Self-management of cataract extraction among diabetes patients

Funke Elizabeth AKINTUNDE, Olaolorunpo OLORUNFEMI, Rasidi Akinade SALAWU, Mary Olabisi OYEKANMI, Babatunde Abdul-latef ADEYENI, Olawale Rasheed OLADAPO, Jeminat Omotade SODIMU

1Department of Medical Surgical Nursing Adeleke University Ede, Osun State, Nigeria; 2Department of Medical Surgical Nursing, Federal University Oye Ekiti, Ekiti State, Nigeria;3Department of Medical Surgical Nursing, Babcock University,Illisha-Remo, Ogun State, Nigeria; 4Department of Medical Surgical Nursing, Achievers University, Owo, Ondo State,Nigeria; 5Department of Clinical Nursing Science, O.A.U T.H.C Ile-Ife Osun State, Nigeria; 6Department of Community Health Nursing, School of Nursing Abeokuta, Ogun State, Nigeria

ABSTRACT

Background: Diabetes-related cataract extraction is a minor surgery required to regain full vision.One of the recognized factors that can delay or prevent full-vision recovery is poor management, and most of this management is being carried out by patients themselves.

Objective: This study aimed to assess the knowledge of diabetes patients on self-management after cataract extraction in two tertiary hospitals in Osun State.

Methods: A cross-sectional descriptive design was conducted among 97 diabetes patients who underwent cataract extraction and were attending clinics and follow-up visits in Osun State.A self-structured questionnaire was used for data collection.

Results: Moderate knowledge was found among the participants on an appropriate diet (56.7%), prevention of injury risk (57.5%), prevention of infection risk (50.9%), and low knowledge on the technique of administration of eye drop (60.8%) after cataract extraction, whereas 74.7% of the total respondents were knowledgeable on the indication for follow-up visit after cataract extraction, these results were found to be below the expected knowledge level.

Conclusion: An intensive and comprehensive educational initiative by nurses should be tailored to meet the specific needs of diabetes patients with cataract surgery.Nurses also need to implement the use of checklist which will enhance learning and improve patient understanding of self-management after cataract extraction.

Keywords: Cataract extraction, diabetes patient, self-management, Nigeria, postoperative cataract care

INTRODUCTION

Diabetes is a chronic systemic disease that affects nearly one in eight adults worldwide, and associated with ocular complications, such as cataracts, that can lead to significant visual impairment.[1]Cataract extraction is a surgical procedure to remove a lens in the eye that has become cloudy over time, and affected vision of that eye.[2]Diabetes patients who underwent cataract surgery procedures often have concern regarding the postoperative self-management activities after their discharge from the hospital.The most common concern is the daily activities,complications, medication administration, and follow-up.[3,4]Patients’ insufficient knowledge of postoperative care may lead to mismanagement and other complications.[5]Such complications according to Brooks et al.[6]in 2017 identified complications of cataract extraction as expulsive hemorrhage,intraocular hemorrhage, corneal hemorrhage, bullous keratopathy shallow anterior chamber, iris prolapse, and acute postoperative endophthalmitis.

Millions of people are affected with cataract worldwide,and yearly, it costs millions of naira in Nigeria and most time associated with several risk factors,[7]such as cataract blindness, loss of self-esteem, significant functional disability, loss of self-care, social burden to relatives, and preventable huge economic loss.[8]Hence, it is important that cataract patient is knowledgeable about the required self-management activities after cataract surgery to ensure optimal recovery.The rise in the development of infection after cataract surgery has been attributed to patients’ poor understanding on how to carry out required self-management procedures after cataract surgery such as administration of eye drop/ointment, how to clean the eyelid edge, how frequent is the cleaning of eye shield and with what solution,and how to prevent soap and water from getting into the eye during bath.[9,10]Diabetes-related cataract patients stay a little longer in the hospital, but generally, cataract patients spend few hours in the hospital after the surgery, the larger aspect of cataract management continues at home which is conducted by the patients or the relative who serves as the caregiver.[11]

