skip to main content

Healthcare Providers’ Knowledge, Attitude, and Perspective regarding Diabetes Self-Management during Ramadan Fasting: A Cross-Sectional Study

*Sh Sugiharto orcid scopus  -  Universitas Muhammadiyah Pekajangan Pekalongan, Indonesia
Wiwiek Natalya  -  Universitas Muhammadiyah Pekajangan Pekalongan, Indonesia
Bambang Widjanarko Otok  -  Institut Teknologi Sepuluh Nopember, Indonesia
Open Access Copyright (c) 2021 Nurse Media Journal of Nursing
Creative Commons License This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Citation Format:

Background: Evidence shows that most general practitioners have low knowledge related to diabetes self-management during Ramadan fasting. However, studies on healthcare providers’ competencies related to diabetes self-management during Ramadan fasting are still rare.
Purpose: This study aimed to investigate healthcare providers’ knowledge, attitude, and perspective concerning diabetes self-management during Ramadan fasting.
Methods: The study applied a cross-sectional design and was conducted in forty-one (41) community health centers in Pekalongan, Central Java, Indonesia. The study participants were medical doctors, nurses, nutritionists, pharmacists, and public health officers. The total sampling technique was used. There were 205 healthcare providers who met the inclusion criteria. Their knowledge, attitude, and perspective were assessed using a questionnaire developed by Zainudin and Hussain. The Wilcoxon test was used to analyze the data.
Results: The healthcare providers’ knowledge of Ramadan fasting was very low (36.79±26.11). More than half of the respondents (53.17%) advised diabetic patients to manage diabetes in general, although specific counseling for diabetic patients related to fasting in Ramadan month was not provided (55.12%). The perspective of Ramadan fasting among healthcare providers was moderate (62.68%±30.40). The results also showed that general and safe practice knowledge significantly affected the healthcare providers’ perspective toward Ramadan fasting (Z=-12.49, p=0.000), (Z=-12.02, p=0.000), respectively.
Conclusion: Healthcare providers’ knowledge and attitude concerning diabetes self-management during Ramadan fasting were low. Accordingly, this affected their perspective. It is strongly recommended that a formal Ramadan fasting management training program should be given regularly to provide appropriate consultations and services.


Fulltext View|Download
Keywords: Attitude; diabetes self-management; healthcare providers; knowledge; Ramadan fasting

Article Metrics:

