UNDERSTANDING THE EXPERIENCES OF DIABETIC PATIENTS REGARDING SELF-

INJECTABLE TREATMENT

A RESEARCH PROPOSAL SUBMITTED IN PARTIAL FULFILMENT OF THE

REQUIREMENT FOR THE BACHELOR OF NURSING SCIENCE CLINICAL HONOURS
DEGREE

OF

THE UNIVERSTY OF NAMIBIA

BY

STUDENT NAME: NDARA FRANS NGUNDA

STUDENT NUMBER: 201708055

DATE: SEPTEMBER 2021

SUPERVISOR: DR VISTOLINA NUUYOMA (UNAM)

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Contents
UNDERSTANDING THE EXPERIENCES OF DIABETIC PATIENTS REGARDING SELF-
INJECTABLE TREATMENT........................................................................................................1
1.Background and introduction.......................................................................................................4
1.1 Problem statement.....................................................................................................................6
1.2 Purpose......................................................................................................................................7
1.3 Objectives..................................................................................................................................7
1.4 Significance of the study...........................................................................................................7
1.5 Limitation of the study...............................................................................................................8
1.6 Delimitation of the study...........................................................................................................8
1.7 Definition of concepts................................................................................................................8
2. Literature review..........................................................................................................................8
3. Research design and methods....................................................................................................11
3.1 Research design....................................................................................................................11
3.2 Population............................................................................................................................11
3.3 Sample and sampling technique...........................................................................................11
Exclusion criteria.......................................................................................................................12
3.4 Study setting.........................................................................................................................12
3.5 Data collection method and instrument...............................................................................13
3.6 Data collection procedure....................................................................................................13
3.7 Data analysis........................................................................................................................14
3.8. Pilot study...........................................................................................................................14
3.9. Trustworthiness...................................................................................................................14
3.9.1 Transferability...............................................................................................................15
3.9.2 Confirmability...............................................................................................................15
3.9.3 Credibility......................................................................................................................15
3.9.4 Dependability................................................................................................................15
3.10. Research ethics..................................................................................................................15
Research budget.............................................................................................................................16
Research timeframe.......................................................................................................................17
6. Reference...................................................................................................................................17

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1.Background and introduction
Diabetes mellitus is a group of metabolic diseases characterized by increased levels of glucose in
the blood (hyperglycaemia) (Hinkle & Cheever 2018). It is a chronic disease characterised by
chronic hyperglycaemia that requires lifelong treatment (MoHSS, 2013). Diabetic patients
present with different manifestations, this depends on their level of glucose in the blood. Hinkle
and Cheever (2018) noted that “classic clinical manifestations of diabetes include the “three Ps”,
polyuria, polydipsia, and polyphagia. Polyuria is defined as increased urination, polydipsia refers
to increased thirst and polyphagia is described as increased appetite.

According to Galan (2018), diabetic patients present with fatigue and weakness. Fatigue refers to
body weakness, this occurs as there is reduced breakdown of fats and proteins. Sudden loss of
visions also arises in most diabetic patients, they may have poor visions or at times they may
report that they are seeing things or changing visions. Tingling and numbness of the hands and
feet is also one of the signs that diabetic patients experience in their daily basis, they also present
with a dry skin and at the same time they have skin lesions or wounds that are normally slow to
heal that they bring infections. There are minor symptoms at onset of the disease, patients
experience sudden weight loss, they start vomiting or nausea and they have abdominal pain.
MoHSS (2011) also states that some patients run into shock, they have a ketonic smell (sweet
apple smell), they also have a deep acidotic breathing, sometimes subnormal temperature.

Diabetes is a related to certain factors, although the main cause is elevated sugar, there are other
factors that increases the occurrence of diabetes in certain human beings. Family history, one is
at risk of getting diabetes if one of the parents or any close related family was having the disease.
Hinkle & Cheever (2018) states that race or ethnicity also increases the chances of one getting
the disease, people of certain races including black people are at a higher risk. Age also can
increase the risk of one getting diabetes, as one person ages or gets older, the risk of you getting
the disease also tends to rise, as you tend to less exercise and body weakens.

