Knowledge, Attitudes and Practices of Primary Health Care Physicians Regarding Diabetes Management: A Cross Sectional Study in Gharbia Governorate, Egypt

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Mai Mohamed Mahmoud Abu Kahf
Khalil Mohamed Abbas Ayad
Mamdoh Ahmed Gabr
Walaa Mohamed El Sayed Shehata


Background: With increasing prevalence of diabetes mellitus worldwide, primary health care physicians are the main providers of diabetes care and their knowledge, attitudes and practices are important to achieve goals in diabetes management.

Objectives: Assessment of the knowledge, attitude and practices (KAP) of primary health care physicians regarding management of diabetes. To find-out gaps between the practices of primary health care physicians and the already established national and international guidelines.

Methods: This cross- sectional study was conducted on 144 primary health care physicians working in a randomly chosen primary health care centers in Al Garbia Governorate. Data collected concerning knowledge, attitudes and practices of primary care physicians regarding diabetes management.

Results: The study included 144 primary health care physicians working in 38 primary health care centers in Gharbia governorate. About two thirds (95) of the studied physicians were working in rural areas and the rest (49) in urban ones. As regards years since graduation, fifty three of the studied physicians were graduated <5 years and the rest (91) were graduated ≥5 years. Concerning relevant certifications or training courses, about three fourths (106) had relevant past experiences while one fourth (38) had no such experiences. Urban primary care physicians had higher percentage of correct knowledge than the rural ones as regards diagnosis, complications and managements of DM (p value <0.05). Primary care physicians with increased years of practice and who attended relevant training courses had favorable attitude and practices as regards counseling and regular examination of diabetic patients (p value <0.05).

Conclusion: The current study revealed a shortage of knowledge, attitude and practices of primary health care physicians as regards management of diabetes. The defect in knowledge and unfavourability of attitude and inappropriateness of practices are obvious in family physicians working in the rural health care facilities, those without relevant experience and those graduated less 5 years.

Primary health care physicians, diabetes management, knowledge, attitude and practices (KAP), Urban primary care physicians.

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How to Cite
Abu Kahf, M. M. M., Ayad, K. M. A., Gabr, M. A., & Shehata, W. M. E. S. (2020). Knowledge, Attitudes and Practices of Primary Health Care Physicians Regarding Diabetes Management: A Cross Sectional Study in Gharbia Governorate, Egypt. Asian Journal of Medicine and Health, 17(4), 1-15.
Original Research Article


World Diabetic Foundation, Diabetic facts; 2006.

King H, Rewers M: WHO Ad Hoc Diabetes Reporting Group: Global estimates for prevalence of diabetes and impaired glucose tolerance in adults. Diabetes Care. 1993;16:157–177.

King H, Aubert RE, Herman W: Global burden of diabetes, 1995–2025, prevalence, numerical estimates and projecttion. Diabetes Care. 1998;21:1414– 1431.

Global Burden of Diabetes: WHO projects a 170% growth in the number of people with diabetes in developing countries by 2025.Press Release WHO/63 14 September; 1998.

Mokta J, Mokta K, Ranjan A, Joshi I, Garg M. Diabetes drug prescription pattern and awareness among health care providers in Sub-Himalayan Region of India: A Population Based Study. Journal of The Association of Physicians of India. 2017; 65:50–54.

Arafa NA, Amin GE: The epidemiology of diabetes mellitus in Egypt: Results of a National Survey. Egypt J Community Med. 2010;28:29–37.

Mabrouk N, Abdou M, Nour-Eldin H, Omar SA, Sliem HA: Knowledge, attitude, and practice of family physicians regarding diabetic neuropathy in family practice centers. Suez Canal University. International Journal of Medicine and Public Health 2013;3(4):230–234.

Alzaidi MM, Almalki HS, Alghamdi GM, Al Ghamdi AH, Gumaa SA, Althomali TA, Al Ghamdi AN. Attitudes and practice of diabetic complications among physicians in Taif Saudi Arabia. The Egyptian Journal of Hospital Medicine. 2016;65:693-695.

Harris MI. Medical care for patients with diabetes, epidemiologic aspects. Ann Int Med 1996;124:117–122.

Drass J, Kell S, Osborn M, Bausel B, Corcoran J JR, Moskowt A, Fleming B. Diabetes care for beneficiaries. Attitude and behaviors of primary care physicians. Diabetes Care. 1998;21:1282–1287.

Wagner EH, Austin BT, Davis C, Hindmars M, Schaefar J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff (Millwood). 2001;20: 64–78.

Hehseth LD, Susman JL, Crabtree BF, O’Conor PG. Primary care physicians’ perception of diabetes management. A balancing act. J Famil Pract. 1999;48:37– 42.

Zhang JQ, Van Leuven KA, Neidlinger SH. System Barriers Associated With Diabetes Management in Primary Care. The Journal for Nurse Practitioners (JNP). 2012;8(10): 822–827.

International Diabetes Federation. IDF Diabetes Atlas, 7th Edition.
[Cited 2017 April].
Available: http://www.

