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NUTRITION - ORIGINAL ARTICLES
Year : 2021  |  Volume : 11  |  Issue : 3  |  Page : 189-193

Assessment of Knowledge, Practice and Treatment Adherence of Patients with Hypothyroidism in Endocrinology Department


1 Sri Ramachandra Faculty of Nursing, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamilnadu, India
2 Department of Medical Surgical Nursing, Sri Ramachandra Faculty of Nursing, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India

Date of Submission02-Mar-2021
Date of Decision14-Mar-2021
Date of Acceptance21-Apr-2021
Date of Web Publication28-Jul-2021

Correspondence Address:
Abinaya Nagendiran
Sri Ramachandra Faculty of Nursing, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamilnadu
India
Kavitha Kalaimani
Department of Medical Surgical Nursing, Sri Ramachandra Faculty of Nursing, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnpnd.ijnpnd_7_21

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   Abstract 


Assess the knowledge, practice, and treatment adherence of patients with hypothyroidism attending in endocrinology department in Chennai. The research design adopted for this study was descriptive. Using convenience sampling technique, a total of 120 patients both male and female who had diagnosed with hypothyroidism, Sri Ramachandra Hospital who met the inclusion criteria were recruited. The data related to background variables and assessment of knowledge, practice and treatment adherence on patients with hypothyroidism were obtained using questionnaires through interview method. The data were analyzed using descriptive and inferential statistics. The study findings showed that 61.7% of patients had moderately adequate level of knowledge on hypothyroidism, 76.7% of them had adequate level of practice and 49.2% of them had low adherence. The mean score of knowledge on hypothyroidism was 16.69, practice was 8.28, and treatment adherence was 2.09. The study showed that the knowledge, practice, and treatment adherence with hypothyroidism were moderately adequate among patients with hypothyroidism.

Keywords: Knowledge, practice, patients with hypothyroidism and treatment adherence


How to cite this article:
Nagendiran A, Kalaimani K, Anantharani K. Assessment of Knowledge, Practice and Treatment Adherence of Patients with Hypothyroidism in Endocrinology Department. Int J Nutr Pharmacol Neurol Dis 2021;11:189-93

How to cite this URL:
Nagendiran A, Kalaimani K, Anantharani K. Assessment of Knowledge, Practice and Treatment Adherence of Patients with Hypothyroidism in Endocrinology Department. Int J Nutr Pharmacol Neurol Dis [serial online] 2021 [cited 2021 Oct 25];11:189-93. Available from: https://www.ijnpnd.com/text.asp?2021/11/3/189/322487




   Introduction Top


Hypothyroidism means suboptimal function of thyroid hormone. Thyroid deficiency can affect all body functions and can ranges from mild, subclinical forms to myxedema (severe deficiency) and an advanced life threatening form. More than 95% of patients with hypothyroidism have primary or thyroidal hypothyroidism, which refers to dysfunction of the thyroid gland.[1] Hypothyroidism denotes deficient production of thyroid hormone by the thyroid gland and can be primary (abnormalityin thyroid gland itself) or secondary/central (as a result ofhypothalamic or pituitary disease). Approximately 99% cases are primary hypothyroidism.

The prevalence of hypothyroidism in developed countries is about 4% to 5%, whereas in India, it is reported to be around 10.95%, and the prevalence of SCH, a mild thyroid failure, was found to be 8.02%. It is reported to be 11.4% for women and 6.2% for men.[2]

According to the most recent nationwide study in India, the prevalence of overt undiagnosed hypothyroidism was 3.5% and the prevalence of subclinical hypothyroidism (SCH) was 8.5%. In a study from Delhi, SCH was present in 19.3% of subjects and 4.2% had overt hypothyroidism.[3] According to a World Health Organization’s report[4] regarding the intake of Indian among iodine households, about 83.2% in urban and 66.1% in rural were taking micronutrient iodine adequately. This study result showed a major transformation in the state of iodine deficiency. Complication of hypothyroid patients is myxedema coma, a condition that has been associated with mortality as high as 80%.[5]

Goel et al.,[6] conducted a study on 244 consecutive hypothyroid patients a total of 41 patients (16.8%) felt that it could be discontinued once reports normalized. A total of 16 patients (6.55%) felt it should be continued till the symptoms subside and 12 patients (4.91%) thought it should be taken till their neck swelling subsides. Shrestha et al.[7] conducted a cross sectional study among 113 patients showed that 85.8% of them were females. Majority, 76.10% of them belonged to the age group of 31-40 years. More than half, 51.3% of the patients were adherent to medication.