MoHSS (2011) also states that those that are obese and constantly stressing are at a higher risk
of getting diabetes, as those that are obese have developed more fatty tissues and that the cells
become more resistant to insulin (hormone that lowers the glucose\sugar level in the tissue), this
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in turn raises the sugar level in the body. People that are inactive are also capable of getting
diabetes, as these people are inactive, large amounts of sugar are stored, and one who is physical
active tends to use up the sugar and reduce them, that diabetes is lowered. Those that have high
blood pressure are likely to have to have diabetes. Other diabetic patients have got the disease
due to consuming of unhealthy diets, that’s when they eat high sugary diets, fats and any other
substance containing high sugar contents, this increases the sugar level in the body that the
insulin is unable to use up or lower down

According to World Health Organisation (WHO) (2015) , the number of people with diabetes
has risen from 108 million to 422 million in 2014, an estimated death of 1.6 million deaths were
directly caused by diabetes in the world. The world health organisation (2012) estimates that
diabetes was seventh leading cause of death in the world. In a study by Perez, Alvarez, Dilla,
Vicente & Domingo (2013) Insulin treatment has also increased to the number of deaths as some
patients do not normally follow instructions, or certain patients do not really understand how to
use this medication, studies have indicated that recommended glycaemic goals are achieved by
less than 50% despite the benefits of insulin therapy. WHO states in its latest data published in
2017,that diabetes in Namibia reached 615 or 3.98% of the total deaths, 52, 77 per 100000 of the
population, With that it ranks the country at position 33 in the world relating to deaths from
diabetes, with different causes, including treatment as one of them. The MoHSS (2013) states
that adults of the age 35-64, 44.2% are women and have been diagnosed with diabetes, that
34.7% of men have also been diagnosed with Diabetes. World Health Organisations also states in
its diabetes country profile (2016), that 4% of 2 459 000 were deaths recorded in Namibia.
Regionally, statistics MoHSS (2013) shows that Kavango East region has fewer diabetic cases,
as 0, 5% are women while 1.4% are men. MoHSS, (2018) estimates through the health
information system that Rundu has a total of 568 patients diagnosed with diabetes in a year.

Diabetes continues to be a threat in Rundu intermediate hospital (R.I.H) a number of deaths

from diabetes continues to grow slowly. Death associated with diabetes has to do with, patient
not adhering to self-medication, ulcers that develop gangrenes and wounds that do not heal.
Patients have the tendency of forgetting to inject themselves and in turn this leads to other major
problems such as death. A lot of patients face certain problems, causing them not to take their

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treatment on time, this can be due to alcohol abuse, old age, and others do not just take their
medications at all (MoHSS, 2018).

MoHSS (2011), has put up the main treatment, which is the insulin treatment mainly to those that
have increased sugar levels, As soon as the blood glucose is controlled, a patient is put on a two
times regimen of insulin injection per day, this which some do at home on their own. There are
different types of insulin, the oral and injectable. Patients who are put on injectable insulin are
trained by the nurses on how to inject themselves. They are given all the needed equipment to
use such as container for used needles, cottons and both the needles and syringes. The main
function of insulin is to lower the glucose levels in the body. According to WHO (2018),
treatment for diabetes can involve the changing of proper diets, physical activities and avoiding
the use alcohol and tobacco smoking , as this lowers the glucose level.

1.1 Problem statement

Diabetic patients are initially encouraged to maintain a healthy diet and exercise regimen,
followed by early medication, generally include one or more injectable hypoglaecemic agents
and later may include an oral treatment. To prevent the complications associated with diabetes,
therapy frequently includes medication for control of other complication and other disorders and
it is recommended glycemic goals are achieved by less than 50% of patients (Perez, 2013). There
are many potential reasons for nonadherence to treatment, frequently one or more person has
different life experiences, this could be age, perception and duration of disease, polytherapy ,
psychological factors , tolerability, interaction between patients and healthcare providers and this
tends to increase diabetic patients morbidity in different health facilities (Tiv, Viel, & Mauny,
2012). Simon, Gude, Holleman, Hoekstra, and Peek, (2014), noted that patients experience
difficulties with the timing of injections, and with integrating insulin therapy with other therapies
and daily activities, and this leads to non-adherence which leads to other complications. In
Rundu intermediate hospital, it is estimated that 207 diabetic patients are on self-injectable
insulin as a treatment for diabetes mellitus (MoHSS, 2018). However, it is known that there is
less communication and fewer meetings of patients and the health professionals, and due to the
fact that patients and health professionals hardly meet, there is a little knowledge given about
diabetes to the patients or some patients miss out on the important information regarding their

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condition, and then this results into patients missing out on new information which leads to poor
prognosis in diabetic patients. (MoHSS, 2014). It is not known how diabetic patients on self-
injectable insulin experience the administering of medication in their home settings. This led to
the following research question; how do patients with diabetes experience the self-injectable
treatment?