  1. Abolaban, H., & Al-Moujahed, A. (2017). Muslim patients in Ramadan: A review for primary care physicians. Avicenna Journal of Medicine, 7(3), 81-87.
  2. Adler-Lazarovits, C., & Weintraub, A. Y. (2019). Physicians’ attitudes and views regarding religious fasting during pregnancy and review of the literature. European Journal of Obstetrics & Gynecology and Reproductive Biology, 233, 76-80.
  3. Ahmedani, M. Y., Hashmi, B. Z., & Ulhaque, M. S. (2016). Ramadan and diabetes - knowledge, attitude, and practices of general practitioners: A cross-sectional study. Pakistan Journal of Medical Sciences, 32(4), 5.
  4. AlAlwan, I., & Banyan, A. A. (2010). Effects of Ramadan fasting on children with Type 1 diabetes. International Journal of Diabetes Mellitus, 2(2010), 127-129.
  5. Ali, M., Adams, A., Hossain, M. A., Sutin, D., & Han, B. H. (2016). Primary care providers’ knowledge and practices of diabetes management during Ramadan. Journal of Primary Care Community Health, 7(1), 33-37.
  6. Almalki, M. H., Hussen, I., Khan, S. A., Almaghamsi, A., & Alshahran, F. (2018). Assessment of Ramadan education and knowledge among diabetic patients. Clinical Medicina Insights. Endocrinology and Diabetes, 11, 1179551417751611.
  7. Almansour, H. A., Chaar, B., & Saini, B. (2017). Pharmacists’ perspectives about their role in care of patients with diabetes observing Ramadan. Research in Social Administrative Pharmacy, 13(1), 109-122.
  8. Amin, M. E. K., & Chewning, B. (2014). Community pharmacists’ knowledge of diabetes management during Ramadan in Egypt. International Journal of Clinical Pharmacist, 36, 1213–1221.
  9. American Diabetes Association [ADA]. (2021). Standards of medical care in diabetes 2021. Diabetes Care, 44(Supplement 1), S1-S2.
  10. Babineaux, S. M., Toaima, D., Boye, K. S., Zagar, A., Tahbaz, A., Jabbar, A., & Hassanein, M. (2015). Multi‐country retrospective observational study of the management and outcomes of patients with type 2 diabetes during Ramadan in 2010 (CREED). Journal of Diabetic Medicine, 32(6), 819-828.
  11. Bell, J. (2012). The world's muslims: unity and diversity. Pew Research Center.
  12. Beshyah, S. A., Farooqi, M. H., Farghaly, M., Abusnana, S., Al Kaabi, J. M., & Benbarka, M. M. (2017). Management of diabetes during Ramadan fasting: a comprehensive survey of physicians’ knowledge, attitudes, and practices. Ibnosina Journal of Medicine Biomedical Sciences, 9(2), 28-36.
  13. Beshyah, S. A., Hajjaji, I. M., Ibrahim, W. H., Deeb, A., El-Ghul, A. M., Akkari, K. B., Tawil, A. A., Shlebak, A. (2018). The year in Ramadan fasting research (2017): A narrative review. Ibnosina Journal of Medicine Biomedical Sciences, 10(2), 39-53.
  14. Bravis, V., Hui, E., Salih, S., Mehar, S., Hassanein, M., & Devendra, D. (2010). Ramadan Education and Awareness in Diabetes (READ) programme for muslims with type 2 diabetes who fast during Ramadan. Diabetic Medicine, 27(3), 327-331.
  15. Cambridge Dictionary. (2021). Perspective. Cambridge Dictionary.
  16. Deeb, A., Al Qahtani, N., Akle, M., Singh, H., Assadi, R., Attia, S., Al Suwaidi, H., Hussain, T., & Naglekerke, N. (2017). Attitude, complications, ability of fasting and glycemic control in fasting Ramadan by children and adolescents with type 1 diabetes mellitus. Diabetes Research and Clinical Practice, 126, 10-15.
  17. Eid, Y. M., Sahmoud, S. I., Abdelsalam, M. M., & Eichorst, B. (2017). Empowerment-based diabetes self-management education to maintain glycemic targets during Ramadan fasting in people with diabetes who are on conventional insulin: A feasibility study. Diabetes Spectrum, 30(1), 36-42.
  18. Gaborit, B., Dutour, O., Ronsin, O., Atlan, C., Darmon, P., Gharsalli, R., Pradel, V., Dadoun, F., & Dutour, A. (2011). Ramadan fasting with diabetes: An interview study of inpatients' and general practitioners' attitudes in the South of France. Diabetes Metabolism, 37(5), 395-402.
  19. Gad, H., Al-Muhannadi, H., Purra, H., Mussleman, P., & Malik, R. A. (2020). The effect of Ramadan focused education on patients with type 2 diabetes: A systematic review and meta-analysis. Diabetes Research and Clinical Practice, 162, 108122.
  20. Ghani, F. (2013). Most Muslims say they fast during Ramadan. Pew Research Center.
  21. Hanif, W., Patel, V., Ali, S. N., Karamat, A., Saeed, M., Hassanein, M., Syed, A., Chowdhury, T. A., Farooqi, A., & Khunti, K. (2020). The South Asian health foundation (UK) guidelines for managing diabetes during Ramadan. Diabetes Research and Clinical Practice, 164, 108145.
