Author(s): Bilkis Banu, Farzana Yasmin, Mobarak Hossain Khan, Liaquat Ali, Rainer Sauerborn, Aurélia Souares


DOI: 10.52711/0974-360X.2021.01064   

Address: Bilkis Banu1,2, Farzana Yasmin1, Mobarak Hossain Khan3, Liaquat Ali4, Rainer Sauerborn1, Aurélia Souares1
1Heidelberg Institute of Global Health, Heidelberg University Hospital, INF 130.3, 69120 Heidelberg, Germany.
2Northern University Bangladesh, Holding-13, Road-17, Banani C/A, Dhaka-1213, Bangladesh.
3East West University, Plot-A/2, Jahirul Islam Avenue, Jahirul Islam City, Aftabnagar, Dhaka-1212, Bangladesh.
4Pothikrit Institute of Health Studies, 1/ E, Paribag, Dhaka, Bangladesh.
*Corresponding Author

Published In:   Volume - 14,      Issue - 11,     Year - 2021

This systematic review aimed to gather scientific evidence regarding the methods and indicators used to measure Knowledge Attitude and Practices (KAP) related to their disease among patient with diabetes and the level of KAP measured as outcome. 65 studies were included in this review following the defined inclusion and exclusion criteria and using the 7 electronic databases. Reviewed papers were categorized according to the assessment process of KAP in the studies. Articles were described and analyzed according to a list of criteria defined: the publication year; research location; study design; age of study subjects; addressed issues, process to measure and level of KAP in the article. Assessment of KAP on diabetes was expressed by mean, categories, percentage or in combined process. Majority of the reviewed studies were cross sectional (n=46, 71%), performed among adult patients (n=59, 91%), conducted in Asia (n=39, 60%) and used non- standardized questionnaire (65%). In most of the studies, level of knowledge and attitude on diabetes was found to be average (n=39, 60% & n=7, 11% respectively) and practices were found poor (n=12, 19%). The findings showed different types of indicators produced to measure KAP and the different dimensions being used either independently or together. There is a need for a standard validated questionnaire to be able to produce a measure of knowledge and behaviors of patients with diabetes that will be valid and comparable.

Cite this article:
Bilkis Banu, Farzana Yasmin, Mobarak Hossain Khan, Liaquat Ali, Rainer Sauerborn, Aurélia Souares. A Systematic Review on Knowledge-Attitude-Practice on diabetes: Assessment Process and Outcome Levels. Research Journal of Pharmacy and Technology. 2021; 14(11):6125-8. doi: 10.52711/0974-360X.2021.01064

Bilkis Banu, Farzana Yasmin, Mobarak Hossain Khan, Liaquat Ali, Rainer Sauerborn, Aurélia Souares. A Systematic Review on Knowledge-Attitude-Practice on diabetes: Assessment Process and Outcome Levels. Research Journal of Pharmacy and Technology. 2021; 14(11):6125-8. doi: 10.52711/0974-360X.2021.01064   Available on:

1.    Marathe K R. Wan TTH. Marathe S. A systematic review on the KAP-O Framework for diabetes education and research. Medical Research Archives. KEI Journals. 2016; 4 (1): 2-21.
2.    du Monde M. The KAP survey model (knowledge, attitudes, & practices). 2016. The United States Agency for International Development (USAID). Available online at: Accessed on March 08, 2015.
3.    International Diabetes Federation. IDF Diabetes Atlas. Seventh edition. Brussels, Belgium. Available online at: Accessed on March 09, 2015.
4.    M. Sujatha Kumari. M. Kiran Babu. Rehana Sulthana. M. Srinivas. Ch. Prasanthi. Diabetes Mellitus: Present status and Drug therapy Updates. Research J. Pharm. and Tech. 2014; 7(1): 84-94.
5.    International Diabetes Federation. Diabetes Voice. Volume 16, Issue 2. Brussels, Belgium. Available online at: Accessed on April 12, 2016.
6.    Shin SA. Kim H. Lee K. et al. Effects of diabetic case management on knowledge, self-management abilities, health behaviors, and health service utilization for diabetes in Korea. Yonsei medical journal. 2015; 56(1):244-52. 10.3349/ymj.2015.56.1.244.
7.    S.V. Rupashri. Gheena. S. Recent Advances in Diabetes Research. Research J. Pharm. and Tech. 2016; 9(10):1806-1808. 10.5958/0974-360X.2016.00366.8.
8.    Suraj B. C D Tripathi. Krishna Biswas. B M Padhy. Tarun Arora. A Comparative evaluation of safety, efficacy and cost effectiveness of three add on treatment regimens in type 2 diabetics; not controlled by Metformin alone. Research J. Pharm. and Tech. 2015; 13 (1): 44-50. 10.5958/0974-360X.2015.00009.8.
9.    Kheir N. Greer W. Yousif A. et al. Knowledge, attitude and practices of Qatari patients with type 2 diabetes mellitus. The International journal of pharmacy practice. 2011;19 (3):185-91. 10.1111/j.2042-7174.2011.00118.x.
10.    Hussain Z. Yusoff ZM. Sulaiman SA. Evaluation of knowledge regarding gestational diabetes mellitus and its association with glycaemic level: A Malaysian study. Primary care diabetes. 2015; 9(3):184-90. 10.1016/j.pcd.2014.07.007.
11.    Vivian EM. Ejebe IH. Identifying knowledge deficits of food insecure patients with diabetes. Current diabetes reviews. 2014; 10 (6):402-6. 10.2174/1573399810666141124111453.
12.    Ruiz JG. Andrade AD. Anam R. et al. Computer-based programmed instruction did not improve the knowledge retention of medication instructions of individuals with type 2 diabetes mellitus. The Diabetes educator. 2014; 40(1):77-88. 10.1177/0145721713508825.
13.    Jasper US. Ogundunmade BG. Opara MC. et al. Determinants of diabetes knowledge in a cohort of Nigerian diabetics. Journal of diabetes and metabolic disorders. 2014; 13(1):39. 10.1186/2251-6581-13-39.
14.    Hui SS. Hui GP. Xie YJ. Association between Physical Activity Knowledge and Levels of Physical Activity in Chinese Adults with Type 2 Diabetes. PloS one. 2014; 9 (12): e115098. 10.1371/journal.pone.0115098.  
15.    Araszkiewicz A. Zozulinska-Ziolkiewicz D. Pilacinski S. et al. Baseline diabetic knowledge after 5-day teaching program is an independent predictor of subclinical macroangiopathy in patients with type 1 diabetes (Poznan Prospective Study). Advances in medical sciences. 2014; 59(2):240-4. 10.1016/j.advms.2013.12.005.
16.    Negarandeh R. Mahmoodi H. Noktehdan H. et al. Teach back and pictorial image educational strategies on knowledge about diabetes and medication/dietary adherence among low health literate patients with type 2 diabetes. Primary care diabetes. 2013; 7(2):111-8. 10.1016/j.pcd.2012.11.001.
17.    Mansour-Ghanaei R. Joukar F. Soati F. et al. Association between knowledge, locus of control and health belief with self-management, HbA1c level and number of attendances in type 1 diabetes mellitus patients. International journal of clinical and experimental medicine. 2013; 6 (6):470-7. PMC3703118.
18.    Hu J. Gruber KJ. Liu H. et al. Diabetes knowledge among older adults with diabetes in Beijing, China. Journal of clinical nursing. 2013; 22 (1-2):51-60. 10.1111/j.1365-2702.2012.04273.x.
