1. Ms. PHWAY THINZAR CHIT MYANMAR
HEALTH SEEKING BEHAVIOR OF THE ELDERLY WITH DIABETES AT CLINIC IN MANDALAY, MYANMAR
Ms. PHWAY THINZAR CHIT
MYANMAR

2. Rationale and Justification
In the years of 1980 and 2014, the percentage of the global population aged 60 years or over increased from 8.6% to 12%. [United Nations: Population facts]
The proportion of elderly people (60-year-old and over) comprising for about 9% of the whole Myanmar’s population in 2012 would increase to 15% by [2012 survey of elderly people]
Diabetes has increased as there are rapid cultural and social changes, ageing population, increased urbanization, economic development, dietary changes, reduced physical activity and unhealthy behaviors.
The prevalence of diabetes among population aged between 25 and 65 years was 10.5%. [National survey of ]

3. In 2013, there were 72.1 million of people (aged from years old) with diabetes in Southeast Asia and the number would increase to 123 million of diabetic population by 2035.
[IDF]
Diabetes prevalence (% of population aged from 20 to 79 years old) in Myanmar was 6.1% in [World Bank Data]
According to STEP survey ( ), the prevalence of diabetes in Yangon region was 11.8%.
Challenges in the delivery of diabetic health care service are geographic factors, belief, culture, traditions, educational background, health literacy, economic structure, public health seeking behavior, lifestyle and diet.

4. Myanmar Total Population of Myanmar in 2014– 51,486,253 Population above 65 years old – 5.8% Mandalay Region Population above 65 years old-380,122 Data was collected at Byamaso clinic (Charity clinic) in Mandalay, Myanmar

5. Research Objectives
General objective - To determine the factors associated with health seeking behavior of the elderly with diabetes at Byamaso clinic in Mandalay, Myanmar.
Specific objectives
-To identify the health seeking behavior of the elderly with diabetes on treatment at Byamaso clinic in Mandalay, Myanmar.
-To assess the association between the associated factors and health seeking behavior of the elderly with diabetes at Byamaso clinic in Mandalay, Myanmar.

6. Operational definition
Conceptual framework
Independent variables Dependent variable
Predisposing factors
Operational definition
Health seeking behavior
It refers to the pattern of seeking behavior for treatment and remedial action undertaken by individuals when they perceive they have symptoms of disease and when they have disease after being diagnosed by health care personnel.
Going to governmental health centers (e.g. rural health center, governmental hospital)
Going to non-governmental health centers (e.g. private clinic, GP clinic, private hospital)
Taking traditional medicine
Self- medication
Going to pharmacy or drug store
Receiving health care from basic health workers (e.g. health assistant, midwife)
General characteristics
Age
Sex
Education
Health seeking behavior of the elder with diabetes
Knowledge about diabetes

7. Literature review Materials and Methods
It is described that the decision to engage with a particular medical channel is influenced by socio-economic variables (e.g. age, sex), social status of women, type of illness, accessibility to care services and perception of quality of the service. [Tipping and Segall (1995)]
In Health belief model, individual’s actions to treat and prevent diseases based on Perceived susceptibility, Perceived severity, Perceived benefits, Perceived barriers and Cue to action.
In Andersen Model (Health care utilization model) is to find out the conditions of either facilitating or impeding utilization. The utilization of health care services can be assumed as a kind of individual behavior.
Materials and Methods
Study Design - Cross-sectional study

8. Fig. Sampling flow chart
Sampling method
Study population
Patients who came to the Byamaso clinic in Mandalay, Myanmar
Inclusion criteria
Both male and female, Aged above 60 years old, Patients who come to the clinic for taking health care, Patients with diabetes, Patients who are willing to participate
Exclusion criteria
Patients with mental health problems or dementia
Sample population
Diabetic patients who came to the Byamaso clinic during April, 2016 in Mandalay, Myanmar
Purposive sampling
Data collection
It was conducted during the clinic opening hours and opening days (Saturday, Sunday and Wednesday) in April, 2016.
Fig. Sampling flow chart

9. Sample size calculation
The sample size was calculated by using the following formula: 𝑛= 𝑧 ∝ 2 2 𝑝(1−𝑝) 𝑑 2 𝑛= (1.96) 2 ∗ ∗(1−0.575) (0.09) 2 n = n = sample size 𝑧 ∝ 2 = value of standard normal deviation at 95% confidence level (1.96)  = significant level at 0.05 p = percentage of people who took treatment of diabetes mellitus for first contact at governmental health center as soon as diagnosis in Hmaw-bi township, Yangon in 2012 = 57.5% d = error allowance of 15% of percentage of people who took treatment of diabetes mellitus for first contact at governmental health center = % of the samples was added to cover the missing value = 23 Therefore, estimated sample size was approximately 139.
Data collection and data analysis
Collected data was coded and entered into computer by using Epidata, Analyzed by SPSS version 18; Pearson’s chi-squared test to identify between dependent and independent variables
Results were be determined at 95% confidence level.