  22. Hassan, A., Meo, S. A., Usmani, A. M., & Shaikh, T. J. (2014). Diabetes during Ramadan - PRE-approach model: Presentation, risk stratification, education. European Review for Medical and Pharmacological Sciences, 18(12), 1798-1805
  23. International Diabetes Federation [IDF]. (2019). Diabetes atlas (9th ed.). International Diabetes Federation.
  24. Ismail, S., Hatthakit, U., & Chinawong, T. (2015). Caring science within Islamic contexts: A literature review. Nurse Media Journal of Nursing, 5(1), 34-47.
  25. Jamoussi, H., Othman, R. B., Chaabouni, S., Gamoudi, A., Berriche, O., Mahjoub, F., Sebai, I., & Amrouche, C. (2017). Interest of the therapeutic education in patients with type 2 diabetes observing the fast of Ramadan. Alexandria Journal of Medicine, 53(1), 71-75.
  26. Kaplan, W., & Afandi, B. (2015). Blood glucose fluctuation during Ramadan fasting in adolescents with type 1 diabetes: Findings of continuous glucose monitoring. Diabetes Care, 38(10), e162-e163.
  27. Lagisetty, P. A., Priyadarshini, S., Terrell, S., Hamati, M., Landgraf, J., Chopra, V., & Heisler, M. (2017). Culturally targeted strategies for diabetes prevention in minority population: A systematic review and framework. Diabetes Education, 43(1), 54-77.
  28. Malek, R., Hannat, S., Nechadi, A., Mekideche, F. Z., & Kaabeche, M. (2019). Diabetes and Ramadan - A multicenter study in Algerian population. Diabetes research and clinical practice, 150, 322-330.
  29. Masood, S. N., Sheikh, M. A., Masood, Y., Hakeem, R., & Shera, A. S. (2014). Beliefs of people with diabetes about skin prick during Ramadan fasting. Diabetes Care, 37(4), e68-e69.
  30. Misra, A., Gopalan, H., Jayawardena, R., Hills, A. P., Soares, M., Reza‐Albarrán, A. A., & Ramaiya, K. L. (2019). Diabetes in developing countries. Journal of Diabetes, 11(7), 522-539.
  31. Mubeen, S. M., Mansoor, S., Hussain, A., & Qadir, S. (2012). Perceptions and practices of fasting in Ramadan during pregnancy in Pakistan. Iran Journal of Nursing and Midwifery Research, 17(7), 467-471
  32. Pinelli, N. R., & Jaber, L. A. (2011). Practices of Arab American patients with type 2 diabetes mellitus during Ramadan. Journal of Pharmacological Practice, 24(2), 211-215.
  33. Rashid, F., Abdelgadir, E., & Bashier, A. (2020). A systematic review on the safety of Ramadan fasting in high-risk patients with diabetes. Diabetes research and clinical practice, 164, 108161.
  34. Salti, I., Benard, E., Detournay, B., Bianchi-Biscay, M., Brigand, C. L., Voinet, C., & Jabbar, A., (2004). A population-based study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries. Diabetes Care, 27(10), 2306-2311. 10.2337/diacare.27.10.2306
  35. Sirois, M. L., Darby, M., & Tolle, S. (2013). Understanding Muslim patients: Cross-cultural dental hygiene care. International Journal of Dental Hygiene, 11(2), 105-114.
  36. Tourkmani, A. M., Alharbi, T. J., Rsheed, A. M. B., AlRasheed, A. N., AlBattal, S. M., Abdelhay, O., Hassali, M. A., Alrasheedy, A. A., Al Harbi, N. G., & Alqahtani, A. (2018). Hypoglycemia in type 2 diabetes mellitus patients: A review article. Diabetes Metabolic Syndrome: Clinical Research Reviews, 12(5), 791-794.
  37. Widyarani, D., Susanto, T., Wahyuni, D., & Pham, H. T. T. (2020). Identifying community/public health nursing competencies in Indonesia: A modified Delphi method. Nurse Media Journal of Nursing, 10(3), 350-360. 10.14710/nmjn.v10i3.29435
  38. Zainudin, S. B., & Hussain, A. B. (2017). The current state of knowledge, perception, and practice in diabetes management during fasting in Ramadan by healthcare professionals. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 12(3), 337-342.

Last update:

  1. Healthcare professionals knowledge, attitude, practices, and perspectives providing care to Muslims in Western countries who fast during Ramadan: a scoping review

    Katherine A.W. Hillier, Zoe L. Longworth, Hassan Vatanparast. Applied Physiology, Nutrition, and Metabolism, 49 (4), 2024. doi: 10.1139/apnm-2023-0462
  2. Comprehensive care for patients with diabetes in Ramadan: A module for pharmacy students and pharmacists

    Lina Abdallah Al Rifai, Lama Soubra, Mohamed Hassanein, Mohamed Ezzat Khamis Amin. Saudi Pharmaceutical Journal, 30 (5), 2022. doi: 10.1016/j.jsps.2022.02.008

Last update: 2024-06-15 20:20:16

No citation recorded.