Pourvaghar et al.[8] assessed the knowledge on hypothyroidism among 250 patients which showed that only88 (35.2%) participants were aware of correct meaning of the term thyroid. Similarly, only 128 (51.2%) participants were aware about correct meaning of the term hypothyroidism. 45(18%) participants referred to hypothyroidism as a swelling in the neck or increased hormone production by the thyroid gland. The finding showed that a high >20% prevalence of hypothyroidism in patients with Type2 Diabetes Mellitus, hypertension and Type2 Diabetes Mellitus along with hypertension Talwalkar et al.[9]

Cappelli et al.[10] conducted a study on adherence to levothyroxine treatment among patients with hypothyroidism. A total of 320 patients (272 females), median age 47.9 ± 15.6 years (range, 20–78 years), completed the MMAS-8 questionnaire. 87% of the participants were adhering to their treatment for both tablet and liquid levothyroxine (LT4) formulations, although significant differences emerged. Follow-up testing of serum T4 levels in persons with persistently abnormal TSH levels can differentiate between subclinical (normal T4 levels) and “overt” (abnormal T4 levels) thyroid dysfunction.[11]

Kannan et al.[12] conducted a study among 74 patients with misconceptions prevalent among hypothyroid patients was the belief that iodized salt can be used for treating hypothyroidism (56%). 13 patients (38%) followed dietary restrictions like avoiding cabbage, cauliflowers, soya products. Among the 162 patients with hypothyroidism, 38.27% had high adherence, 43.83% had medium adherence and 29 patients had low adherence to levothyroxine.[13]

Ingoe et al.[14] conducted a study on older patients’ experience of primary hypothyroidism. A qualitative study was conducted in semi-structured interviews with 18 participants aged between 80 and 93 years. Interview transcripts were analyzed using a thematic approach. The themes involved older individual’s knowledge about symptoms, confidence in diagnosis, and understanding of clinical management regimen to understand hypothyroidism. The interpretation of the themes was informed by the Health Belief Model.

Objectives of the study were to
  • assess the knowledge, practice, and treatment adherence among patients with hypothyroidism attending in tertiary care hospital;
  • find out the relationship among knowledge, practice, and treatment adherence among patients with hypothyroidism; and
  • associate knowledge, practice, and treatment adherence with selected background variables of patients with hypothyroidism.



   Materials and methods Top


A quantitative approach with descriptive cross-sectional research design was carried out in the present study. Using convenience sampling technique, a total of 120 patients both male and female who had diagnosed with hypothyroidism and who met the inclusion criteria were recruited. The study was conducted from inpatient and outpatient Department of Medical, Surgical and Endocrinology, Sri Ramachandra Hospital, Chennai, after obtaining ethical clearance from the Institutional Ethical Committee of Sri Ramachandra Institute of Higher Education and Research (DU). A formal permission was obtained from the head of the Department of Endocrinology. Self-structured questionnaire was developed by the investigator consisting of three sections. Background variables and structured questionnaire on knowledge, practice, and treatment adherence of hypothyroidism were developed by Morisky Green Levine.[15] Morisky Green Levine was used to assess the level of treatment adherence of patients with hypothyroidism patients who were taking regular tablet daily. It was adapted to setting of patients who were treated in medical, surgical, and endocrinology in an outpatient department.

Data collection procedure

The written consent was obtained from each participant after explaining the study in detail and the background data were collected. The information sheet was provided to the patients. The purpose and procedure of the study were explained to the participants and a written informed consent was obtained from them before conducting the study. The data on background variable and assessment of knowledge, practice, and treatment adherence on hypothyroidism questionnaire was collected from 120 participants through interview method by maintaining privacy of 1 month duration and a total time taken for data collection procedure of each sample was around 15 to 20 min. A pamphlet which consists of diet, exercise, treatment, and follow-up and complication of hypothyroidism was distributed to the patients. The duration of the data collection period was 1 month. The data were collected from 1 October 2019 to 4 November 2019. Participants were selected based on the inclusion criteria.