1.2 Purpose
The purpose of the study is to explore and describe the lived experiences of patients with
diabetes regarding self-injectable treatment in Rundu, Kavango east region.

1.3 Objectives
The objectives of the study are to:

 Explore the lived experiences of diabetic patients on self-injectable treatment in Rundu

Kavango east region.
 Describe lived experiences of diabetic patients on self-injectable treatment in Rundu
Kavango east region.

1.4 Significance of the study

The study significance is based on the problem identified, thus the research should contribute
benefits to the society and create health science knowledge in a meaningful manner (Brink, van
der Walt & van Rensburg, 2018).

This study bears significance to the following below;

Diabetic patients- the study findings will benefit diabetic patients as they will share their
experiences and based on the results, it’s possible for the MoHSS to come up with educational
materials to help them gain knowledge on how to do the self-injecting treatment well.

The Ministry of Health and Social Services- Findings of the study may contribute valuable
information that may be needed in the formulation of new policies regarding the experiences of

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diabetic patients on self-injectable treatment, as they will have a broad view of experiences of
those living with diabetes.

1.5 Limitation of the study

Limitations are the weakness in the study that cannot be controlled (Brink, Van der Walt & Van
Rensburg, 2018). This study will be conducted at Rundu intermediate hospital only and on
patients that are home based self-care, so findings will not be generalized. This study will be
done on patients that have been diagnosed with diabetes regardless of the years the patients have
been living with diabetes. The study will also be conducted on diabetic patients that have been
recently diagnosed irrespectively of the newly diagnosing criteria of diabetes.

1.6 Delimitation of the study

Delimitations are boundaries set by the researcher in order to control the range of a study, (Brink,
Van der Walt & van Rensberg, 2018). Since the limitations are beyond the researcher’s control,
the delimitations will be within control. The study will just be limited to the experience of
patients on self-injectable treatment and not those that are doing oral anti-diabetic agents. The
study will only be limited to the diabetic patients in Rundu Intermediate Hospital in exclusion of
other hospitals.

1.7 Definition of concepts

Diabetes mellitus - is a group of metabolic diseases characterized by increased levels of glucose
in the blood (hyperglycaemia) (Hinkle & Cheever 2018).

Diabetic patient – a diabetic patient is a person diagnosed with diabetes as a medical condition.

Experience - The accumulation of knowledge or skill that results from direct participation in
events or activities (Kindersley, 2018). In this study, experience as a term focuses on the
accumulated skills and knowledge of diabetic patients regarding self-injectable treatment.

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2. Literature review
A literature review consists of all written sources relevant to the topic of interest, it involves
finding, reading, understanding, and forming conclusions about published research and theory as
well as presenting it in an organized manner (Brink, van der Walt & van Rensburg, 2018). The
purpose of the literature review is to explain and show what is known about the experience of
diabetic patients regarding self-injectable medication, it shows a different number of sources
what is known about this study, the literature review contains various sources that contains
different facts and opinions about the daily lived experiences of type two diabetic patients.

Simon, Gude,., Holleman, , Hoekstra, and Peek, (2014), noted that patients with diabetes on
insulin therapy encounter multiple obstacles when performing self-management behavior. Insulin
injection itself is painful, a daily recurring burden, and can be embarrassing when performed in
the presence of others. Patients experience difficulties with the timing of injections, and with
integrating insulin therapy with other therapies and daily activities. Adjustment of insulin dose is
a challenge; some patients are ignorant of treatment targets and find it difficult to cope with
unpredictable blood glucose levels. Patients have personal problems, with that it may affect the
way they respond to treatment and that may add up to their level of conditions and in turn they
may die.

Another study conducted by Berenguera ,Molló-Inesta, Manel, Josep, Bonaventura, Rubinat and
Mauricio (2016) stated that “The patients perceived the diagnosis of type 2 diabetes mellitus as a
threat to their health, and the diagnosis generated cognitive and emotional representations of type
22 DM. The emotions associated with the diagnosis included fear of the future, worry, denial,
sadness, and dejection. The patients also wondered if there could have been an error in their test
results because they did not present any symptoms.” These results show that some patients face a
denial stage where by they do not accept their conditions.

