Association between Provided Lifestyle Health Advice and Changes on Behavior of Diabetic Patients in Ramallah Governorate driven by Socioeconomic Factors
Abstract
Diabetes is responsible for about (25%) of deaths in adults aged 35 to 64 years across the Middle East region. Recent studies indicated that the prevalence of diabetes among Palestinians aged 20 to79 is approximately (20.6%), which is high in range compared to a worldwide prevalence of 6%, underscoring the urgent need for prevention and management through providing effective education programs. The study aims to assess the relationship between the provided lifestyle health advice in Ramallah government primary health clinics and the changes in diabetes health-related behaviors, driven by socioeconomic demographic factors. In accordance to the provided health advice, the study found that (3.3%) received always and often advice in terms of smoking, (0.8%) of consuming healthy diet, (1.6%) of practicing physical activity similarly to adherence to medication. A statistically significant association was reported only between the diet advice provided by healthcare providers and eating healthy diet (p=.000; p=.000 respectively). On the other hand, age of participants showed a statistically significant difference across the level of delivered health advice respecting to smoking(p=.001), while gender & income affect the ability to receive health advice respecting to diet (p=.048; p=.03 respectively). Educational level & income affect the ability to receive health advice concerning physical activity (p=0.036; p=0.019 respectively). Level of education and the occupation of diabetic participants influenced the level of inquiring health advice regards medication (p=0.025; p=0.032). Health education at the primary level is considered essential for promoting health of diabetic patients by modifying risk factors concerning diet, physical activity, medication, smoking and alcohol consumption. Sociodemographic factors are integral part in understanding and improving these lifestyle behaviors. Initiating training programs for healthcare providers is significant to address the patients’ needs in the primary healthcare clinics, while launching a web-based educational platform, being accessible for patients could be helpful for enrichment of information.
References
2. Albelbeisi et al. (2020). Capacity of Palestinian primary health care system to prevent and control of non-communicable diseases in Gaza Strip, Palestine: A capacity assessment analysis based on adapted WHO-PEN tool. Int J Health Plann Mgmt,1–14. https://doi.org/10.1002/hpm.3022
3. Allen, L., et al. (2017). Socioeconomic status and non-communicable disease behavioural risk factors in low-income and lower-middle-income countries: a systematic review. Lancet Glob Health ,5: e277–89.
4. American Diabetes Association. (2021). Social determinants of health and diabetes: A scientific review. Diabetes Care, 44(1), 258-279. https://doi.org/10.2337/dci20-0053
5. Armocida B, Monasta L, Sawyer SM, Bustreo F, Onder G, Castelpietra G, Pricci F, Minardi V, Giacomozzi C, Abbafati C, Stafford LK, Pasovic M, Hay SI, Ong KL, Perel P, Beran D and GBD 2019 Europe Adolescent Diabetes. (2024). The Burden of Type 1 and Type 2 Diabetes Among Adolescents and Young Adults in 24 Western European Countries, 1990–2019: Results from the Global Burden of Disease Study 2019. Int J Public Health ,68 ,1606491. doi: 10.3389/ijph.2023.1606491
6. Corsi, D. J., Subramanian, S. V., Lear, S. A., Teo, K. K., Boyle, M. H., Raju, P. K., Joshi, R., Neal, B., & Chow, C. K. (2014). Tobacco use, smoking quit rates, and socioeconomic patterning among men and women: a cross-sectional survey in rural Andhra Pradesh, India. European journal of preventive cardiology, 21(10), 1308–1318. https://doi.org/10.1177/2047487313491356
7. Creswell, J. & Clark, V. (2017). Designing and Conducting Descriptive Methods Research. 3rd edi. Sage publications. ISBN:1483346986, 9781483346984
8. https://books.google.ps/books?id=eTwmDwAAQBAJ
9. Dey, S et al. (2022). Socio‑demographic, behavioural and clinical
10. factors influencing control of diabetes and hypertension in urban Mysore, South India:a mixed‑method study conducted in 2018. Archives of Public Health,80(234),2-15. https://doi.org/10.1186/s13690-022-00996-y
11. Dhungana, R.et al.(2014). Prevalence of cardiovascular health risk behaviors in a remote rural community of Sindhuli district, Nepal. BMC Cardiovasc Disord,14, 92. doi: 10.1186/1471-2261-14-92
12. Dweib, M., & El Sharif, N. (2023). Diabetes-Related Microvascular Complications in Primary Health Care Settings in the West Bank, Palestine. Journal of Clinical Medicine, 12(21), 6719. https://doi.org/10.3390/jcm12216719
13. Islam, M. (2017) Association between Socio-Demographic Factors and Blood Sugar Levels in Type 2 Diabetes Mellitus Patients in Bangladesh. Journal of Diabetes Mellitus, 7, 151-159. doi: 10.4236/jdm.2017.73012.
