{"paper_id":"10a0886c-c3a8-47ac-9184-ece68f5ccf12","body_text":"Stress management behavior and its associated factors among diabetes patients: A cross-sectional study in the northern Shoa Zone, Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Stress management behavior and its associated factors among diabetes patients: A cross-sectional study in the northern Shoa Zone, Ethiopia Akine Eshete, Gizachew Kebebew, Wondesen Asegidew, Tewodros Kifleyohans, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5191330/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Despite evidence supporting the positive impact of effective stress management on diabetes care, self-stress management remains a challenge for diabetic patients worldwide, including in Ethiopia, where research on self-stress management is lacking. This study examines stress management behaviors and their factors among individuals with diabetes. Method A facility-based cross-sectional study was conducted in public hospitals of North Shoa Zone from September 1–29, 2023. The study included 422 diabetic patients randomly selected from four public hospitals. Data entry was performed via Epi Data V.3.1, followed by analysis via SPSS version 22. Continuous variables are presented as the means and standard deviations, whereas categorical variables are expressed as percentages. Descriptive statistics were employed to summarize the study variables. To identify factors associated with stress management practices, binary logistic regression models were utilized. A p value of ≤ 0.05 and an odds ratio (OR) with a 95% confidence interval (CI) were considered indicative of statistically significant associations. Results Stress management practices were observed in 50.7% of the patients (95% CI: 46.5–55.6%). After adjusting for confounders, factors associated with greater engagement in stress management included formal education (AOR:1.77, 95% CI:1.29–2.77), good diabetic self-care knowledge (AOR:1.90, 95% CI:1.22–2.99), good health promotion services (AOR:2.02, 95% CI: 1.30–3.14), urban residence (AOR: 2.06, 95% CI: 1.29–3.28), and the absence of comorbidities (AOR:2.09, 95% CI:1.33–3.28). Conclusion The findings of this study reveal a significant gap in stress management practices, emphasizing the urgent need for healthcare providers in diabetes care to prioritize the implementation of strategies that strengthen patient education, expand self-care knowledge, and deliver holistic health promotion services. Stress management behavior Patients with diabetes Public Hospital North Shoa Zone Background Diabetes and mental health are closely connected, with individuals facing higher risks of depression, anxiety, and stress [ 1 ]. Diabetes patients often face negative emotions due to stress, which significantly impacts their self-care practices and overall well-being [ 2 , 3 ]. The American Diabetes Association highlights the importance of managing mental health issues, including stress, to optimize diabetes management and prevent complications [ 4 , 5 ]. Stress is a biological reaction to stimuli that can lead to various issues, significantly impacting diabetes patients [ 6 ] and influencing disease development and progression [ 7 , 8 ]. Evidence shows that stress negatively impacts health status [ 9 , 10 ], with approximately 39.3% of diabetic individuals in India experiencing stress [ 11 ]. Published data from Saudi Arabia indicate that 49.8% of diabetic patients experience stress [ 12 ], whereas a systematic review and meta-analysis reported that this figure was as high as 79% [ 13 ]. A systematic review in Ethiopia indicated that depression significantly impacts diabetes patients, with a prevalence rate of 34.61% [ 14 ]. Focusing on psychological aspects, particularly stress management, can enhance treatment strategies and health outcomes [ 15 ]. Adopting self-stress management behavior is essential for individuals with diabetes, leading to improved self-care and better health outcomes [ 16 ]. Stress management behaviors encompass various techniques and strategies that effectively reduce and control stress by adjusting responses, making lifestyle changes, fostering resilience through coping strategies, and employing psychotherapies [ 17 , 18 ]. Adapting to stress-coping strategies is essential for positive outcomes, as effective stress management improves diabetes management [ 19 ]; without such management, inappropriate responses may occur [ 8 , 20 , 21 ]. Stressful events can hinder problem-solving skills, leading to ineffective management; thus, integrating adaptive coping strategies in healthcare