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transparency and easy access of funds, in order to settle purchases and expenditures effectively with time.
Limitations
Initial analysis of the baseline data between hospital and health clinics had shown a significant difference rendering these two samples not comparable for further
analysis. This indirectly split our initial sample size into two, making the sample size smaller. This had also opened the possibilities of difference in effectiveness of this
intervention between these two centers.
The convenient sampling method and time chosen opened the possibility of sampling patients who had never been intervened before.
This study took into account illiterate patients and the intervention package materials for patients are mainly reading materials. A substantial portion of the samples were
illiterate in this study, therefore, they might not benefit from this study and this might also affect the outcome.
Pamphlets and reading materials charts, stickers were produced in one language only, therefore limited the use for those who can only read in Bahasa Malaysia only.
While in our samples, the non Malays are a substantial bulk of patients.
6.2 Discussions of Results
As discussed earlier in the problem statement under the introduction chapter, patients’ knowledge on OHA are affected by several factors. Socio-demographic
difference in diabetic patients would yield different levels of knowledge on their own OHA.
As described in the analysis, the intervention yield statistically significant improvement in patients’ knowledge on OHA in both hospital and health clinics.
Health clinics showed significant improvement but not hospital. This was mainly due to dedicated staffs appointed in health clinic to maintain and supervise this
intervention which was not available in hospital due to problem in manpower.
Analysis on seven specific questions regarding OHA revealed initial good knowledge of patients for both hospital and health clinics ≥90. Subsequent analysis of p
value showed p0.05. This is not worrying since substantial change in this area is not expected. If critically considered, hospital showed increase from 92.0 to 92.6 in
P1 and 96.7 in P2, while in health clinic 91.5 to 90.6 in P1 and eventually 100 in P2.
From this study, even with drastic change p value 0.001, patients knowledge about OHA side effect in both centers remained low. It was similar to a study done
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by Thomson FJ et al 1991 – 88 patients taking OHA denied any knowledge of hypoglycemia. 54 of the OHA groups have been associated with severe and
prolonged hypoglycemia.
In outpatient department in hospital, patients with lower education level, namely those who had primary school as their maximum education patients with no
formal education were included, was found to have significant improvement of knowledge after continuous intervention done. This is quite odd as patients
with higher education level, namely those who had secondary education as their minimum education, was expected to yield better result than the former group.
However, in this study, it was the other way around. This was most probably due to premature judgment by healthcare providers that patients with higher education
level did not need intensive counseling and attention in terms of explanation compared to those with lower educational level.
This stereotype misconception among healthcare providers led to different approaches to patients. Those with higher education level would be explained
in a faster way and less time spent with them educating about OHA, healthcare providers were prone to use complicated terminologies rather than simple ones,
and less repetition of information was done.
However, in health clinics, the intervention gave out better effects on patients who were having diabetes mellitus as their sole morbidity. However, this improvement
was not statistically sustained with significance until P2. It could be seen that this group of patients would benefit from the intervention as we hoped.
Out of seven areas of question regarding knowledge of OHA, health clinics improved significantly in question on physical OHA properties, frequency and correct action if
missed medication. However, most of the improvement only can be seen in those who on single OHA. Obviously, patient with less medication are able to concentrate
more on their medication and subsequently will be less confused.
In the other hand, Hospital OPD patients only showed significant improvement in knowledge regarding correct side effect of the OHA. This improvement was
significant in the entire patient regardless of their number of OHA. This was because this specific area was very poorly understood prior to intervention, thus intervened,
this area improved so much. Other areas was not so bad in the beginning, therefore a little rise was not significant but still good.
However, question pertaining to the name of the consumed OHA did not show improvement. This was because this study had a significant amount of patients who
were poorly educated primary schooled and no formal education. Therefore, they had a problem in memorizing name since they could not even read the material
