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Knowledge, Attitudes, Practices and Behaviour on Non-Communicable Diseases, Kosovo 2016
Qamile Ramadani, Elvira Rasimi, Ariana Bytyci
Accessible Quality Healthcare Project
• Funded by:
• Implemented by:O
utc
om
e 1
• Primary Health Care providers in project municipalities deliver quality services that respond better to communities’ needs, including those of vulnerable groups
Ou
tco
me
2
• Health managers in project municipalities improve their performance in guiding service delivery towards continuous quality improvement that responds to communities’ needs
Ou
tco
me
3
• Health awareness and care seeking behavior of the population in project municipalities improves (in particular of vulnerable groups)
Purpose of KAPB study
Assess the knowledge, attitude,
practice and behaviour of general
population, particularly focusing on
vulnerable groups regarding selected
non-communicable diseases (NCDs),
and citizens’ rights to health.
Methodology
1) Quantitative survey
• Quantitative questionnaire
• Face-to-face interviews
• “In-home”
• 1200 respondents, 18+
• Urban and rural areas
• Multi-staged random probability sampling
2) Qualitative research
• 12 focus group discussion
• Each group 4-5 participants
• 18+
• Urban and rural areas
• Random selection with criteria of the target group
Sampling
1) Quantitative survey
• 1200 respondents
• 100 respondents per Municipality
• 30-50 respondents in the small Municipalities
• 48% males and 52% females
• Albanian sub-sample: 950 effective interviews
• RAE sub-sample: 250 effective interviews
2) Qualitative research
• 12 focus group discussions
• 9 Albanian community (6 with women, 3 with men)
• 3 RAE community (1 with women, 3 with men)
• 5 Urban
• 7 Rural
Methodology
• The questionnaire for the quantitative stage had the following sections:
Chronic Respiratory Diseases
Salt and Sugar
Tobacco UseAlcohol Consumption
High Blood Pressure
Lifestyle Advice
Physical Activity
Cardiovascular Diseases
Child Diarrhoea
DiabetesDiet Healthcare Seeking
Patients Rights
Results
1) Quantitative Survey
Risk Factors of NCDs
Yes, 20.6%
No, 79.4%
Do you currently smoke any tobacco products, such as cigarettes, cigars or pipes?
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
Tota
l
Use
rs
No
n-u
sers
Pu
blic
ser
vice
use
rs
Pri
vate
ser
vice
use
rs
Alb
ania
n
RA
E
Mal
e
Fem
ale
Ru
ral f
emal
es
18
-24
yo
25
-34
yo
35
-44
yo
45
-54
yo
55
+ yo
0-1
99
EU
R
20
0-3
99
EU
R
40
0-5
99
EU
R
60
0+
EU
R
Less
th
an p
rim
ary
Pri
mar
y
Seco
nd
ary
Un
iver
sity
an
d h
igh
er
Urb
an
Ru
ral
Total Usage Users Ethnicity Gender Age HH Income Education Residence
Tobacco use among demographic segments
a) Tobacco use
Risk Factors of NCDs
Yes, 15.7%
No, 84.3%
Have you ever consumed any alcohol such as beer, wine or spirits?
0%
10%
20%
30%
40%
50%
Tota
l
Use
rs
No
n-u
sers
Pu
blic
ser
vice
use
rs
Pri
vate
ser
vice
use
rs
Alb
ania
n
RA
E
Mal
e
Fem
ale
Ru
ral f
emal
es
18
-24
yo
25
-34
yo
35
-44
yo
45
-54
yo
55
+ yo
0-1
99
EU
R
20
0-3
99
EU
R
40
0-5
99
EU
R
60
0+
EU
R
Less
th
an p
rim
ary
Pri
mar
y
Seco
nd
ary
Un
iver
sity
an
d h
igh
er
Urb
an
Ru
ral
TotalUsage Users Ethnicity Gender Age HH Income Education Residence
Consumption of alcohol (ever used) among demographic segments
b) Alcohol consumption
Risk Factors of NCDs
0
1
2
3
4
5
6
Tota
l
Use
rs
No
n-u
sers
Pu
blic
ser
vice
use
rs
Pri
vate
ser
vice
use
rs
Alb
ania
n
RA
E
Mal
e
Fem
ale
Ru
ral f
emal
e
18
-24
yo
25
-34
yo
35
-44
yo
45
-54
yo
55
+ yo
0-1
99
EUR
20
0-3
99
EU
R
40
0-5
99
EU
R
60
0+
EU
R
Less
th
an p
rim
ary
Pri
mar
y
Seco
nd
ary
Un
iver
sity
an
d h
igh
er
Urb
an
Ru
ral
Usage Users Ethnicity Gender Age HH Income Education Residence
Consumption of fruits in a typical week
Days a week eating fruit Number of servings per day
c) Diet
Consumption of fruits:
- on average 5 days in a week
- on average2 servings of fruits on those days where they do eat fruits
c) Diet
Usage of food in diet
Several
times a
day
Once a
day
Several
times a
week
Less
oftenNever
22% 29% 18% 7%
24% 28% 12% 3%
Cakes, sweets, chocolate or biscuits 5% 18% 35% 25% 12%
Soft drinks, such as Coca Cola, Fanta, energy drinks 16% 22% 28% 21% 8%
15% 9% 5% 3%
Commercially baked goods 2% 8% 40% 33% 14%
3% 11% 26% 13%
Solid fats 2% 18% 30% 15% 5%
Fried food 12% 23% 32% 17% 13%
Frequency of usage of food in diet
21%
32%
65%
40%