is vital for supporting diabetes patients [ 22 , 23 ]. Effective diabetes self-management relies on problem-solving skills and stress-coping styles [ 24 ]. Management goals can be achieved without advanced techniques, as effective stress management improves diabetes control and is correlated with HbA1c levels, treatment adherence, and stress [ 8 , 25 , 26 ]. Despite ample evidence on stress-coping skills, self-stress management remains a challenge for diabetic patients globally, including in Ethiopia, where research is limited. Few studies, such as qualitative research from Georgia, Iowa [ 27 ], the rural Dominican Republic [ 28 ], and northern Portugal [ 29 ], have revealed various stress coping strategies used by diabetes patients. A study in India revealed that stressed diabetic patients identified physical activity and recreation as effective coping strategies [ 30 ], whereas research in northern Ethiopia revealed that 51.2% of diabetic patients employed stress coping strategies to reduce stress [ 31 ]. Research on identifying contributing factors remains limited, yet aspects such as gender, education, age, family and social support, health values, and self-efficacy have been linked to stress management behaviors [ 32 – 35 ]. To date, no research has specifically investigated stress management behaviors and their influencing factors among diabetic patients. This study seeks to bridge that gap by assessing these behaviors and identifying key determinants. The findings will support evidence-based decision-making and guide the creation of targeted community interventions, aiding both diabetic patients and healthcare providers in adopting effective stress management strategies. Method of study Study area and design A facility-based cross-sectional study was conducted in public hospitals of North Shoa Zone from September 1–29, 2023. This zone encompasses 23 districts and 9 cities, with Debre Berhan as its capital, located 130 km northeast of Addis Ababa. Within the North Shoa Zone, there are a total of 13 hospitals, including 2 private and 11 public facilities, all dedicated to providing comprehensive patient care and follow-up services for diabetes management [ 36 ]. Sampling and sampling procedure The sample size was calculated via the single population proportion formula, which is based on a stress management practice proportion of 51.2% in North Ethiopia [ 31 ]. A 5% precision level and a 10% contingency for nonresponse were included, resulting in a total sample size of 422. Patients were recruited from four local hospitals. Sampling frames were established via registration logbooks, and participants were proportionally allocated and selected through computer-generated random sampling. A waiting period of up to one month was allowed for each patient, as they had at least one appointment during that time. Diabetic patients over 18 years old who resided in the area were invited to participate. Those unable to communicate during the data collection period were excluded from the study. Measurement of study variables The dependent variable of the study is stress management behavior, while the independent variables are broadly organized into sociodemographic characteristics, treatment- and clinical-related factors, health service-related factors, and behavior-related factors. Stress management behaviors were evaluated through eight items adapted from established stress coping techniques and tools [ 37 , 38 ]. An overall average score was determined, with scores above average indicating better stress management practices. Knowledge of diabetic self-care was evaluated via 29 questions across three main items, with correct answers scored as \"1\" and incorrect answers as \"0.\" A score above 50% indicated good knowledge, whereas a score below 50% indicated low knowledge. The perception of diabetes was assessed through eight questions with the same scoring system; respondents with scores above 50% were classified as having good perceptions. Health promotion services were evaluated on the basis of discussions and education with healthcare providers, utilizing 21 items related to diabetes management, including diet and exercise. Respondents scoring above 50% were classified as having 'good' health promotion services. Family and friend support in diabetes management was recognized when participants received emotional encouragement, practical assistance with medications and dietary choices, and involvement in lifestyle changes such as exercise. Data collection instruments A survey instrument was initially created in English, translated into Amharic, and