Treatment adherence questionnaire with four items is developed by Morisky Green Levine.[15] A score of “1” is given for the right answer and “0” for the wrong answer for all questions. The total score is 4.The score interpretation of the level of treatment adherence was interpreted as follows:

Treatment Adherence Score

High adherence 0 (0%)

Medium adherence 1 or 2 (25% or 50%)

Low adherence 3 or 4 (75% or 100%)

The confounding factors considered in the study were background and clinical variables with knowledge, practice, and treatment adherence of patients with hypothyroidism.

Limitations of the study

  • The self-report method was utilized to collect data on knowledge, practice, and treatment adherence among patients with hypothyroidism. This might have posed potential issues concerning the accuracy of information.
  • The barriers of practice were not studied. Identification of barriers might have helped the investigator to recommend solution for an inadequate practice.
  • Minimal number of male was included in the study.
  • Data were collected only 1 month.



   Results and discussion Top


The result of the present examination was 54.2% belonged to the age group of 26 to 35 years. With respect to gender, 97.5% of them were females. In relation to marital status, 89.2% were married. The data on educational qualification depict that 48.3% of the participants had secondary level of education. The type of occupation showed that 78.3% were homemakers. In relation to the family income, 37.5% of them had an income of above Rs.10, 000 per month. Regarding the presence of family history of hypothyroidism, 83.3% did not have family history of hypothyroidism. In relation to comorbidity conditions, 76.7% does not have any comorbidities of hypothyroidism. With regard to history of menopause, 17.5%had menopause, 80.0%had not attained menopause, and 32.5% was not applicable for men. In relation to duration of illness, 35.0%had hypothyroidism for duration of 1 to 2years.According to clinical variables in relation to body mass index, 37.5% was normal, with regard to T4 level, 70.8% was in a range between 0.8 and 1.8ng/dL. With regard to thyroid-stimulating hormone (TSH) level, 74 (61.7%) were above 4µIU/mL ([Table 1] and [Table 2]).
Table 1 Distribution of patients with hypothyroidism according to their demographic variables (N=120)

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Table 2 Distribution of clinical variables of patients with hypothyroidism (N =120)

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The present investigation results depict that 61.7% had moderately adequate knowledge and 7.5% had inadequate knowledge. The mean knowledge score was 16.69 and standard deviation was 3.81 [Figure 1].
Figure 1 Distribution of level of knowledge of patients with hypothyroidism (N = 120)

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The present investigation results depict that 76.7% of the patients had adequate practice on hypothyroidism, 23.3% had moderately adequate practice, and none of them had inadequate practice on hypothyroidism. The mean practice score was 8.28and standard deviation was 1.36 [Figure 2].
Figure 2 Distribution of level of practice of patients with hypothyroidism (N = 120)

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The present investigation results depict that 49.2% had low treatment adherence on hypothyroidism, 30% of patients had high treatment adherence on hypothyroidism, and 20.8% had medium adherence on hypothyroidism. The mean score on treatment adherence was 2.09 and standard deviation was 1.550 [Figure 3].
Figure 3 Distribution of level of treatment adherence of patients with hypothyroidism (N = 120)

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The present examination exhibits that a relationship existed between knowledge and practice (r = 0.002) which was statistically significant at P < 0.001and between practice and treatment adherence (r = 0.018) at P < 0.05. The present examination exhibits that the association between knowledge on hypothyroidism and the background variables, the study found that there was a statistically significant association between the level of knowledge and marital status at P < 0.01.

Perumal et al.[16] conducted a cross-sectional study was done on 100 clinical diagnosed hypothyroid patients using 57 item questionnaires. Mean age of participants was 38 years (SD=12) with median age of 39.5 years, majority of the participants being females (77%) and living in urban setting (52%).

The present examination exhibits that association between practice on hypothyroidism and the background variables showed that there was a statistically significant association between the level of practice and occupation at P<0.001. Also, a statistically significant association was observed in age in years at P < 0.01and also statistically significant association was seen in monthly income, education, and marital status at P<0.05. The present examination exhibits that association between treatment adherence on hypothyroidism and the background variables, the findings depicted that there was a statistically non significant association between the level of treatment adherence and background and clinical variables.