According to a study done by Engström, Leksell, Johansson, and Gudbjörnsdottir (2016) to live a
good life with diabetes is demanding for the individual, but experienced barriers can be eased by
support from others in the personal sphere, and by professional support from diabetes care.
Furthermore diabetes care was a crucial resource to nurture the individual’s ability and
knowledge to manage diabetes, and to facilitate life with diabetes by supplying support,
guidance, medical treatment and technical devices tailored to individual needs. The analysis

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resulted in the overarching theme ‘To live a good life with diabetes’ constituting the two main
categories ‘How I feel and how things are going with my diabetes’ and ‘Support from diabetes
care in managing diabetes’ including five different categories. This study aims to explain that
one that has been diagnosed with diabetes needs support from others and a little bit of knowledge
on how they can cope with the condition and the way they accept their condition.

Another study conducted by Zheng , Liu , and Deng (2019) stated in their study which was based
on effects of an outpatient diabetes self-management education on patients with type 2 diabetes
in china, indicates poor self-management behaviour of these patients. This means that most
patients did not manage their conditions in a way that they were expected to when they were
alone or when they heard to take care of themselves. This study also was able to finalise that
based on the above fears of injection, the patients would rather take more OADs (oral anti-
diabetic agents) than inject insulin, Thus, they showed a poor adherence to injection compared to
OADs. This study showed that the 2-session diabetes education programme could improve the
level of self-reported self-management, psychological distress, and glycaemic control in patients
with type 2 diabetes mellitus.

A study which was conducted by Tuula, Eija & Päivi (2013), which was based on the everyday
living with diabetes described by family members of adult people with type 1 diabetes stated a
fact that adherence to the self-management is a long process for the person with diabetes and for
the family members. There are many barriers too optimal diabetes self-management faced by the
person with diabetes. Self-management is affected by several factors, such as feelings, attitudes,
self-efficacy, knowledge and skills, and the motivation of the person with diabetes. To add on,
this study shows that support from the family is also important in managing diabetes, family
members supporting diabetic patients need education and knowledge on this condition and how
they can manage it in the right way.

Carolan, Holman & Ferrari (2014), in their study experiences of diabetes self-management: a
focus group study among Australians with type 2 diabetes finalized with two different findings
whereby one was focused to the health workers and the other one was focused to the participants.
Participants described their experiences of managing their diabetes as emotionally, physically
and socially challenging, throughout, participants highlighted the impact of diabetes on the
family, and the importance of family members in providing support and encouragement to assist

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their self-management efforts. Patients faced different problems that could hamper their
adherence to treatment, and that these people mostly needed assistance from the other support
groups. They also stated that, it was important for healthcare professionals and family members
to recognize the significant emotional burden that diabetes imposes, and the type and quantity of
information individuals with diabetes prefer. Health workers needed to provide clear information
to diabetic patients and information that made sense to them for them to cope with their
condition.

3. Research design and methods

3.1 Research design

A qualitative phenomenological design will be used in the study, as it is mostly based diabetic
patients experiences. Qualitative phenomological studies examine human experience through
descriptions provided by the people involved and answer questions, ‘ what is it like to experience
this or that?, and these experiences are called ‘lived experiences’ Brink, van der Walt & van
Rensburg (2016), A qualitative research design is naturalistic, which focuses on natural settings
where interactions occur (Maree, 2016).This design was chosen because it is going to focus on
the lived experiences of diabetic patients on insulin self- injectable treatment.

3.2 Population
Brink, van der Walt & van Rensburg (2016), defined population as elements or entire groups of
individuals, objects, events or substances that possess some characteristics that is of the interest
to the researcher. In Rundu Intermediate Hospital there is a male medical ward and a female
medical ward where they usually have admissions of less than 20 diabetic patients on self-
injectable treatment and another surgical ward whereby they have admissions of less than 15
diabetic patients in a month or two on self-injectable treatment, when they have certain
complications, and by that the researcher will select then the participants from the two medical
wards (male and female ward) and surgical ward because they are the wards where most diabetic
patients on self-injectable treatment are admitted.