subsequently back-translated to ensure accuracy. It was modified to suit the study's purpose. A pretest was conducted on 5% of the sample from a different hospital to ensure clarity and consistency, allowing for adjustments on the basis of feedback regarding question acceptability, data collection methods, and collector performance. Four nursing students, following comprehensive training, served as data collectors for the study. Daily checks conducted by the principal investigator and supervisors ensured the completeness and accuracy of the data. The questionnaire underwent content validation by health experts from Debre Berhan University, who assessed both its readability and content validity. The internal consistency of the stress management practices tool was confirmed, with a high reliability score and a Cronbach's alpha coefficient of 0.82. Data processing and analysis The data were entered into EpiData version 3.1 and subsequently exported to SPSS version 22 for analysis. Descriptive statistics summarize the frequency distributions of the variables, with continuous variables presented as the means ± standard deviations and categorical variables as percentages. The relationships between the independent variables and stress management behavior were evaluated via binary logistic regression. Only variables with a p value less than 0.20 in the bivariate analysis were included in the final model to ensure robustness. The significance of the associations was assessed via p values and 95% confidence intervals (CIs) for odds ratios (ORs). Results 1.1. Sociodemographic characteristics of the respondents The study included 422 individuals who were diagnosed with diabetes, with an average age of 52 years (SD ± 11.1). A slight majority of the participants were male (51.9%), and most identified as Orthodox Christians (79.9%). The majority lived in urban areas (60.0%) and were married (75.4%). Half of the participants reported a high household income, and most had received formal education. The family sizes predominantly ranged from 4 to 5 members, comprising 174 individuals (41.2%) (Table 1 ). Table 1 Sociodemographic characteristics of the study participants at public hospitals in the North Shoa Zone, Amhara Region, Ethiopia, 2023 Variables (n = 422) Frequency n (%) Age of the respondent (Mean ± SD; 52 ± 11.1 Age group (15–47 years) 130 (30.1) Age group (48–63 years) 223 (53.5) Age group ( ≥ 64) years 69 (16.4) Sex of the respondent Male 219 (51.9) Female 203(48.1) The religion of the respondent Orthodox 337 (79.9) Muslim 60(14.2) Protestant 25 (5.7) The residential area of respondents Urban 253 (60.0) Rural 169 (40.0) Current marital status of the respondent Married 318 (75.4) Single 30 (7.1) Divorce 40 (9.5) Widowed 34 (8.1) Educational status of the respondent No formal education 185 (43.8) Attending formal education 237 (56.2) Employment status of the respondents Government employee 69 (16.4) Merchant/Business/ 97 (23.0) Housewife 123 (29.1) Farmer 133 (31.5) Family monthly Income (Ethiopia Birr) Low-income level 105(24.9) Middle-income level 105(24.9) High-income level 212(50.2) How many household members including you live in your house? Mean 4 + 2.2SD ≤ 3house hold member 109 (25.8) 4–5 house hold member 174 (41.2) ≥ 6 house hold member 1139 (33.0) Do you live with 1. Family member 399 (94.5) 2. Live alone 23 (5.5) 1.2. Patient clinical and behavioral characteristics Among the participants, 369 individuals (87.4%) reported no alcohol consumption, and 408 (96.7%) were nonsmokers. Additionally, 293 participants (69.4%) were diagnosed with diabetes mellitus in the past five years. Comorbid conditions were present in approximately 35.3% of the participants, with hypertension being the most common, affecting 113 individuals (75.8%). Diabetes-related complications were reported by 96 patients (22.7%) (Table 2 ). Table 2 Patient clinical and behavioral characteristics among patients at public hospitals, North Shoa Zone, Amhara Region, Ethiopia, 2023 Questions Responses Are you drinking alcohol? Yes 53 (12.6) No 369 (87.4) Do you smoke cigar ate? Yes 14 (3.3) No 408 (96.7) How long has it been since you diagnosed with DM?