title: Diabetes related health knowledge, attitude and practice among diabetic patients in Nepal.
abstract: BACKGROUND
  Globally, diabetes is the top priority chronic disease. Health literary would be cost effective for prevention and control of diabetes and its consequences. This study was conducted to determine the level of diabetes related health knowledge, attitude and practice (KAP) among diabetic patient and factors associated with KAP.
  
  
  METHODS
  An institutional based cross-sectional study was conducted using a non-probability sampling technique to select the diabetic patients. A total of 244 diabetic patients were interviewed from July to November 2014. Data was collected by face to face interview using structured interviewer rater questionnaires. Relative risk ratio (RRR) and 95% confidence interval (CI) of associated factors were estimated by a stepwise likelihood ratio method with multinomial logistic regression.
  
  
  RESULTS
  More than half (52.5%) of all patients were female, 18% were illiterate, and 24.6% were from rural residence. The diabetes related risk factors were common among diabetic patients; 9.8% smoker, 16% alcohol drinking, and 17.6% reported low or no physical activity. Median score for knowledge, attitude, and practice were 81, 40 and 14 respectively. Among all patients, 12.3%, 12.7% and 16% had highly satisfactory knowledge, attitude and practice respectively. Using highly insufficient knowledge as the baseline, the likelihood of having a level of highly sufficient knowledge was 17 times higher among patients who have graduated and above level of education compared to those who were illiterate. Albeit this value was comparatively lower than insufficient level of knowledge. The probability of having a sufficient level of practice among diabetic patient with a history of smoking was 0.10 times lower than in patient with no history of smoking.
  
  
  CONCLUSIONS
  Our study reveals a variation between diabetes related health knowledge, attitude and practice in Nepal among those who are affected by diabetes. Our results show the potential diabetes health literacy needs to be improved or developed for better health promotion.
authors.affiliation: Department of Public Health, Pokhara University, Nobel College, Sinamangal, Kathmandu, Nepal. anjumissing@gmail.com.
authors.forename: Anju
authors.initials: A
authors.lastname: Gautam
authors.affiliation: Department of Public Health, Pokhara University, Nobel College, Sinamangal, Kathmandu, Nepal. dnbhatta@yahoo.com.|Faculty of Medicine, Epidemiology Unit, Prince of Songkla University, Songkhla, Thailand. dnbhatta@yahoo.com.
authors.forename: Dharma Nand
authors.initials: DN
authors.lastname: Bhatta
authors.affiliation: Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal. aryalumesh@gmail.com.
authors.forename: Umesh Raj
authors.initials: UR
authors.lastname: Aryal
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D011795:Surveys and Questionnaires