The present study reveals that the level of knowledge and practice was comparatively high among the patients with hypothyroidism. This could be due to the fact that as humans grow older, the importance of health is realized, application of knowledge is shown through practice, and their treatment adherences become desirable.


   Conclusion Top


The present investigation surmises that better knowledge and understanding of thyroid disorder will encourage patients to be more compliant with medications, follow-up regularly, and convey message and facts to their relatives and friends.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Ross DS, Mana DL, Bruno OD, Wartofsky L. Coma mixedematoso [Myxedema coma]. Medicina (B Aires) 2012; 77.  Back to cited text no. 1
    
2.
Unnikrishnan A, Bantwal G, John M, Kalra S, Sahay R, Tewari N. Prevalence of hypothyroidism in adults: An epidemiological study in eight cities of India. Indian J Endocrinol Metab 2013 17:647.  Back to cited text no. 2
    
3.
Marwaha RK, Tandon N, Garg MK et al. Thyroid status two decades after salt iodization: Country‑wide data in school children from India. Clin Endocrinol (Oxf) 2012;76:905–10.  Back to cited text no. 3
    
4.
World Health Oraganization. Indicators for assessing Iodine Deficiency Disorders and their control through salt iodization. Geneva, WHO/ NUT/94.6. 2013.  Back to cited text no. 4
    
5.
Palace MR. Perioperative management of thyroid dysfunction. Health Serv Insights 2017;10:117.  Back to cited text no. 5
    
6.
Goel A, Shivaprasad C, Kolly A, Pulikkal AA, Boppana R, Dwarakanath CS. Frequent occurrence of faulty practices, misconceptions and lack of knowledge among hypothyroid patients. J Clin Diagn Res 2017;11:OC15–OC20.  Back to cited text no. 6
    
7.
ShakyaShrestha S, Risal K, Shrestha R, Bhatta RD. Medication adherence to levothyroxine therapy among hypothyroid patients and their clinical outcomes with special reference to thyroid function parameters. Kathmandu Univ Med J 2018;16:129–37.  Back to cited text no. 7
    
8.
Pourvaghar MJ, Bahram ME, Sayyah M et al. Adiponectin, insulin sensitivity and diabetic retinopathy in latinos with type 2 diabetes. J Clin Endocrinol Metab 2016;11; 3348–55.  Back to cited text no. 8
    
9.
Talwalkar P, Deshmukh V, Bhole M. Prevalence of hypothyroidism in patients with type 2 diabetes mellitus and hypertension in India: a cross-sectional observational study. Diabetes Metab Syndr Obes 2019;12:369–76.  Back to cited text no. 9
    
10.
Cappelli C, Castello R, Marini F et al. Adherence to levothyroxine treatment among patients with hypothyroidism: a northeastern Italian survey. Front Endocrinol 2018;9:699.  Back to cited text no. 10
    
11.
LeFevre ML, Siu AL, Bibbins-Domingo K et al. Screening for thyroid dysfunction: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2015;162:641–50.  Back to cited text no. 11
    
12.
Kannan. Knowledge, Awareness and Practices (KAP) among patients with hypothyroidism attending endocrine clinics of community hospitals in Chennai. Thyroid Res Practice 2010;7:11.  Back to cited text no. 12
    
13.
Kamalanathan S, Mohan A, Sc M. Research article pattern of medication adherence and its determinants factors, Professor cum Principal (Ag), College of Nursing, JIPMER, 2017.  Back to cited text no. 13
    
14.
Ingoe LE, Hickey J, Pearce S et al. Older patients’ experience of primary hypothyroidism: a qualitative study. Health Expect 2018;21:628–35.  Back to cited text no. 14
    
15.
Morisky DE, Green LW, Levine DM. Concurrent and predictive validity measure of medication adherence. Med Care 1986;24 (1):64–74  Back to cited text no. 15
    
16.
Perumal SS, Prasad S, Surapaneni KM, Joshi A. Health Information-Seeking Behavior Among Hypothyroid Patients at Saveetha Medical College and Hospital. Ethiop J Health Sci 2015 Apr;25(2): 147–54.  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2]



 

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