(year) Mean year 5 ± 3.9SD ≤ five year 293 (69.4) > five year 129 (30.6) Duration of treatment (Years) Mean year 4.5 ± 4.0SD ≤ five year 313 (74.2) >Six year 109 (25.8) Do you have family history of DM? Yes 130 (30.8) No 292 (69.2) Have you ever faced drug related side effect? Yes 81 (19.2) No 341 (80.8) Do you have another comorbidity disease Yes 149 (35.3) No 273 (64.7) If yes, what type of comorbidity? (n = 149) Hypertension 113 (75.8) Asthma 7 (4.7) CVD 17 (11.4) Other specify 12 (8.1) Do you ever face diabetic related complications? Yes 96 (22.7) No 326 (77.3) How satisfied are you with the support you get from family and friends for dealing with your diabetes? Have satisfied with family support 310 (73.5) Did not satisfied with Family support 112 (26.5) 1.3. Stress management behavior among individuals with diabetes Among the study participants, 204 individuals (50.7%) exhibited good stress management behaviors (95% CI: 46.9, 55.3). As indicated in Table 3 , the most commonly reported strategies were allocating time for daily relaxation (42.7%), using specific stress control techniques (41.7%), and maintaining a consistent sleep routine (41.5%). Table 3 Stress management behavior among individuals with diabetes at public hospitals in the North Shoa Zone, Amhara Region, Ethiopia, 2023 Item/variables (n = 422) Frequency (n= %) Never Sometimes Often Routinely Get enough sleep 29 (6.9) 111(26.3) 107 (25.4) 175(41.5) Take some time for relaxation each day 112 (26.9) 180 (42.7) 97 (23.0) 33(7.8) Accept those things in my life which I cannot change. 145 (34.4) 153 (36.3) 93 (22.0) 31(7.3) Concentrate on pleasant thoughts at bedtime. 138 (32.7) 149(35.3) 117 (27.7) 18(4.3) Use specific methods to control my stress. 130(30.8) 175 (41.5) 92 (21.8) 25(5.9) Balance time between work and play. 155 (36.7) 166 (39.3) 82 (19.4) 19 (4.5) Practice relaxation for 15–20 minutes daily. 169 (40.0) 171 (40.5) 62 (14.7) 20 (4.7) Pace me to prevent tiredness 82 (19.2) 171 (40.5) 132 (31.3) 37(8.8) Stress management behavior Mean score ± SD 17.3 ± 4.7 Having poor stress management behavior Having good stress management behavior 208 (49.3); 95% CI; (44.7, 53.1) 214 (50.7); 95% CI; (46.9, 55.3) 1.4. Factors associated with stress management behavior In the bivariate analysis, older individuals (COR = 0.44, 95% CI: 0.24, 0.81) and those with low to moderate incomes reported poorer stress management practices. In contrast, individuals with formal education (COR = 2.44, 95% CI: 1.67, 3.62), support from family and friends (COR = 1.88, 95% CI: 1.21, 2.92), strong diabetic self-care knowledge (COR = 1.92, 95% CI: 1.27, 2.90), effective health promotion services (COR = 1.62, 95% CI: 1.08, 2.43), and no comorbidities (COR = 2.00, 95% CI: 1.34, 3.01) were more likely to practice effective stress management. After adjusting for confounding factors, individuals with formal education were nearly twice more likely to engage in stress management practices than those without formal education (AOR = 1.77, 95% CI: 1.29, 2.77). Furthermore, patients with a strong understanding of diabetic self-care (AOR = 1.90, 95% CI: 1.22, 2.99), those receiving effective health promotion services (AOR = 2.02, 95% CI: 1.30, 3.14), individuals without comorbidities (AOR = 2.09, 95% CI: 1.33, 3.28), and urban residents (AOR = 2.06, 95% CI: 1.29, 3.28) were also more likely to practice stress management (Table 4 ). Table 4 Factors associated with stress management practices among diabetic patients at public hospitals in the North Shoa Zone, Amhara Region, Ethiopia, 2023. Characteristics Stress management Behavior COR 95%CI AOR 95%CI Having good SMB Having Low SMB Age of the respondent Young age group (15–47 years) 69(16.4) 61(14.5) 1 1 Middle age group (48–63 years) 122(28.9) 101(23.9) 1.07(0,67-1.65) 1.15(0.71–1.88) Elder age group ( ≥ 64) 23(5.5) 46(10.9) 0.44(0.24–0.81)* 0.61(0.31–1.20) The residential area of respondents Urban 150(35.5) 103(24.5) 2.39(1.6–3.56)* 2.06(1.29–3.28)** Rural 64(15.2) 105(24.9) 1 Family monthly Income (EBirr) Low-income level 41(9.7) 64(15.2) 0.40(0.25–0.65)* 0.63(0.37–1.07) Middle-income level 43(10.2) 62(14.7) 0.44(0.27–0.71)* 0.54(0.33–0.91)** High-income level 130(30.8) 82(19.4) 1 1 Educational status of the respondent No formal education 71(16.8) 114(27.0) 1 1 Attending formal education 143(33.9) 94(22.3) 2.44(1.67–3.62)* 1.77(1.29–2.77)** Family and friends support on dealing with diabetes Have family and support 170(40.3) 140(33.2) 1.88 (1.21–2.92)* 1.2(0.73–2.01) Having low Family and friend support 44(10.4) 68(16.1) 1 1 Diabetes self-care knowledge Poor knowledge 55(13.0) 83(19.7) 1 1 Good knowledge 159(37.7) 125(29.6) 1.92(1.27–2.90)* 1.90(1.22–2.99)** Got Health promotion service at health facility Poor health HP service 63(14.9) 84(19.9) 1 1 Good health HP service 151(35.8) 124(29.4) 1.62(1.08–2.43)* 2.02(1.30–3.14)** Duration of treatment (Years) ≤ five year 165(39.1) 148(35.1) 1 1 > five year 49(11.6) 60(14.2) 0.73(0.47–1.14) 0.73(0.44–1.19) Having comorbidity disease Yes 59(14.0) 