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Tilburg University Psychosocial Functioning in Individuals Living with Diabetes Mellitus in Zambia Hapunda, G

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Tilburg University Psychosocial Functioning in Individuals Living with Diabetes Mellitus in Zambia Hapunda, G Tilburg University Psychosocial functioning in individuals living with Diabetes Mellitus in Zambia Hapunda, G. Publication date: 2015 Document Version Publisher's PDF, also known as Version of record Link to publication in Tilburg University Research Portal Citation for published version (APA): Hapunda, G. (2015). Psychosocial functioning in individuals living with Diabetes Mellitus in Zambia. Ridderprint. 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Download date: 02. okt. 2021 Psychosocial Functioning in Individuals Living with Diabetes Mellitus in Zambia Given Hapunda Psychosocial Functioning in Individuals Living with Diabetes Mellitus in Zambia ©2015, G. Hapunda, The Netherlands All rights reserved: No part of this thesis may be reprodcued, stored in a retrieval system, or transmitted in any form or by any means, without the written permission from the author, or when appropriate, from the publishers of the publications. Cover: Remco Wetzel,The Netherlands (www.remcowetzels.nl) Lay-out: Ridderprint BV, Ridderkerk, The Netherlands Printed by: Riderprint BV, Ridderkerk, The Netherlands Financial support by the International Society for the Study of Behavioral Development/Jacobs Foundation Mentored Fellowship and the University of Zambia is gratefully acknowledged. PSYCHOSOCIAL FUNCTIONING IN INDIVIDUALS LIVING WITH DIABETES MELLITUS IN ZAMBIA PROEFSCHRIFT ter verkrijging van de graad van doctor aan Tilburg University op gezag van de rector magnificus, prof.dr. E.H.L Aarts, in het openbaar te verdedigen ten overstaan van een door het college voor promoties aangewezen commissie in de Ruth First zaal van de Universiteit op dinsdag 24 november 2015 om 14.15 uur door Given Hapunda geboren op 31 januari 1981 te Mkushi, Zambia Promotores: Prof.dr. A.J.R. van de Vijver Prof.dr. F. Pouwer Copromotor: Dr. A.A. Abubakar Overige commissieleden: Prof.dr. A.A. Maes Prof.dr. Y.H. Poortinga Prof.dr. F.J. Snoek Dr. P.M.C. Mommersteeg Dr. N.M. Maas-van Schaaijk Table of Contents Chapter 1 ................................................................................................................................................. 1 General Introduction ............................................................................................................................... 1 Part 1 ..................................................................................................................................................... 26 Understanding Diabetes in Sub-Saharan Africa and Zambia ............................................................... 26 Chapter 2 ............................................................................................................................................... 29 Diabetes in Sub-Saharan African Children: Risks, Care and Challenges ............................................. 29 Chapter 3 ............................................................................................................................................... 67 Living with Type 1 Diabetes is Challenging for Zambian Adolescents: Qualitative Data on Stress, Coping with Stress and Quality of Care and Life ................................................................................. 68 Part 2 ..................................................................................................................................................... 98 Psychosocial Functioning in People with Diabetes .............................................................................. 98 Chapter 4 ............................................................................................................................................. 100 Validity and Reliability of the Zambian Version of the Problem Areas in Diabetes Scale (PAID): A Triangulation with Cognitive Interviews ............................................................................................ 100 Chapter 5 ............................................................................................................................................. 136 Diabetes mellitus and co-morbid depression in Zambia ..................................................................... 136 Chapter 6 ............................................................................................................................................. 150 Gender, Age and Socioeconomic Status are Associated with Self-Care among People with Diabetes in Zambia ................................................................................................................................................ 150 Part 3 ................................................................................................................................................... 176 Thesis Integration: Discussion and Conclusion .................................................................................. 176 Chapter 7 ............................................................................................................................................. 178 General Discussion and Conclusion ................................................................................................... 178 Chapter 8 ............................................................................................................................................. 214 Thesis Summary.................................................................................................................................. 214 Acknowledgement .............................................................................................................................. 220 List of Publications ............................................................................................................................. 222 About the Author ................................................................................................................................ 224 Appendices .......................................................................................................................................... 226 Chapter 1 General Introduction 1 Background information The research presented in this thesis aimed at investigating psychosocial functioning in people with diabetes mellitus in Zambia. The sample in the thesis included urban adolescents and adults with both type 1 and type 2 diabetes mellitus. The thesis addressed the following questions: 1. What is the prevalence of diabetes in children in Sub-Saharan Africa (SSA), what are the consequences and risk factors for diabetes and what does diabetes care look like in SSA? (Chapter 2) 2. What are the sources of stress, the ways of coping with stress, the perceived quality of care and the quality of life as experienced by Zambian adolescents living with type 1 diabetes? (Chapter 3) 3. Does the Zambian version of the Problem Areas in Diabetes (PAID) have sound psychometric properties and what are the levels of diabetes-specific emotional distress in people with type 1 and 2 diabetes in Zambia? (Chapter 4) 4. How common is co-morbid depression in individuals with type 1 and 2 diabetes in Zambia? (Chapter 5) 5. What is the association between symptoms of depression with diabetes self-care in individuals with type 1 or 2 diabetes? (Chapter 6) To place this thesis into context, this introduction provides background information about psychosocial issues among people living in diabetes both globally and within the Zambian context. Additionally, an outline of the thesis is provided. 2 Psychosocial issues common in diabetes In 1994, the psychological well-being working group of the World Health Organization/International Diabetes Federation St Vincent Declaration Action Program for Diabetes published guidelines for encouraging psychological well-being in people with diabetes [1]. The guidelines included: improving communication between diabetes health-care teams and the person with diabetes; protecting self-esteem of people with diabetes; responding to individuals’ differing needs; helping patients learn about their own individual responses; helping to motivate self-care; monitoring of psychological well-being and proposing organizational changes aimed at optimizing psychological aspects of diabetes care [1]. 20 years down the line, psychosocial aspects of diabetes are almost never taken care of in the Zambian health care system and there is a dearth of research on the subject in Sub-Saharan Africa. Diabetes is a chronic metabolic disease characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both [2]. According to the World Health Organization (WHO), diabetes mellitus can be classified into four types: type 1 diabetes, type 2 diabetes, other specific types of diabetes and gestational diabetes mellitus [3]. Type
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