Cataract extraction is defined as the removal of opacified lens and replacement with a synthetic lens known as an intraocular lens.[12]This surgery helps patients to regain their sight and is one of the most common procedures performed worldwide and it may be considered one of the most effective procedures in the management of cataract.[13]Surgical intervention was found to be the major treatment to terminate the existence of cataracts, and this surgery is undertaken when the lost vision affects the person’s quality of life.[14,15]The number of cataract surgeries has continued to increase yearly in many countries, with many of those patients having other coexisting eye problems that can affect surgical recovery.[16]Osun State has about 600 operable cases of cataract, and there is development of an effective,affordable, and accessible cataract outreach program with an increased number of intraocular lens surgeries.

Based on an increasing number of operable cases of cataract among diabetes patients in Osun State, and those who underwent cataract extraction in most cases coming down with complications which were found to be associated with their poor understanding of self-care management after cataract extraction,[17-19]this study aimed to determine the knowledge of self-management after cataract extraction among diabetes patients in the two tertiary hospitals in Osun State, Nigeria.

METHODS

Study design

A cross-sectional descriptive research design was used to assess the patients’ knowledge regarding self-management of cataract surgery among cataract patients attending ophthalmology departments in the two tertiary hospitals in Osun State.

Study setting

The study was carried out in Osun State, which is one of the states in the south western part of Nigeria.The capital of State of Osun, Osogbo, shares boundary with Kwara State,Ekiti State, and Oyo State.At present, there are two different tertiary hospitals in Osun State which are Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, and Ladoke Akintola University of Technology Teaching Hospital, Osogbo,Osun State.The two institutions have ophthalmology departments with many patients scheduled for cataract surgery in their ophthalmology clinics.

Participants

The study population consisted of all postcataract surgery patients from Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, and Ladoke Akintola University of Technology Teaching Hospital Osogbo, Osun State.The eligibility criteria were all diabetes patients who underwent cataract extraction and were attending clinics and follow-up visit and were ready to voluntarily participate in the study.

Data source

Data were collected through the use of self-structured questions.The questionnaire was administered to patients who underwent cataract extraction in the ophthalmology clinics in two tertiary hospitals in Osun State.The questionnaire consists of three major sections which include (A) demographic data with 11 items, (B) knowledge of cataract patients on postoperative self-management with 26 items, and (C) techniques of administration of eye drop with 18 items.Fifteen copies of the instruments were administered to postcataract surgery patients in the ophthalmology clinic at University College Hospital Ibadan, Oyo State, and subjected to a reliability test.Cronbach alpha coefficient of 0.78 was obtained using split-half internal consistency method, and the result implies that the instrument is reliable.

Method of data collection

The researchers and four research assistants were involved in the administration of the instrument to each of the respondents.They were given an orientation for 2 days on the research and how to carry out the administration of the questionnaires.The administration of the instrument and collection of data lasted 1 month.A questionnaire was administered and collected on Tuesday and Friday clinics at Obafemi Awolowo University Teaching Hospital and it was also administered on Tuesday and Thursday in Ladoke Akintola University of Technology Teaching Hospital Osogbo clinics.Postoperative cataract patients or their caregivers who could read and write were given copies of the questionnaire to complete by themselves.The instrument was read to the participants who cannot read or understand English as the instrument was equally translated into the local language (Yoruba).

Study size

A total enumeration sampling method was used in which all postcataract surgery patients in the two teaching hospitals in the state of Osun were recruited for the study, which gave 97 postoperative cataract patients.

Statistical analysis

The data obtained were coded and analyzed using SPSS statistical software version 21.00 (IBM corp released 2012 Armonk, NY,USA: IBM Corp), using both descriptive and inferential statistics to answer the research questions and objectives.