90(21.3) 1 1 No 155(36.7) 208(49.3) 2.00(1.34–3.01)* 2.09(1.33–3.28)** Statistically significant variables are indicated at p < 0.05 in the multivariable analysis. CI represents the 95% confidence interval; COR is the crude odds ratio; and AOR is the adjusted odds ratio, with 1 as the reference variable; SMB; Stress Management behavior Discussion The study revealed that 50.7% of the participants demonstrated effective stress management practices. The key factors associated with successful stress management included formal education, a strong understanding of diabetic self-care, and access to adequate health promotion services, urban residency, and the absence of comorbidities. The current study revealed that 50.7% of the participants exhibited effective stress management behavior (95% CI: 46.9–55.3), which was slightly lower than the 51.2% reported in a previous study conducted in the North Shoa Zone [ 31 ]. However, this finding is greater than that of a study conducted at Mekelle University (42%) [ 39 ]. Despite the limited research available, this study and prior findings highlight the critical importance of stress management practices for diabetic patients [ 27 – 30 , 40 ]. Previous studies [ 41 , 42 ] have shown that effective stress management is linked to improved self-care behaviors in diabetes management, suggesting that managing stress enhances overall diabetic care. The study revealed that participants commonly practiced stress management through adequate sleep, positive thinking, and daily relaxation. Implementing these techniques is essential for managing stress effectively, enabling individuals with diabetes to cope better with their condition and enhancing their overall well-being [ 8 , 25 ]. Thus, adopting stress management behaviors is crucial for individuals with diabetes, helping them cope effectively with life demands and challenges. This study revealed that patients with formal education were nearly twice as likely to engage in stress management practices than were those without, which is consistent with findings from Mekelle University [ 39 ] and other studies [ 34 , 35 ]. Education enhances access to information about stress management and fosters critical thinking, problem-solving, and coping skills, which are essential for handling stress. This study revealed that patients with good knowledge of diabetic self-care are nearly twice more likely to engage in stress management than those with less knowledge. Adequate self-care knowledge equips patients with tailored stress management techniques, helping them navigate diabetes-related stressors. Overall, there is a positive association between self-care knowledge and stress management practices, but further research is needed to explore this relationship and its contributing factors. The study revealed a significant association between effective health promotion services and stress management practices, indicating that patients who receive these services are twice as likely to engage in stress management. These services are essential for equipping individuals with the knowledge, skills, and support necessary to effectively manage stress. The study indicated that patients without comorbidities are twice more likely to engage in stress management practices than those with additional health conditions. These findings suggest that individuals focusing solely on diabetes may have a greater ability to manage stress effectively. However, further research is needed to confirm this relationship. Limitations of the Study This study highlights the importance of healthcare professionals addressing stress management in their patients to improve outcomes, quality of life, and overall well-being. However, there are limitations to consider. First, self-reported measures may introduce response bias, with participants potentially giving socially desirable answers or misinterpreting their own practices. Second, the tool used to assess stress management needs refinement to improve accuracy and reliability, particularly in considering the local context and culture. Finally, the sample may not reflect the broader community, limiting the generalizability of the findings. A more diverse participant pool is needed for a comprehensive understanding of stress management practices. Conclusion The study demonstrated that stress management behavior were generally low among participants. However, individuals with formal education, good diabetic self-care knowledge, access to effective health promotion services, urban residency, and no coexisting health conditions were significantly more likely to