10. Results
Health seeking behavior of DM patients seeking care at Byamaso clinic as first choice for diagnosis and treatment of diabetes(n=139)
39.6% (n=55) DM patients seeking care at Byamaso clinic as first choice
60.4% (n=84) DM patients seeking care at other health care facilities as first choice

11. Association between general characteristic of DM patients and health seeking behavior of DM patients seeking care at Byamaso clinic as first choice for diagnosis and treatment of diabetes
General characteristics
Seeking care at Byamaso clinic as first choice
Seeking care at other health care facilities as first choice
 p-value
Total samples (n=139)
No.
(n=55)
% (39.6%)
(n=84) %
(60.4%)
Age (in years)
0.317
60 – 67 78 28
35.9 50
64.1
>67 61 27
44.3 34
55.7
Sex
0.106
Male 7
25.9 20
74.1
Female
112 48
42.9 64
57.1
Education
0.295
Never go to school 8 5
62.5 3
37.5
Under secondary
education level 97 39
40.2 58
59.8
High school,
Graduatre 11
32.4 23
67.6

12. Discussion
Out of 60.4% (n=84) DM patients (who didn’t choose Byamaso clinic as first choice), 57.9% went to non-governmental health centers ; 29.4% went to governmental health centers; 3.2% of them took traditional medicine.
Reasons - being easy to access and few of them chose after getting health information from friends.
One third of patients (n=139, 39.6%) chose Byamso clinic as first choice.
Reasons – Very much lower health care service fees and most of the anti-diabetic drugs are available without charge.
This is an advantage for reducing the financial burden of elderly patients
In one study in Yangon, Myanmar, 57.5% out of 153 respondents chose the governmental health centers as the first initiation in treatment of diabetes rather than non-governmental health center (Due to accessibility of health care)

13. Number and percent of knowledge (n=139)
Knowledge statement
Correct statement
Number
Percent
Blood glucose level can be controlled by compliance to anti- diabetic drugs regularly following the prescribed medication.
134
96.4
Diabetes can damage kidneys.
127
91.4
Diabetes mellitus can be prevented by changing life-style such as diet, quitting smoking and drinking alcohol and doing exercise.
125
89.9
DM can be cured completely to become a healthy person. 87
62.6
Urine testing is the best method for testing blood glucose. 20
14.4
Eating too much sugar and other sweet foods can cause diabetes. 5
3.6
Might miss hypoglycemia/hyperglycemia and might distribute misconception of information
Level of knowledge about diabetes
Respondents were worried a lot in choosing type of foods and failed to eat balanced diet.
Knowledge about diabetes
Number
Percent
Good (≥4) 81
58.2
Moderate (3-2) 56
40.3
Poor (<2) 2
1.5

14. Association between knowledge about DM and health seeking behavior of DM patients seeking care at Byamaso clinic as first choice
 Statement
 Total samples
(n=139)
Seeking care at Byamaso clinic as first choice
Seeking care at other health care facilities as first choice
 p-value
No.
(n=55) %
(39.6%)
(n=84)
(60.4%)
Knowledge about DM
0.738
Good 81 33
40.7 48
59.3
Poor 58 22
37.9 36
62.1

15. Discussion
Out of 139 patients, 40.7% of DM patients with good knowledge sought health care at Byamaso clinic as first choice and 59.3% of them with good knowledge didn’t.
There was no significant association between knowledge about diabetes and health seeking behavior of DM patients seeking care at Byamaso clinic as first choice.
Out of total respondents, most of the patients presented with signs and symptoms of DM such as frequent urination, excessive thirst, numbness in the hands or feet.

16. In one study in Nepal, there was a statistically significant difference in the level of knowledge to age (p<0.05) and education (p<0.001).
In this study, one-fifth of all respondents had no proper education(very few patients couldn’t write or read) and the majority of the DM patients had primary education level.
There was no significant association between education and health seeking behavior of DM patients seeking care at Byamaso clinic as first choice.

17. Knowledge level is important for forcing patients to seek health care.
Participants were weak at knowledge about the causes, treatment of DM and blood testing for detecting blood glucose level.
A few patients who delayed in treatment of DM were found out.
Because they didn’t know that delaying in treatment could cause serious complication (e.g. blindness).

18. Conclusion
Although there were no significant association between education, knowledge and health seeking behaviors of diabetic patients, it was found out that nearly half of the patients had poor knowledge about DM.
Health literacy about the causes, treatment of diabetes and testing blood glucose level should be clearly provided to the patients.
As the patients were elderly and had no proper education, more effective programs of health literacy on diabetes (including diagnosis, treatment, adherence to treatment and reading prescription) should be implemented at Byamaso clinic.

19. THANK YOU VERY MUCH!