14. Kawi, J., Fudolig, M., Serafica, R., Reyes, A. T., Sy, F., Leyva, E. W. A., & Evangelista, L. S. (2024). Health information sources and health-seeking behaviours of Filipinos living in medically underserved communities: Empirical quantitative research. Nursing open, 11(3), e2140. https://doi.org/10.1002/nop2.2140
15. Kontsevaya and Farrington. (2017). Implementation of a package of essential noncommunicable (PEN) disease interventions in Kyrgyzstan: evaluation of effects and costs in Bishkek after one year. The Regional Office for Europe of the World Health Organization. https://www.who.int/europe/publications/m/item/implementation-of-a-package-of-essential-noncommunicable-(pen)-disease-interventions-in-kyrgyzstan-evaluation-of-effects-and-costs-in-bishkek-after-one-year
16. Kyrou et al. (2020). Sociodemographic and lifestyle-related risk factors for identifying vulnerable groups for type 2 diabetes: a narrative review with emphasis on data from Europe. BMC Endocrine Disorders, 20(Suppl 1),134. https://doi.org/10.1186/s12902-019-0463-3
17. Landrine, H., Corral, I., & Campbell, K. M. (2018). Racial disparities in healthcare provider advice to quit smoking. Preventive medicine reports, 10, 172–175. https://doi.org/10.1016/j.pmedr.2018.03.003
18. Mazlan, A., Adzharuddin, N., Omar, S., & Tamam, E. (2021). Online Health Information Seeking Behavior of Non-Communicable Disease (NCD) Among Government Employees in Putrajaya Malaysia. Jurnal Komunikasi: Malaysian Journal of Communication Jilid ,37(1) ,419-433
19. Migdalis, I.N. (2024). Chronic Complications of Diabetes: Prevalence, Prevention, and Management. J. Clin. Med, 13, 7001. https://doi.org/10.3390/ jcm13237001
20. Ong, K. L., et al. (2023). Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: A systematic analysis for the Global Burden of Disease Study 2021. The Lancet, 402(10397), 203–234. https://doi.org/10.1016/S0140-6736(23)01301-6
21. Palestinian Central Bureau of Statistics (PCBS). (2024). Palestine in Figures 2023.Ramallah- Palestine.
22. Palestinian Health Information Center (PHIC). (2024). The Annual Health Report for 2023. Palestinian Ministry of Health, Ramallah -Palestine
23. Rawal, L. B., Kharel, C., Yadav, U. N., Kanda, K., Biswas, T., Vandelanotte, C., Baral, S., & Abdullah, A. S. (2020). Community health workers for non-communicable disease prevention and control in Nepal: a qualitative study. BMJ open, 10(12), e040350. https://doi.org/10.1136/bmjopen-2020-040350
24. Sánchez Urbano, RE., et al. (2021). Reception of Dietary and Other Health-Related Lifestyle Advice to Address Non-communicable Diseases in a Primary Care Context: A Mixed-Method Study in Central Argentina. Front. Nutr, 8,622543,1-12. doi: 10.3389/fnut.2021.622543
25. Shawahna, R., Mohammad, J., Zmiro, A., & Kashkoush,S. (2024). Factors associated with physical inactivity among Palestinians with type 2 diabetes mellitus treated in resource‑limited settings. Nature Portfolio, 14(11256).1-10. https://doi.org/10.1038/s41598-024-60876-z
26. Sinclair J, Lawson B, &Burge F. (2008). Which patients receive on diet and exercise? Do certain characteristics affect whether they receive such advice? Canadian FamilyPhysician,54(3):404-12.
27. Singh, H.& Bharti, J. (2021). Non-Communicable Diseases and Their Risk Factors: Review. EAS J Parasitol Infect Dis,3(6),83-86. ISSN: 2663-09. DOI: 10.36349/easjpid. 2021.v03i06.001
28. Walker, R. J., Strom Williams, J., & Egede, L. E. (2016). Influence of social determinants, diabetes knowledge, health behaviors, and diabetes distress on glycemic control in adults with type 2 diabetes. BMC Endocrine Disorders, 16(1), 1-14. https://doi.org/10.1186/s12902-016-0119-1
29. Wheeler, T. (2024). What is A MET score? WebMD. http://www.webmd.com/fitness-exercise/what-is-a-met -score
30. World Bank Group. (2025). Diabetes prevalence (% of population ages 20 to 79), health risk factors. International Diabetes Federation, Diabetes Atlas. Retrieved from https://data.worldbank.org/indicator/SH.STA.DIAB.ZS
31. World Health Organization (WHO). (2025) Fact Sheet: Diabetes. Retrieved from : https://www.who.int/health-topics/diabetes#tab=tab_1
32. World Health Organization. (2013). The WHO STEP wise approach to noncommunicable disease risk factor surveillance (STEPS). 20 Avenue Appia, 1211 Geneva 27, Switzerland. Retrieved from: www.who.int/ncds/steps
33. Wu, F., et al. (2015). Common risk factors for chronic non-communicable diseases among older adults in China, Ghana, Mexico, India, Russia and South Africa: the study on global AGEing and adult health (SAGE) wave 1. BMC Public Health,15(88),1-13. doi: 10.1186/s12889-015-1407-0.
Copyright (c) 2025 Fatemah Yaser Mahmoud Abu Abed
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