3.3 Sample and sampling technique

A sample is referred to as to a subset of a population comprising those selected to participate in
the study, Polit and Beck (2012), and sampling refers to the researchers process of selecting the
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sample from a population in order to obtain information regarding a phenomenon in a way that
represents the population (Brink, Van der Walt & van Rensberg, 2018). As it is a qualitative
study there will be no exact sample size as the accessible population will determine the
participant. The study is going to use non-probability sampling, because samples would not
present the whole total population, since the access to participants is limited. The researcher is
going to select participants who know the best or have the most knowledge regarding experience
of self-injectable treatment at their homes. A purposive/ judgmental sampling technique will be
used when selecting participants, this technique is based on the researcher’s judgment regarding
the participant, or object that are typical or representative of the study phenomena who are
especially knowledgeable (Brink, van der Walt & van Rensburg (2016). There is no exact
number of participants, researcher is going to continuously collect data from the knowledgeable
participants until data saturation will be reached.

Selection of the participants will include the following;

- Diabetic patients that has gone under self-injectable for at least one month at their homes.
- These diabetic patients should be admitted in Rundu Intermediate Hospital
- The diabetic patients should be above 18 years old and willing to participate in the study.

Exclusion criteria
- Those that are on self-injectable treatment, but less than 18 years old of age.
- Patients on self-injectable less than one month

3.4 Study setting

This study will be conducted in Rundu Intermediate Hospital, in Kavango East region. Rundu
Intermediate Hospital has sections or wards within it, and that’s Casualty and outpatient
department, surgical ward, high care ward, female ward, male ward, pediatric and maternity
ward including prem unit. The study will only be focused at three different wards that are the two
medical wards (female and male ward), where they are about 50 beds for each patient and the
surgical ward where they are 87 beds.

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3.5 Data collection method and instrument
Polit and brink (2012), in a qualitative study, the researcher goes into the field and collects data
by interviewing the participants, thus in this study the interview process is going to be used.
Unstructured interviews are limited by the researcher’s focus, interviews are conducted in a
conversational manner , but with a purpose, they are particularly useful for exploratory studies
where the researcher cannot structure questions before data collection, Brink, van der Walt &
van Rensburg (2016),. The researcher asks questions that are going to enable the interviewee to
elaborate more information that the researcher needs through a conversation, depending on the
interviewees answers the researcher would invite them to elaborate more. Unstructured
interviews will be imposed in this study, in order to produce in depth information from the
participants that are going to take part, as they will talk more about the experiences based on the
questions they are going to be asked. The researcher will use an interview guide which will
consist of the following main questions; the main questions will be,

 What are your experiences on the self-injectable treatment as a diabetic patient?

Furthermore to these questions there will be probe follow-ups questions just to increase detailed
exploration.

3.6 Data collection procedure

The researcher will seek for ethical clearance and approval from the Ministry of Health and
Social Services. After the approval has been granted, the researcher will approach the senior
medical officer or matron of Rundu intermediate hospital for the second approval to go in the
wards, then the researcher will seek approval from the registered nurses in-charge of the medical
and surgical wards in order to explain the process and gain another consent from the ward in-
charges. Then the researcher will approach the patients that are on self-injectable treatment and
seek consent from them and, to explain the aim and the inclusion criteria of this study. Then the
researcher will request for their permission to participate in the study and determine the
participants. Each participant who will agree to participate in the study will be given an informed
consent which he/she has to sign before participation in the study and the procedure of data
collection will be explained to him/her the research will use a recording tape for each participant
discussion to avoid loss of information from the participants and for better data analysis.

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3.7 Data analysis
Data analysis is to organize, provide structure to, and to elicit meaning from data (Polit & Beck,
2012). In this study, manual analysis strategy will be used whereby the researcher will have a
thorough review of all recorded information and then the process of coding which involves
inventing and applying a category system, Brink, van der Walt & van Rensburg (2016), the
researcher will thus have several categories or codes will be identified within the data collected
and the researcher will work with these categories to identify ones most prevalent for the
participant, researcher compares the data collected from one participant with that of another
until a final theme is determined. Different type of descriptive codes will be used in order to
organize data as these codes will be closely related to what participants will say.

3.8. Pilot study

Brink, Van der Walt and van Rensberg (2018), defines a pilot study as a small- scale, or a
dummy run of the main study. It allows the researcher to recognize and address unforeseen
problems that may arise during the course of the main study. This simply means the researcher
does the pre-testing of instruments that are going to be used in the main study. The researcher is
going to do a pilot study on admitted diabetic patients in different wards whereby they are going
to be interviewed as diabetic patients, this is going to be done to assess the interview process and
the interviewing skills and to observe if the questions being asked are enough to produce the data
that is needed by the researcher.