Sugar in your tea or coffee
Packaged snack foods
Salt or a salty sauce to your food right before you eat it
or as you are eating it
Salt, salty seasoning or a salty sauce used in cooking or
preparing foods in your household
39%
52%
46%
0%
10%
20%
30%
40%
50%
60%
Men Women Both sexes
Not meeting WHO recommendations on physical activity for health
Risk Factors of NCDs d) Physical activity
KAPB on NCDs a) Diabetes
Diabetes
Risk factors
Early signs
Preventive measures
• KAPB on NCDs
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Tota
l
Use
rs
No
n-u
sers
Pu
blic
ser
vice
use
rs
Pri
vate
se
rvic
e u
sers
Alb
ania
n
RA
E
Mal
e
Fem
ale
Ru
ral f
emal
es
18
-24
yo
25
-34
yo
35
-44
yo
45
-54
yo
55
+ yo
0-1
99
EU
R
20
0-3
99
EU
R
40
0-5
99
EU
R
60
0+
EUR
Less
th
an p
rim
ary
Pri
mar
y
Seco
nd
ary
Un
iver
sity
an
d h
igh
er
Urb
an
Ru
ral
Total Usage Users Ethnicity Gender Age HH Income Education Residence
Knowledge about diabetes among demographic segments
a) Diabetes
• Knowledge about diabetes higher among users of health services compared to non-users
• Direct correlation between knowledge about diabetes and:- Age - Household
income and- Level of education
KAPB on NCDs a) Diabetes
Seeking treatment
Confidence among diabetics
Informed about prob. associated with diabetes
Willingness to be informed
KAPB on NCDs a) Diabetes
Glucose measurements
Taking medication
HH member taking medication
HH member taking insulin
Taking insulin
Glucose measurements
Taking medication
Taking insulin
KAPB on NCDs b) Hypertension
Hypertension
Complications
KAPB on NCDs b) Hypertension
Confidence
Informed about prob. associated with hypertension
Willingness to be informed
Results
2) Qualitative Research
• Perception:
– Young people smoke more than others
– Young males smoke more than young females do
• Most smokers smoke in their home environment
• They believe smoking within enclosed spaces affects the health of other family members
• BUT they would only stop smoking inside the house, when they have guests that do not smoke, otherwise they will not stop.
“I can’t imagine what would it would be like, if I couldn’t smoke inside. It has never occurred to me to stop smoking inside the
house, I am used to this.”(Group with female, Gjakove, urban)
Risk Factors: a) Attitudes and practices about smoking
70% of smokers smoke inside their houses and that 21% of smokers that declared that they smoke inside their houses have children under 18 years
old in their household
Risk Factors: b) Attitudes and practices about physical activity
Rural areas
• Have limited opportunities for physical activity
• See as an obstacle the mind-set that still prevails in these rural areas
Urban areas
• Youth is more physically active because they have lots of sport centres and gyms nearby
• Elderly and mothers with children are less active because there is a lack of walking trails or parks
“A doctor advised me that housework is not enough, I have to walk. But where can I walk here in the village, people will start talking!” (Group with female, Malisheva, rural)
• Usually have two main meals per day
• Lunch and dinner are most important
• The types of foods for breakfast, lunch and dinner - almost the same….
Diet: Eating habits
Breakfast
• Dairy products
• Fried eggs
• Dough products
• Milk
• Children:
• Processed meat (salami, sausage)
• Chocolate cream
• Butter
Lunch
• Usually:
• Meat products
Dinner
• Pasta
• Bread
• Corn bread etc
High knowledge about NCDs, but a very low level of knowledge about risk factors, early signs and preventive measures
General lack of understanding about smoking as a risk factor for NCDs
Significant portion of the population lacks the recommended physical activity
RAE community shows far riskier behaviours especially towards smoking
Women are more knowledgeable about NCDs than men, especially when it comes to risk factors, early signs and preventive measures
Conclusions
Raise awareness particularly of the RAE community, on risk factors, early signs and preventive measures of NCDs
Inform public on the associated problems with NCDs through healthcare professionals
Increase understanding that smoking is a risk factor related to NCDs
Inform public about the importance of a healthy diet and physical activity
Raise awareness about the importance of seeking medical treatment in cases people have NCDs.
Recommendations
Recommended