19.    Fenwick EK. Xie J, Rees G. et al. Factors associated with knowledge of diabetes in patients with type 2 diabetes using the Diabetes Knowledge Test validated with Rasch analysis. PloS one. 2013;8(12): e80593. 10.1371/journal.pone.0080593.
20.    Ali HI. Jarrar AH. El Sadig M. et al. Diet and carbohydrate food knowledge of multi-ethnic women: a comparative analysis of pregnant women with and without Gestational Diabetes Mellitus. PloS one. 2013;8 (9): e73486. 10.1371/journal.pone.0073486.
21.    Rovner AJ. Nansel TR. Mehta SN. et al. Development and validation of the type 1 diabetes nutrition knowledge survey. Diabetes care. 2012; 35 (8):1643-7. 10.2337/dc11-2371.
22.    Pereira DA. Costa NM. Sousa AL. et al. The effect of educational intervention on the disease knowledge of diabetes mellitus patients. Revistalatino-americana de enfermagem. 2012; 20(3):478-85.
23.    Mufunda E. Wikby K. Bjorn A. et al. Level and determinants of diabetes knowledge in patients with diabetes in Zimbabwe: a cross-sectional study. The Pan African medical journal. 2012; 13:78. 23396799.
24.    Lai PS. Chua SS. Tan CH. et al. Validation of the diabetes, hypertension and hyperlipidemia (DHL) knowledge instrument in Malaysia. BMC medical research methodology. 2012; 12:18. 10.1186/1471-2288-12-18.
25.    Goodarzi M. Ebrahimzadeh I. Rabi A. et al. Impact of distance education via mobile phone text messaging on knowledge, attitude, practice and self-efficacy of patients with type 2 diabetes mellitus in Iran. Journal of diabetes and metabolic disorders. 2012; 11(1):10. 10.1186/2251-6581-11-10.
26.    Wysocki T. Lochrie A. Antal H. et al. Youth and parent knowledge and communication about major complications of type 1 diabetes: associations with diabetes outcomes. Diabetes care. 2011; 34(8):1701-5. 10.2337/dc11-0577.
27.    Malathy R. Narmadha M. Ramesh S. et al. Effect of a diabetes counseling programme on knowledge, attitude and practice among diabetic patients in Erode district of South India. Journal of young pharmacists: JYP. 2011; 3(1):65-72. 10.4103/0975-1483.76422.
28.    Bains SS. Egede LE. Associations between health literacy, diabetes knowledge, self-care behaviors, and glycemic control in a low-income population with type 2 diabetes. Diabetes technology & therapeutics. 2011; 13 (3):335-41. 10.1089/dia.2010.0160.
29.    Ardena GJ. Paz-Pacheco E. Jimeno CA. et al. Knowledge, attitudes and practices of persons with type 2 diabetes in a rural community: phase I of the community-based Diabetes Self-Management Education (DSME) Program in San Juan, Batangas, Philippines. Diabetes research and clinical practice. 2010; 90 (2):160-6. 10.1016/j.diabres.2010.08.003.
30.    Al-Adsani AM. Moussa MA. Al-Jasem LI. et al. The level and determinants of diabetes knowledge in Kuwaiti adults with type 2 diabetes. Diabetes & metabolism. 2009; 35 (2):121-8. 10.1016/j.diabet.2008.09.005.
31.    McPherson ML. Smith SW. Powers A. et al. Association between diabetes patients' knowledge about medications and their blood glucose control. Research in social & administrative pharmacy: RSAP. 2008; 4(1):37-45. 10.1016/j.sapharm.2007.01.002.
32.    Koves IH. Boucher A. Ismail D. et al. Satisfaction of care in a tertiary level diabetes clinic: correlations with diabetes knowledge, clinical outcome and health-related quality of life. Journal of paediatrics and child health. 2008; 44(7-8):432-7. 10.1111/j.1440-1754.2008.01317.x
33.    Fitzgerald N. Damio G. Segura-Perez S. et al. Nutrition knowledge, food label use, and food intake patterns among Latinas with and without type 2 diabetes. Journal of the American Dietetic Association. 2008; 108(6):960-7. 10.1016/j.jada.2008.03.016.
34.    Yun LS. Hassan Y. Aziz NA. et al. A comparison of knowledge of diabetes mellitus between patients with diabetes and healthy adults: a survey from north Malaysia. Patient education and counseling. 2007; 69(1-3):47-54. 10.1016/j.pec.2007.06.017.