3.9. Trustworthiness
Brink, Van der Walt and van Rensberg ( 2018), defines trustworthiness in a qualitative research
that it tends to reject reliability and validity in favor of dependability, credibility, transferability,
conformability, consistency, auditability and recurrent patterning. The study will only ensure
trustworthiness by using credibility, conformability, transferability and dependability study (Polit
& Beck, 2012).

3.9.1 Transferability
Transferability refers to the ability to apply the process to other settings or groups (Polit & Beck,
2012). In this study, transferability will be ensured, by findings of the study could be used to
determine other patients experiences with different medical conditions.

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3.9.2 Confirmability
Polit & Beck (2012), confirmability refers to the potential for congruency of data in terms of
relevancy, meanings and relevant. The study will be supported with data from other sources that
will include reference.

3.9.3 Credibility
Polit & Beck (2012) defined credibility as the truth of the findings, as judged by participants and
others within the discipline. In this qualitative phenomenon design, this could be an indicative
that the data to be obtain will be of quality. This will be achieved through prolonged engagement
and persistent observation with the participants in the field. Interviews will surely put concrete to
the data as the participants will say what they experience.

3.9.4 Dependability
Brink, van der Walt & van Rensburg (2018) defines dependability as a further criterion to
establish the trustworthiness of the study. The enquiry auditor in this study will follow all the
processes and procedures that are being used by the researcher and they will determine if they
are acceptable or not.

3.10. Research ethics

Ethics in research refers to moral principles that call for respect of the right of the research
participants by researchers. Participation in the research will be voluntary and the informed
consent for participation will be obtained from the participants themselves. The participants have
the right to withdraw from the study at any time without the risk of penalty or prejudicial
treatment. Confidentiality of the information will be guarded and the privacy of all participants
will be respected, as the participants identities are going to be kept a secret and the participants
data are not going to be shared with their fellow participants or anyone. The research will explain
to participants of every group that the information to be discussed in that particular group should
not be disclosed to ensure anonymity. Furthermore, the researcher will not disclose the
participants’ names and link their identity to the research data Brink, van der Walt & van
Rensburg (2018).

Principle of respect and autonomy

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Principle of autonomy means that people should be free to do and decide whatever they want to
do, and respect for a person in African ethics embodies the right of a person to choose and to
make his or her own decision (Jegede, 2017). In this study, this two will be ensured in a way that
the participation in the study will be voluntary, as well as an informed consent will be issued to
participants whereby they will choose to participate or not, at the same time participants will
have the right to withdraw from the study at any time without any penalties.

Principle of justice
The principle of justice relates to fairness, fair selection of participants Mulaudzi, Mokoena &
Troskie (2010). Participants will be selected in relation to the purpose of the study, which is
every patient that has been diagnosed with diabetes and has gone under the self-care treatment at
home will have the chance to participate in the study.

Principle of beneficence
Beneficence is the duty to do or promote good, also states the potential benefits of individuals to
be maximized Mulaudzi, Mokoena & Troskie (2010). In this study patients that are going to
participate will be interviewed in a well working environment to prevent any harm.

Research budget

Item Price/unit Total

1. Photocopying &
Binding

Participant information sheet N$ 1 per page x 1 N$ 1. 00

and consent form

Interview guide N$ 1 per page x 1 N$1.00

Printing of final report N$ 1 per page x30 pages x 2 N$ 60.00

Binding N$ 35 x 2 N$ 70. 00

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 Subtotal N$ 132,00

2. Data collection
materials

Voice tape recorder device N$ 600 N$ 600

Memory card 4GB N$ 60 N$ 60

Subtotal N$ 660

3. Taxi fares Estimate based on:

Number of trips = 12 ( To
and from the hospital for data
collection)

Cost per trip = N$ 12

Sub – total N$ 144.00

Total estimated cost N$ 936,00

Research timeframe

Date Due Research Activities

10 July 2021 Submit proposal to MoHSS for ethical clearance
05 August 2021 Submit for permission to collect data at Rundu Intermediate Hospital
11 August 2021 Pilot study
30 August 2021 Data collection
10 September Data analysis
2021
30 October 2021 Whole Report draft
05 November Language editing
2021

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 30 November Final Report
2021
10 February 2022 Dissemination of findings (MoHSS and UNAM)

6. Reference
Berenguera A, Molló-inesta A, Manel M, Josep F, Bonaventura B, Rubinat E, Mauricio D.
(2016). Understanding the physical, social, and emotional experiences of people with
uncontrolled Type 2 diabetes: a qualitative study, Institut Universitari d’investigació en Atenció
Primàr, Spain

Brink, H., Van der Walt & Van Rensburg, G (2018). Fundamentals of Research Methodolgy
For Healthcare Professional (4th Ed.) Cape Town: Juta.