Hilts L, Howard M, Price D, Risdon C, Agarwal G, Childs A. Helping primary care teams emerge through a quality improvement program. Family Practice. 2013;30(2):204–211.

Shera AS, Jawad F, Basit A: Diabetes related Knowledge. Attitude and Practices of Family Physicians in Pakistan. JPMA. 2002;44:49-58.

Khan AR, Al Abdul Lateef ZN, Khamseen MB, Al Aithan MA, Khan SA, Al Ibrahim I. Knowledge, attitude and practice of ministry of health primary health care physicians in the management of type 2 diabetes mellitus: A cross-sectional study in the Al Hasa District of Saudi Arabia. Nigerian Journal of Clinical Practice. 2010; 14(1):52–59.

Jingi AM, Nansseu JR, Noubiap JJ. Primary care physicians' practice regarding diabetes mellitus diagnosis, evaluation and management in the West region of Cameroon. BMC Endocr Disord. 2015; 15(18):1-9.

O'Keefe JH, Carter MD, Lavie CJ: Primary and secondary prevention of cardio-vascular diseases: A practical evidence-based approach. Mayo Clin Proc. 2009; 84(8):741-57.

Peimani M, Tabatabaei MO, Heshmat R, Moghaddam SA. Knowledge, attitude and practice of physicians in the field of diabetes and its complications; a pilot study. Iran J Diabetes Lipid Disord. 2010; 9:1-7.

Aghili R, Malek M, Baradaran HR, Peyvandi AA, Ebrahim Valojerdi A, Khamseh ME. General practitioners' knowledge and clinical practice in management of people with type 2 diabetes in Iran. The Impact of Continuous Medical Education Programs. Arch Iran Med. 2015;18(9):582-585.

Vahidshahi K, Mahmudi M, Shahbaznejad L. General practitioner views on the status and motives of participants in retraining programs and how its implementation. Iranian Journal of Education in Medical Sciences. 2007;7(1):162-168.

Diwan VK; Sachs L & Wahlström R: Practice knowledge-attitudes-practice: An explorative study of information in primary care. Soc Sci Med. 1997;44:1221-1228.

Shuval K; Linn S; Brezis M; Shadmi E; Michael L & Reis GS: Association between primary care physicians’ evidence-based medicine knowledge and quality of care. International Journal for Quality in Health Care. 2010;22(1):16–23.

Fogelman Y; Goldfracht M & Karkabi K. Managing Diabetes Mellitus: A Survey of Attitudes and Practices Among Family Physicians. J Community Health. 2015; 40(5):1002–1007.

Papatheodorou K; Papanas N; Banach M; Papazoglou D & Edmonds M: Complications of Diabetes 2016. Journal of Diabetes Research. 2016;35(2):1-3.

Niroomand M; Ghasemi SN; Karimi-Sari H& Khosravi MH: Knowledge, Attitude, and Practice of Iranian Internists Regarding Diabetes: A Cross Sectional Study. Diabetes Metab J. 2017;41(3):179-186.

Aldarbi MA; Alsaleem MA; Alsaleem SA & Alsamghan AS: The variance of knowledge and practices about diabetes mellitus in primary health care physicians of Jazan region, Kingdom of Saudi Arabia. 2018; 29(10):2083-2089.

Murray S; Lazure P; Schroter S; Philipp J; Posel P, Kellner T, Jenkins RD: International challenges without borders: A descriptive study of family physicians’ educational needs in the field of diabetes. BMC Family Practice. 2011;12:1-9.

Bairey Merz CN, Buse JB, Tuncer D, Twillman GB. Physician attitudes and practices and patient awareness of the cardiovascular complications of diabetes. J Am Coll Cardiol. 2002;40:1877-1881.

Chasuk RM, Brantley PJ, Martin PD. Knowledge and attitudes of family physicians about clinical practice guidelines and the care of patients with type 2 diabetes mellitus. J La State Med Soc. 2001;153:31-44.

O'Brien SV, Michaels SE, Hardy KJ. A comparison of general nurses' and junior doctors' diabetes knowledge. Prof Nurse. 2003;18:257-260.

Chwalow AJ, Costaghiola DG, Mesbah M, Eschwege E. Management of type 2 diabetes mellitus in France: Attitudes and practitioners among a representative sample of general practitioners. Diabetes Metab. 2016;4:458-464.

Theban AA, Bajaba MA. Knowledge, attitude and practice regarding diabetes among Saudi MOH Primary Healthcare Physicians in Jeddah: A Cross Sectional Study; 2019.

Vinker S, Nakar S, Rosenberg E, Bero-Aloni T, Kitai E. Attitudes of Israeli family physicians toward clinical guidelines. Arch. Fam. Med. 2000;9:835-840.

Wong T, Foote EF, Lefavour GS, Cody RP, Brown CJ, Sherman RA. Physician knowledge and practice patterns relating to diabetic nephropathy. J Am Pharm Assoc. 2000;39:785-90.

Yeniceri N, Shahin C, Osdes I, Ceyhan MN, Yildirim B, Guldal D, Akababa G. Family physicians’ attitudes toward managing diabetes and their self evaluation of their competencies. Acta Medica Mediterranea. 2015;31(2): 309-315.