35.    Sabri AA. Qayyum MA. Saigol NU. et al. Comparing knowledge of diabetes mellitus among rural and urban diabetics. McGill journal of medicine: MJM: an international forum for the advancement of medical sciences by students. 2007; 10 (2):87-9. 10.26443/mjm.v10i2.741.
36.    He X. Wharrad HJ. Diabetes knowledge and glycemic control among Chinese people with type 2 diabetes. International nursing review. 2007; 54 (3):280-7. 10.1111/j.1466-7657.2007.00570.x.
37.    Ding CH. Teng CL. Koh CN. Knowledge of diabetes mellitus among diabetic and non-diabetic patients in KlinikKesihatan Seremban. The Medical journal of Malaysia. 2006; 61(4):399-404.
38.    Rothman RL. Malone R. Bryant B. et al. The Spoken Knowledge in Low Literacy in Diabetes scale: a diabetes knowledge scale for vulnerable patients. The Diabetes educator. 2005; 31(2):215-24. 10.1177/0145721705275002.
39.    Garrett N. Hageman CM. Sibley SD. et al. The effectiveness of an interactive small group diabetes intervention in improving knowledge, feeling of control, and behavior. Health promotion practice. 2005; 6(3):320-8. 10.1177/1524839903260846.
40.    Chapman-Novakofski K. Karduck J. Improvement in knowledge, social cognitive theory variables, and movement through stages of change after a community-based diabetes education program. Journal of the American Dietetic Association. 2005; 105(10):1613-6. 10.1016/j.jada.2005.07.010.
41.    NP Hawal. Shivaswamy M.S. S Kambar. et al. Knowledge, attitude and behaviour regarding self-care practices among type 2 diabetes mellitus patients residing in an urban area of South India. International Multidisciplinary Research Journal. 2012; 2(12):31-35.
42.    T Aklilu. D Hiko. MA. Mohammed. et al. Diabetic Patients' Knowledge of Their Disease, Therapeutic Goals, and Self-management: Association with Goal Attainment at Dessie Referral Hospital, Ethiopia.  Therapeutic Innovation & Regulatory Science. 2014. DOI: 10.1177/2168479014524960. 10.1177/2168479014524960.
43.    SH Ng. KH Chan. ZY Lian. et al. Reality vs Illusion: Knowledge, Attitude and Practice among Diabetic Patients. International Journal of Collaborative Research on Internal Medicine & Public Health. 2012; 4 (5): 709-718.
44.    Gautam A. Bhatta DN. Aryal UR. Diabetes related health knowledge, attitude and practice among diabetic patients in Nepal. BMC endocrine disorders. 2015; 15:25. 10.1186/s12902-015-0021-6.
45.    de Oliveira KC. Zanetti ML. Knowledge and attitudes of patients with diabetes mellitus in a primary health care system. Revista da Escola de Enfermagem da U S P. 2011; 45(4):862-8. 10.1590/s0080-62342011000400010.
46.    Rodrigues FF. Zanetti ML. dos Santos MA. et al. Knowledge and attitude: important components in diabetes education. Revistalatino-americana de enfermagem. 2009; 17(4):468-73. 10.1590/S0104-11692009000400006.
47.    Rafique G. Azam SI. White F. Diabetes knowledge, beliefs and practices among people with diabetes attending a university hospital in Karachi, Pakistan. Eastern Mediterranean Health Journal. 2006 ; 12(5): 590-8.
48.    HI Okonta. JB Ikombele. GA Ogunbanjo. Knowledge, attitude and practice regarding lifestyle modification in type 2 diabetic patients. African Journal of Primary Health Care & Family Medicine. 2014; 6(1): 655-660. 10.4102/phcfm.v6i1.655.
49.    Pena-Purcell NC. Boggess MM. An application of a diabetes knowledge scale for low-literate Hispanic/Latinos. Health promotion practice. 2014; 15(2):252-62. 10.1177/1524839912474006.
50.    Guler N. Oguz S. The spoken knowledge of low literacy in patients with diabetes. Diabetes research and clinical practice. 2011; 92(2):238-43. 10.1177/0145721705275002.
51.    Shah VN. Kamdar PK. Shah N. Assessing the knowledge, attitudes and practice of type 2 diabetes among patients of Saurashtra region, Gujarat. International Journal of Diabetes in Developing Countries. 2009; 29(3):118-22. 10.4103/0973-3930.54288.
