two items that examined separately: question 1 asks about an individual's overall perception of quality of life and question 2 asks about an individual's overall perception of his or her health and are scaled in a positive direction (i.e. higher scores denote higher quality of life)⁽³⁾. Reliability [Cronbach's alpha] was 0.94 on Kannada version of tool.

Data collection was started after obtaining administrative permission from institutional ethical committee Kasturba hospital Manipal, Dean Manipal College of Nursing Manipal, respective Panchayats and informed consent from each person by interviewing them.

Results

The gathered data was coded and summarized in a master data sheet and then both descriptive and inferential statistics were used to analyze by using SPSS 16.0 version based on objectives and hypothesis.

3.1

3.1 Sample characteristics

shows that that among 200 subjects, majority were in the age group of 60-69 years (31.5%), females (71%), illiterate (33.5%), Hindu (94.5%) by religion, unemployed (33%), having a monthly family income of ‘2936- ’4893 (41%) and belongs to joint family (79.5%) All (100%) were visiting any one of the morbidity clinic and most of the subjects were interested to go to private practitioner/ clinic (65%). Majority (52.5%) of subjects were suffering from hypertension

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Fig.1

frequency distribution of subjects based on disease condition

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Fig.2

percentage distribution of subjects with occupation

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Table 1 Frequency and percentage distribution of sample characteristics n= 200

Sample Characteristics	f	%
Age in years:
Below 50	27	13.5
50-59	39	19.5
60-69	63	31.5
70-79	56	28
80 and above	15	7.5
Gender:
Male	58	29
Female	142	71
Educational status:
Illiterate	67	33.5
Primary school	44	22
Higher primary	57	28.5
High school	22	11
PUC, Diploma, Degree	10	5
Religion:
Hindu	189	98.5
Muslim	9	45.
Christian	2	1
Marital status:
Married	131	65.5
Widow/ widower	66	33
Separated / divorced	2	1
Unmarried	1	0.5
Type of family:
Nuclear	41	20.5
Joint	159	79.5
Monthly family income in rupees:
‘2936-’4893	82	41
‘4894-’7322	41	20.5
‘7323-’9787	39	19.5
‘9788-’19574	27	13.5
>‘19575	11	5.5
Visits to clinic:
Yes	200	100
No	0	0
Type of clinic:
Private practitioner/ clinic	130	65
MCON morbidity clinic	12	6
PHC	55	27.5
All the above	3	1.5
Frequency of visits:
Once in a month	61	30.5
2-4 months	33	16.5
5-7 months	6	3
If any problem	100	50
Duration of illness (in years)
1-5	138	69
6-10	34	17
11-15	11	5.5
16-20	10	5
21 & above	7	3.5
Medications getting from:
MCON morbidity clinic	15	7.5
PHC	43	21.5
Medical shop	142	71
Others	0	0
Distance from house to clinic in km:
0-5	142	71
6-10	38	19
11-15	20	10
Health insurance:
Yes	114	57
No	86	43
If yes, specify the type of insurance:
Manipal Arogya Card	37	32.45
Konkani Health Card	27	23.68
ESI , Medicare	40	35.08
Others	10	07.77

Discussion

Description of quality of life of people living with non- communicable diseases

Present study shows that compare to other domains psychological domain having median=20, IQR= 19- 21 which can be depicted as low quality of life and environmental domain having a Median =31 and IQR= 31- 32 with a maximum obtained score of 40 can be termed as good quality of life. Overall quality of life of subjects with median = 93, IQR= 89- 98 represents good quality of life.

The findings were supported by a study on morbidity profile and quality of life of inmates in old age homes in Udupi district, Md Asadullah et al revealed that most prevalent morbidities were hypertension (47.8%) and diabetes (43.5%). The mean score of physical, psychological, social and environmental domains were 53.71±15.64, 58.16±13.57, 34.66±14.87 and 60.46±10.14 respectively, where maximum score in environmental domain and minimum in social domain were observed.⁽⁴⁾

Association between quality of life of people living with non-communicable diseasesand selected variables.

Present study shows that age [χ² =14.847, p=0.005], occupation [χ²=15.590, p=0.008], educational status [χ²=13.093 p = 0.042] and marital status [χ² 23.318,p=0.001] of the people have significant association with their total Quality of life.

This was supported by B. S. Sathvik et al conducted a study to assess the quality of life in hemodialysis patients using the WHO QOL BREF questionnaire revealed that educational status and family income were associated with their QOL. There was no association between type of co-morbidities and the type of primary kidney disease on the QOLof hemodialysis subjects.⁽⁵⁾

Conclusion

It was found that majority of subjects felt their quality of life was good. Majority of subjects were neither satisfied nor dissatisfied towards their health. Compared to other domains psychological domain has Median=20, IQR=19- 21 which represent low quality of life while environmental domain have good quality of life. People with diabetes mellitus have good quality of life when compared to other diseases such as hypertension, asthma and both diabetes mellitus & hypertension.

Limitations of the study were The study used non probability purposive sampling, so generalizability of the study was limited and study was limited only to the people living with non-communicable diseases such as asthma, hypertension, diabetes mellitus and both hypertension and diabetes mellitus in adopted villages of Manipal College of Nursing Manipal.

Recommendations of the study are: A comparative study can be undertaken between urban and rural areas to identify the differences in their quality of life, a qualitative study can be done by including all non-communicable diseases present in the selected villages and study can be replicated by using stratified sampling method considering large sampling size.