exhibit better stress management behaviors. Implications for practice To improve stress management behavior among diabetic patients, several key actions are recommended: implementing health education programs to increase self-care knowledge and promote effective stress management; launching targeted awareness campaigns aimed at middle-income individuals; integrating mental health support into diabetes care; strengthening and expanding accessible health promotion services; conducting regular screenings for comorbid conditions; and offering tailored counseling for affected individuals. Future research should employ mixed-methods approaches that consider cultural factors and individual differences, thereby providing a comprehensive understanding of the challenges faced by this population. Declarations Ethics approval and consent to participate : Ethical approval was obtained from the Ethics Review Committee of the Asrat Woldeyes Health Science Campus at Debre Berhan University (Approval No: IRB-088). All study methods were conducted in compliance with the institution's guidelines and regulations. Permission was also obtained from the appropriate administrators. All participants provided written informed consent. By removing identifiers from the questionnaire, confidentiality was maintained, and all the data were handled with strict confidentiality throughout the process. Consent for publication: Not applicable Availability of data and materials All data generated from this study are fully presented in the manuscript. Raw data are available upon request from the corresponding author at [email protected] . Competing interests: The authors declare that they have no conflicts of interest. Funding: This study did not receive any funding from external agencies. Authors' contributions Conceptualization, Investigation and Formal analysis: Akine Eshete, Gizachew Kebebew, Wondesen Asegidew Methodology: Akine Eshete, Gizachew Kebebew, Wondesen Asegidew, Dr. Tewodros Kifleyohans, Dr. Tilahun Deress, Dr.Yibeltal Assefa Project administration: Akine Eshete, Gizachew Kebebew, Wondesen Asegidew Software: Akine Eshete, Gizachew Kebebew, Dr. Tewodros Kifleyohans, Dr. Tilahun Deress, Dr.Yibeltal Assefa Supervision: Akine Eshete, Gizachew Kebebew, Wondesen Asegidew Validation and Visualization: Akine Eshete, Gizachew Kebebew, Wondesen Asegidew Writing – original draft: Akine Eshete, Gizachew Kebebew, Wondesen Asegidew, Dr. Tewodros Kifleyohans, Dr. Tilahun Deress, Dr.Yibeltal Assefa Writing – review & editing: Akine Eshete, Gizachew Kebebew, Wondesen Asegidew, Dr. Tewodros Kifleyohans, Dr. Tilahun Deress, Dr.Yibeltal Assefa Author’s information Akine Eshete (MPH, Assistant Professor), Department of Public Health, Debre Berhan University, Debre Berhan, Ethiopia, email: [email protected] Gizachew Kebebew (MPH), Department of Public Health, Debre Berhan University, Debre Berhan, Ethiopia; email: [email protected] Wondesen Asegidew (MPH, Assistant Professor), Department of Public Health, Debre Berhan University, Debre Berhan, Ethiopia, email: [email protected] Dr. Tewodros Kifleyohans (MD, Surgeon), School of Medicine, Debre Berhan University, Debre Berhan, Ethiopia, email. 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Sendhilkumar M, Tripathy JP, Harries AD, Dongre AR, Deepa M, Vidyulatha A, Poongothai S, Venkatesan U, Anjana RM, Mohan V: Factors associated with high stress levels in adults with diabetes mellitus attending a tertiary diabetes care center, Chennai, Tamil Nadu, India . Indian journal of endocrinology and metabolism 2017, 21 (1):56-63. Eshete A, Mohammed S, Deresse T, Kifleyohans T, Assefa Y: Association of stress management behavior and diabetic self-care practice among diabetes type II patients in North Shoa Zone: a cross-sectional study . BMC health services research 2023, 23 (1):767. Barrera M, Toobert DJ, Angell KL, Glasgow RE, MacKinnon DP: Social Support and Social-ecological Resources as Mediators of Lifestyle Intervention Effects for Type 2 Diabetes . Journal of Health Psychology 2006, 11 (3):483-495. Yilmaz FT, Sabancıogullari S, Aldemir K, Kumsar AK: Does social support affect development of cognitive dysfunction in individuals with diabetes mellitus? Saudi medical journal 2015, 36 (12):1425-1431. Chiu C-J, Wray LA: Gender differences in functional limitations in adults living with type 2 diabetes: biobehavioral and psychosocial mediators . Annals of Behavioral Medicine 2011, 41 (1):71-82. Hara Y, Hisatomi M, Ito H, Nakao M, Tsuboi K, Ishihara Y: Effects of gender, age, family support, and treatment on perceived stress and coping of patients with type 2 diabetes mellitus . BioPsychoSocial Medicine 2014, 8 (1):16. Health D: North Shoa Zone Health Department report. 