52.    Kandula NR. Nsiah-Kumi PA. Makoul G. et al. The relationship between health literacy and knowledge improvement after a multimedia type 2 diabetes education program. Patient education and counseling. 2009; 75(3):321-7. 10.1016/j.pec.2009.04.001.
53.    Mehta RS. Karki P. Sharma SK. Risk factors, associated health problems, reasons for admission and knowledge profile of diabetes patients admitted in BPKIHS. Kathmandu University medical journal. 2006; 4(1):11-3. 10.4103/0973-3930.22775.
54.    N Badruddin. A Basit, MZI Hydrie. et al. Knowledge, Attitude and Practices of Patients visiting a diabetes care unit. Pakistan Journal of Nutrition. 2002; 1 (2): 99-102. 10.3923/pjn.2002.99.102.
55.    DK Upadhyay. MIzham MI. VM Alurkar. et al. Evaluation of knowledge, attitude and practice of newly diagnosed diabetes patients-a baseline study from Nepal.  International Journal of Pharmacy Teaching & Practices. 2012; 3(2): 245-252.
56.    Gul N. Knowledge, attitudes and practices of type 2 diabetic patients. Journal of Ayub Medical College Abbottabad. 2010; 22(3): 128-131. PMID: 22338437.
57.    Singh R P. Khobragade M. Kumar A. A cross-sectional study on knowledge, attitude and practices among diabetic patients about diabetes and its complications in Central Delhi. MRIMS Journal of Health Sciences. 2013; 1 (2): 44-47. 10.11648/j.sjph.20150304.20.
58.    Mangaiarkkarasi A. Nitya S. Mehar Ali R. et al. Study to Assess the Knowledge, Attitude and Practice about Diabetes among Diabetic Patients in Pondicherry. Research Journal of Pharmaceutical, Biological and Chemical Sciences. 2012; 3 (4): 1185-1196. 10.7860/JCDR/2016/19568.7862.
59.    Ku GM. Kegels G. Knowledge, attitudes and perceptions of people with type 2 diabetes as related to self-management practices: Results of a cross-sectional study conducted in Luzon, Philippines. Chronic illness. 2015; 11(2):93-107. 10.1177/1742395314538291.
60.    Quandt SA. Ip EH. Kirk JK. et al. Assessment of a short diabetes knowledge instrument for older and minority adults. The Diabetes educator. 2014; 40(1):68-76. 10.1177/0145721713508824.
61.    Ku GM. Kegels G. Effects of the First Line Diabetes Care (FiLDCare) self-management education and support project on knowledge, attitudes, perceptions, self-management practices and glycaemic control: a quasi-experimental study conducted in the Northern Philippines. BMJ open. 2014; 4(8): e005317. 10.1136/bmjopen-2014-005317.
62.    Jackson IL. Adibe MO. Okonta MJ. et al. Knowledge of self-care among type 2 diabetes patients in two states of Nigeria. Pharmacy practice. 2014; 12 (3):404. 10.4321/s1886-36552014000300001.
63.    Perera DP. De Silva RE. Perera WL. Knowledge of diabetes among type 2 diabetes patients attending a primary health care clinic in Sri Lanka. Eastern Mediterranean health journal. 2013; 19 (7):644-8. PMID: 24975310.
64.    Saleh F. Mumu SJ. Ara F. et al. Knowledge and self-care practices regarding diabetes among newly diagnosed type 2 diabetics in Bangladesh: a cross-sectional study. BMC public health. 2012; 12: 1112. 10.1186/1471-2458-12-1112.
65.    Hartayu TS. Mi MI. Suryawati S. Improving of type 2 diabetic patients' knowledge, attitude and practice towards diabetes self-care by implementing Community-Based Interactive Approach-diabetes mellitus strategy. BMC research notes. 2012; 5:315. 10.1186/1756-0500-5-315.
66.    Al-Qazaz HK. Hassali MA. Shafie AA. et al. Perception and knowledge of patients with type 2 diabetes in Malaysia about their disease and medication: a qualitative study. Research in social & administrative pharmacy: RSAP. 2011; 7(2):180-91. 10.1016/j.sapharm.2010.04.005.
67.    Pongmesa T. Li SC. Wee HL. A survey of knowledge on diabetes in the central region of Thailand. Value in health: the journal of the International Society for Pharmacoeconomics and Outcomes Research. 2009; 12 Suppl 3: S110-3. 10.1111/j.1524-4733.2009.00641.x.