Ethical considerations

Permission and ethical clearance was obtained from Babcock University Health Research Ethics Committee on January 31,2018, with reference number: BUHREC 009/18 to conduct the study.An introductory letter was collected from the school of nursing science, Babcock University Illisan Remo,Ogun State.Preliminary visits were made to the head of the ophthalmology department in the teaching hospitals to gather some background information.Permission to carry out the study was obtained from the head of the department of ophthalmology of the two teaching hospitals.Data collection was conducted after verbal consent was obtained from patients.Confidentiality and adequate privacy of respondent’s information was ensured and anonymity was maintained throughout the study, and they were free to withdraw at any stage of the research work.Questions were entertained and all questions were answered with all sincerity.

RESULTS

The respondents were within the 40-70 years age range with a mean age of 55.7 ± 3.12 (standard deviation).The sociodemographic profiles of the study population based on the gender revealed that majority (50.5%) of the respondents were female.The occupation of the patients showed that majority were self-employed (40.2%), Christians (64.9%),married (83.5%), and Yoruba (60.8%).This revealed further that about 77% had family support, whereas 81.4% had no record of medical disorder [Table 1].

Table 1: Sociodemographic profile of the study population (n=97)

This study showed that the patients’ knowledge level on an appropriate diet after cataract surgery and the rating scale on knowledge were categorized as high (3), moderate/average (2), and low (1).About 50 (51.5%) of the respondents had moderate knowledge on an appropriate diet after cataract surgery, whereas 38 (39.2%) had low knowledge,and the remaining 9 (9.3%) had high knowledge.Using the mean score, it was observed that the patients had a mean score of 1.701 which was equivalent to 56.7% level of knowledge.It could then be deduced from the outcome of the results presented above that majority of the patients who participated in this study were averagely knowledgeable on an appropriate diet after cataract surgery.

This present study also presented that the patients’ knowledge level on prevention of injury risk after cataract surgery, and their knowledge levels were categorized as high (4-5),moderate/average (2-3), and low (0-1).Majority (66 [68.1%])of the respondents had moderate knowledge on prevention of injury risk after cataract surgery, and about 28 (28.8%)had high knowledge, and the remaining 3 (3.1%) had low knowledge.Using the mean score, it was observed that the patients had a mean score of 2.876 which was equivalent to 57.5% level of knowledge.

This study showed the patients’ knowledge level on prevention of infection risk after cataract extraction, based on a rated scale of high (4-5) scores, moderate/average (2-3),and low (0-1).Majority (63 [64.9%]) of the respondents had moderate knowledge on prevention of infection risk after cataract surgery, 25 (25.7%) had low knowledge, and the remaining 9 (9.3%) had high knowledge.Using the mean score,it was observed that the patients had a mean score of 3.052 which was equivalent to 50.9% level of knowledge.It could then be deduced from the outcome of the results presented above that majority of the patients who participated in this study were averagely knowledgeable on the prevention of infection risk after cataract surgery.

Concerning the patients’ knowledge level on the indication for follow-up visit postoperatively, with a rating scale of high (9-12), moderate/average (5-8), and low (1-4), it was found that majority (66 [68%]) of the respondents had high knowledge on indication for follow-up visits after cataract surgery and the remaining (31 [32%]) had moderate knowledge.Using the mean score, it was observed that the patients had a mean score of 8.959 which was equivalent to 74.7% level of knowledge.It could then be deduced from the outcome of the results presented above that majority of the patients who participated in this study were highly knowledgeable on indication for follow-up visits after cataract extraction.

Furthermore, this study also showed that the patients’knowledge level on technique of administration of eye drop after cataract extraction, with a rating scale of high (11-15),moderate/average (6-10), and low (1-5).This found that majority (59 [60.8%]) of the respondents had low knowledge on technique of administration of eye drop after cataract surgery and the remaining 38 (39.2%) had moderate knowledge.Using the mean score, it was observed that the patients had a mean score of 10.556 which was equivalent to 50.4% level of knowledge.It could then be deduced from the outcome of the results presented above that majority of the patients who participated in this study were averagely knowledgeable on technique of administration of eye drop after cataract extraction.