2022. DEAL: Managing Stress and Coping strategies: Making Choices, . KishHealth System Diabetes Education Center.Lifestyle & Diabetes Questionnaire.Reviewed 6/2013 Hailu GN: Practice of stress management behaviors and associated factors among undergraduate students of Mekelle University, Ethiopia: a cross-sectional study . BMC Psychiatry 2020, 20 (1):162. Kim HR, Kim J-S: Stress, Depression, and Unhealthy Behavior Changes among Patients with Diabetes during COVID-19 in Korea . Healthcare 2022, 10 (2):303. Thomas JJ, Moring J, Bowen A, Rings JA, Emerson T, Lindt A: The influence of stress and coping on diabetes self-care activities among college students . J Am Coll Health 2021;16:1-6 doi: 101080/0744848120211928142 Epub ahead of print PMID: 34133266 2021:1-6. Alkhormi AH, Mahfouz MS, Alshahrani NZ, Hummadi A, Hakami WA, Alattas DH, Alhafaf HQ, Kardly LE, Mashhoor MA: Psychological Health and Diabetes Self-Management among Patients with Type 2 Diabetes during COVID-19 in the Southwest of Saudi Arabia . Medicina (Kaunas) 2022;58(5):675 doi: 103390/medicina58050675 PMID: 35630093; PMCID: PMC9146289 . Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-5191330\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Article\",\"associatedPublications\":[],\"authors\":[{\"id\":367617549,\"identity\":\"d66e6844-045e-4537-8420-c57e09a3095d\",\"order_by\":0,\"name\":\"Akine Eshete\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYDACHsYGMG0AIj4wMCSQooWZgXEGcVqgNEgLMw8xWvh7Drc9+MBgY2/O3n/wsW2bXR4/ewPjh485uLVInG1sN5zBkJa4s+cws3FuW3KxZM8BZsmZ2/BYc56xTZqH4XCCwY1kNuncNubEDTcS2Jh58WiRB2n5w/Df3uD+Y/bflm31hLUYnG1sk2ZgOMC44QYzGzNj22HCWgzPHGyT7DFITtxwJtlYsufc8cSZPQeb8fpF7kz6M4kfFXb2BscPPvzwo6w6sZ+9+eCHj/i8D3EelGZkA5MNhNQjgz+kKB4Fo2AUjIKRAgCDe1Jm7u6RwgAAAABJRU5ErkJggg==\",\"orcid\":\"\",\"institution\":\"Debre Berhan University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Akine\",\"middleName\":\"\",\"lastName\":\"Eshete\",\"suffix\":\"\"},{\"id\":367617550,\"identity\":\"e007b793-df90-4f73-aed9-ae717a6e052d\",\"order_by\":1,\"name\":\"Gizachew Kebebew\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Debre Berhan University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Gizachew\",\"middleName\":\"\",\"lastName\":\"Kebebew\",\"suffix\":\"\"},{\"id\":367617551,\"identity\":\"1f058eb3-4c99-43c2-a312-d39a81b232d4\",\"order_by\":2,\"name\":\"Wondesen Asegidew\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Debre Berhan University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Wondesen\",\"middleName\":\"\",\"lastName\":\"Asegidew\",\"suffix\":\"\"},{\"id\":367617552,\"identity\":\"c04f2562-21bb-4de1-9f6a-d27c58056c0f\",\"order_by\":3,\"name\":\"Tewodros Kifleyohans\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Debre Berhan University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Tewodros\",\"middleName\":\"\",\"lastName\":\"Kifleyohans\",\"suffix\":\"\"},{\"id\":367617553,\"identity\":\"db1a24ac-639c-45b7-96ba-1de1cb9bd414\",\"order_by\":4,\"name\":\"Tilahun Deress\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Debre Berhan University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Tilahun\",\"middleName\":\"\",\"lastName\":\"Deress\",\"suffix\":\"\"},{\"id\":367617554,\"identity\":\"7e5dfedb-eddd-40f3-8dae-e4060014a1c1\",\"order_by\":5,\"name\":\"Yibeltal Assefa\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"the University of Queensland\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Yibeltal\",\"middleName\":\"\",\"lastName\":\"Assefa\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2024-10-02 07:38:20\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-5191330/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-5191330/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":69313530,\"identity\":\"31549bfc-2953-4e48-8753-5c2028c42562\",\"added_by\":\"auto\",\"created_at\":\"2024-11-19 05:32:34\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":2241900,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5191330/v1/a206b530-b0a7-4a47-9e7b-e5b43c7311b8.