68.    Huang JP. Chen HH. Yeh ML. A comparison of diabetes learning with and without interactive multimedia to improve knowledge, control, and self-care among people with diabetes in Taiwan. Public health nursing. 2009; 26 (4):317-28. 10.1111/j.1525-1446.2009.00786.x.
69.    SA Feleke. CM Alemayehu. HT Adane. Assessment of the level and associated factors with knowledge and practice of Diabetes Mellitus among Diabetic Patients attending at FelegeHiwot Hospital, Northwest Ethiopia. Clinical Medicine Research; 2013: 2(6): 110-120. 10.11648/j.cmr.20130206.11.
70.    DK Upadhyay. S Palaian. PR Shankar. P Mishra. Knowledge, Attitude and Practice about Diabetes among Diabetes Patients in Western Nepal. Rawal Medical Journal. 2008; 33(1): 8-11.
71.    Z Saadia. S Rushdi. M Alsheha. et al. A Study of Knowledge Attitude and Practices of Saudi Women towards Diabetes Mellitus. A (KAP) Study in Al-Qassim Region. The Internet Journal of Health. 2009. 11 (2). 10.4236/jdm.2015.52014
72.    Al-Maskari F. El-Sadig M. Al-Kaabi JM. et al. Knowledge, Attitude and Practices of Diabetic Patients in the United Arab Emirates. PLoS ONE. 2013. 8(1): e52857. 10.1371/journal.pone.0052857.
73.    Vandamme E. Concepts and challenges in the use of knowledge-attitude-practice surveys: Literature review. Department of Animal Health. Institute of Tropical Medicine. 2009; 1:1-7. 74002477.
74.    Kaliyaperumal K. Guideline for Conducting a Knowledge, Attitude and Practice (KAP) Study. AECS Illumination. 2004; 4 (1): 7-9.
75.    Facts and Figures. Asian Diabetes Prevention Initiative. 2015. Available online at: Accessed on January 25, 2020.
76.    Chao J. Song L. Zhang H. et al. Effects of comprehensive intervention on health-related quality of life in patients with chronic hepatitis B in China. BMC health services research. 2013; 13(1): 386. 10.1186/1472-6963-13-386.
77.    Samidha Kamtekar. Vrushali Keer. Management of Diabetes: A Review. Research J. Pharm. and Tech. 2014; 7(9): 1065-1072.
78.    Beauchamp A. Batterham RW. Dodson S. et al. Systematic development and implementation of interventions to OPtimise Health Literacy and Access (Ophelia). BMC public health. 2017 Dec 1; 17(1):230. 10.1186/s12889-017-4147-5.
79.    Li Z. Jin H. Chen W. et al. Influencing Factors of Knowledge, Attitude, and Practice regarding Medical Nutrition Therapy in Patients with Diabetes: A National Cross-Sectional Study in Urban China. Journal of diabetes research. 2017. 10.1155/2017/8948452.
80.    Hisham A. Abbas. Mona A. El-Sayed. Laila M. Al-Kadi. Amany I. Gad. Diabetic foot infections in Zagazig University Hospital: bacterial etiology, antimicrobial resistance and biofilm formation. Research J. Pharm. and Tech. 2014; 7(7): 783-788.
81.    Sajel S. Saranya P. Quality of Life in patients experiencing Diabetic Foot Ulcer: A cross sectional study in a Clinical Pharmacist’s Perspective. Research J. Pharm. and Tech. 2017; 10 (1): 219-222. 10.5958/0974-360X.2017.00046.4.
82.    Li Z. Jin H. Chen W. et al. Influencing Factors of Knowledge, Attitude, and Practice regarding Medical Nutrition Therapy in Patients with Diabetes: A National Cross-Sectional Study in Urban China. Journal of diabetes research. 2017; 2017. 10.1155/2017/8948452.
83.    Knight J. Nigam Y. Andrade M. Diabetes management 2: long-term complications due to poor control. Nursing times. 2017; 113(4):45-8.
84.    Pun SP. Coates V. Benzie IF. Barriers to the self‐care of type 2 diabetes from both patients’ and providers’ perspectives: literature review. Journal of Nursing and Healthcare of Chronic Illness. 2009; 1(1): 4-19. 10.1111/j.1365-2702.2008.01000.x.

Recomonded Articles:

Research Journal of Pharmacy and Technology (RJPT) is an international, peer-reviewed, multidisciplinary journal.... Read more >>>

RNI: CHHENG00387/33/1/2008-TC                     
DOI: 10.5958/0974-360X 

56th percentile
Powered by  Scopus

SCImago Journal & Country Rank

Recent Articles


Not Available