Carolan M, Holman J and Ferrari M.(2014). Experiences of diabetes self-management: a focus

group study among Australians with type 2 diabetes, College of Health and Biomedicine, St
Alban’s Campus, Australia

Engström M.S, Leksell J, Johansson U, Gudbjörnsdotti S, (2016). What is important for you? A
qualitative interview study of living with diabetes and experiences of diabetes care to establish a
basis for a tailored Patient-Reported Outcome Measure for the Swedish National Diabetes
Register, Sweden

Galan N.(2018) "What are the early signs of type 2 diabetes?." Medical News Today.
MediLexicon, Retrieved 5 Aug. 2019 . https://www.medicalnewstoday.com/articles/323185.php

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Hinkle JL, Cheever KC. (2018). medical surgical nursing(4 edition) America

Jegede S, (2017). African ethics, health care research and community and individual
participation. Journal of Asian and African studies, 44(2)239-53

Kindersley, D. (2018). Illustrated Oxford Dictionary. London: Oxford University Press.

Maree , K. (2016). First steps in research. Pretoria: Van Schaik.

Ministry Of Health And Social Services, (2018). Namibia demographic and health survery
(2013), namibia statistics agency, windhoek, namibia

Ministry Of Health And Social Services, (2011). namibia standard treatment guideline, listed,
february 2011, Windhoek, namibia

Ministry of Health and Social Services, (2014). Assessment of the National Quality Management
Systems Used to Monitor and Improve Quality in Health Service Provision in Hospitals and
Health Centres in Namibia, Windhoek, Namibia

Mulaudzi FM, Mokoena JD & Troskie R, (2010). Basic nursing ethics in practice(2nd ed) South
Africa

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Perez G. LE, Alvarez M, Dilla T, Vicente GG, Domingo OB, (2013). Adherence to therapies in
patients with type 2 diabetes, Spain

Polit, F.D., & Beck, C.T. (2012). Nursing Research: Generating and Assessing Evidence for
Nursing Practice (9th ed.). China: Lippincott Williams & Wilkins.

Simon, A. C., Gude, W. T., Holleman, F., Hoekstra, J. B., & Peek, N. (2014). Diabetes patients'
experiences with the implementation of insulin therapy and their perceptions of computer-
assisted self-management systems for insulin therapy. Journal of medical Internet
research, 16(10), e235. doi:10.2196/jmir.3198

Tiv M, Viel JF, Mauny F, (2012), medication adherence in type 2 diabetes. Medical information
department university hospital of Besancon, France

Tuula MR, Eija P, Päivi A, (2013), Everyday Living with Diabetes Described by Family
Members of Adult People with Type 1 Diabetes, SchoolofHealthScience NursingScience
UniversityofTampere, Finland

world health organisation (2016) diabetes country profile, retrieved on 27 march 2019 at
www.who.diabetescountry-profiles/nam

world health organisation (2018) standards of medical carewith diabetes retrieved on 27 march
19at www.int.medicalcarewithdiabetes

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 Zheng F, Suixin L, Yuan Liu, and Lihua Deng, “Effects of an Outpatient Diabetes Self-
Management Education on Patients with Type 2 Diabetes in China: A Randomized Controlled
Trial,” Journal of Diabetes Research, vol. 2019, Article ID 1073131, 7 pages, 2019.
https://doi.org/10.1155/2019/1073131

UNDERSTANDING THE EXPERIENCES OF DIABETIC PATIENTS REGARDING SELF-

INJECTABLE TREATMENT

INFOMED CONSENT

I hereby invite you to participate in my study which is on understanding the experiences of

diabetic patients regarding self-injectable treatment. This study is being conducted by Ndara
Frans in fulfillment of the requirements for the Bachelor of Nursing Science (clinical) (honours)
of the University of Namibia. The purpose of the study is to understand the lived experiences of
diabetic patients regarding the self-injectable treatment. Although the study will not benefit you
directly, the information that is going to be obtained may help the Ministry of health to identify
problems in the way their services are being offered and the changes that may be brought up.
You were being selected as a participant because you are diagnosed with diabetes and you are on
self-injectable treatment. There are no risks involved in participating in this study. You will be
required to meet with me once for a voice recorded interview that will approximately last for 25
minutes. I will keep a record of the studies participants, as well as the recordings of our
interviews. Your name will not appear on the recording, no one will be able to identify you, as
well as the information you will provide will not be known by anyone except the researcher only,
and no one will know that if have participated in the study or not, the study will be anonymous.
Your participation in this study is voluntary and you are under no obligation to participate. You
are free to withdraw without any penalty, even in the middle of the interview.