DISCUSSION

This study showed that majority of the respondents had moderate knowledge on an appropriate diet after cataract surgery.This is supported by a study conducted in Sabatia Eye Hospital, Kenya, and found that the patients’ nutritional knowledge exists but not to all and the frequency of consumption and the diet diversity of antioxidant-rich foods were low, and they recommended sensitization of frequency of intake of antioxidant food sources at the community and hospital level through a multidisciplinary approach.[20]

In addition to that, this study also observed that more than average of the patients who participated in this study was moderately knowledgeable on prevention of injury risk after cataract surgery.The implication of this result might be as a result of orientation nurses always give to diabetes patients on prevention of injury.This finding disagrees with a study carried out by Pundareekaksha[21]in India in 2016,who found that many postcataract patients lack adequate knowledge on personal care of eye, regular follow-up visits,and so on .He, therefore, concluded that this knowledge gap can lead to a significant impact on quality of life and also causes unnecessary increase in health-care cost, resulting in financial constraints to both patients and health-care system as a whole.Therefore, continuous health education is recommended to update knowledge on postcataract surgery management for preventing risk of injury and other complications.

The outcome of this study on the patients’ knowledge level on prevention of infection risk after cataract surgery showed that majority of the respondents had moderate knowledge on prevention of infection risk after cataract surgery.This contradicts the study carried out by Pieper et al.[22]in 2016 who found that patients who underwent surgical procedures often have self-care concerns because of their poor knowledge level on prevention of infection risk and they therefore recommend that nurses have a critical role in the development of discharge educational programs for postoperative diabetes patients.Since unmet discharge needs can contribute to poor-patient outcomes and readmission,it is critical that wound, ostomy, and continence nurses,advanced practice nurses, and clinical staff nurses accurately identify patients’ informational needs and find ways to meet these needs, especially with the aging population,new/advanced surgical procedures, vulnerability/poverty, and literacy level of patients.[22]

Moreover, the result showed that majority of the respondents had high knowledge on indication for follow-up visits after cataract surgery.The implication of this finding is that those patients who demonstrate good knowledge of cataracts will demonstrate good self-management and enhance the follow-up visits behavior.This also reveals that effective health teaching will boost their eye care-seeking behavior,and subsequently, result in reduction of blindness that occurs from poor self-management of patients after discharge.This result is in line with a study conducted in India which showed that all patients knew the importance of regular follow-up after the surgery.[20]

That is not all, the result also revealed that majority of the respondents had poor knowledge on technique of administration of eye drop after cataract surgery.The outcome of this study is in agreement with that of An et al.[23]in 2014 whose study showed that 31% of the respondents reported difficulty to instill the eye drops, 69% reported always washing their hands before using the drops, 42% believed that they never missed eye when instilling drops,58% believed they never touched their eye with bottle tip, and 50% showed an improper administration technique, including missing the eye, contaminating the bottle tip (57%), or failing to wash hands before putting in eye drops.

The study was faced with some limitations: this study was conducted in a single state in Nigeria; it may be difficult to generalize the result to all states in Nigeria.

CONCLUSION

This study concluded that patients who participated in this study are averagely knowledgeable on an appropriate diet, prevention of injury risk, prevention of infection risk after cataract surgery, and low knowledge of technique of administration of eye drops but are highly knowledgeable on indication for follow-up visit.Therefore, cataract patient’s knowledge on self-management of postcataract extraction is important for the patients and needs to be improved,especially on the technique of administration of eye drop after cataract surgery.On admission and before discharge,nurses need to emphasize the importance of having adequate knowledge on those items and the importance of keeping hospital appointments to enhance self-management after cataract extraction among diabetes patients.

What is known about this topic?

• Poor understanding of self-management among cataract patients

• Cataract is common among diabetes patients

• Self-management is one of the best methods for the management of postcataract surgery patients.

What this topic adds to the body of knowledge?

• Diabetes patients with cataract extraction are more knowledgeable about self-care management in related to other patients

• Focus education to meet specific technique of administration of eye drop after cataract surgery

• Diabetes patients with cataract spend more time in the hospital which accounts for the better knowledge as found in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.