If you have any questions about the study, please feel free to contact me (Ndara Frans) at my
cell.

0813526895

20
Or at my e-mail: franslanny01gmail.com

I agree to participate in this study voluntarily and can withdraw at any time with no penalty:

Signature…………………………… date…………………………

Interview guide

1. Opening question

Tell me about your experiences on diabetes self-injecting treatment?

Would you elaborate more on how you do this self-treatment care at home?

2. Positive aspects

How is the self-care injecting strategy benefiting you as a patient that does this at home

3.Negative aspects

What are some of the challenges you face as a patient when you do the self-care injecting
strategy?

Concluding question

Before we finish with this interview, is there anything you would like to add on?

TO: Prof. L Pretorius

21
Associate Dean: School of Nursing

University of Namibia

THROUGH: Mr D Ashipala

Head of Department; School of Nursing

University of Namibia

Rundu Campus

FROM: Mr Ndara Frans Ngunda

201708055

University of Namibia

Rundu Campus

August 2021

Dear Sir/Madam

RE ; APPLICATION FOR APPROVAL OF RESEARCH PROJECT:

Herewith, I request permission to undertake a research study. I am currently registered with the
University of Namibia, Rundu Campus, as a Bachelor of Nursing Science (clinical) Honours
Degree nursing student. Undertaking a research is mandatory in order to complete this course.

22
The title of my research topic is: UNDERSTANDING THE EXPERIENCES OF DIABETIC
PATIENTS REGARDING SELF-INJECTABLE TREATMENT, Kavango East region. The
objective of the study is to explore the lived experiences of diabetic patients on self-injectable
treatment and describe lived experiences of diabetic patients on self-injectable treatment. . The
participants in the study will include Diabetic patients that has gone under self-injectable for at
least one month at their homes, these diabetic patients should be admitted in Rundu Intermediate
Hospital and The diabetic patients should be above 18 years old and willing to participate in the
study

The results of the proposed study will enlighten the Ministry of Health and Social Services
(MOHSS) to identify problems in the way their services is being offered at homes. Proposed
study could contribute to interventions for improving diabetic patients knowledge on their
condition and self-treatment care, and consequently improve the services as there will be proof
from the patients themselves on how they experience the self-injecting strategy.

Attached herewith please receive the proposal for your approval.

Thank you very much.

Yours Faithfully,

Mr Ndara Frans ngunda

TO: Executive Director

MINISTRY OF HEALH AND SOCIAL SERVICES

23
 PRIVATE BAG 1331

WINDHOEK

FROM: Mr Ndara Frans Ngunda

University of Namibia

Rundu Campus

August 2021

Dear Sir

RE: APPLICATION FOR APPROVAL OF RESEARCH PROJECT:

Herewith, I request permission to undertake a research study. I am currently registered with the
University of Namibia, Rundu Campus, as a Bachelor of Nursing Science (clinical) Honors
Degree nursing student. Undertaking a research is mandatory in order to complete this course.
The title of my research topic is: UNDERSTANDING THE EXPERIENCES OF DIABETIC
PATIENTS REGARDING SELF-INJECTABLE TREATMENT , Kavango East region. The
objective of the study is to explore the lived experiences of diabetic patients on self-injectable
treatment and describe lived experiences of diabetic patients on self-injectable treatment. The
participants in the study will include Diabetic patients that has gone under self-injectable for at
least one month at their homes. These diabetic patients should be admitted in Rundu
Intermediate Hospital and the diabetic patients should be above 18 years old and willing to
participate in the study.

The results of the proposed study will enlighten the Ministry of Health and Social Services
(MOHSS) to identify problems in the way their services is being rendered. proposed study could

24
contribute to interventions for improving diabetic patients’ knowledge on their condition and
self-treatment care, and consequently improve the services. The data may assist policy makers,
program administrators and others in the development field to develop effective programs and
policies to improve access to information on diabetes self-care services to diabetic patients.

Attached herewith please receive the proposal for your approval.

Thank you very much.

Yours Faithfully,

Mr Ndara Frans ngunda

25