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Stress management behavior and its associated factors among diabetes patients: A cross-sectional study in the northern Shoa Zone, Ethiopia\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003eDiabetes and mental health are closely connected, with individuals facing higher risks of depression, anxiety, and stress [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. Diabetes patients often face negative emotions due to stress, which significantly impacts their self-care practices and overall well-being [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. The American Diabetes Association highlights the importance of managing mental health issues, including stress, to optimize diabetes management and prevent complications [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. Stress is a biological reaction to stimuli that can lead to various issues, significantly impacting diabetes patients [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e] and influencing disease development and progression [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eEvidence shows that stress negatively impacts health status [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e], with approximately 39.3% of diabetic individuals in India experiencing stress [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. Published data from Saudi Arabia indicate that 49.8% of diabetic patients experience stress [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e], whereas a systematic review and meta-analysis reported that this figure was as high as 79% [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. A systematic review in Ethiopia indicated that depression significantly impacts diabetes patients, with a prevalence rate of 34.61% [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. Focusing on psychological aspects, particularly stress management, can enhance treatment strategies and health outcomes [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eAdopting self-stress management behavior is essential for individuals with diabetes, leading to improved self-care and better health outcomes [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]. Stress management behaviors encompass various techniques and strategies that effectively reduce and control stress by adjusting responses, making lifestyle changes, fostering resilience through coping strategies, and employing psychotherapies [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eAdapting to stress-coping strategies is essential for positive outcomes, as effective stress management improves diabetes management [\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e]; without such management, inappropriate responses may occur [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e]. Stressful events can hinder problem-solving skills, leading to ineffective management; thus, integrating adaptive coping strategies in healthcare is vital for supporting diabetes patients [\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]. Effective diabetes self-management relies on problem-solving skills and stress-coping styles [\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e]. Management goals can be achieved without advanced techniques, as effective stress management improves diabetes control and is correlated with HbA1c levels, treatment adherence, and stress [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eDespite ample evidence on stress-coping skills, self-stress management remains a challenge for diabetic patients globally, including in Ethiopia, where research is limited. Few studies, such as qualitative research from Georgia, Iowa [\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e], the rural Dominican Republic [\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e], and northern Portugal [\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e], have revealed various stress coping strategies used by diabetes patients. A study in India revealed that stressed diabetic patients identified physical activity and recreation as effective coping strategies [\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e], whereas research in northern Ethiopia revealed that 51.2% of diabetic patients employed stress coping strategies to reduce stress [\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e]. Research on identifying contributing factors remains limited, yet aspects such as gender, education, age, family and social support, health values, and self-efficacy have been linked to stress management behaviors [\\u003cspan additionalcitationids=\\\"CR33 CR34\\\" citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eTo date, no research has specifically investigated stress management behaviors and their influencing factors among diabetic patients. This study seeks to bridge that gap by assessing these behaviors and identifying key determinants. The findings will support evidence-based decision-making and guide the creation of targeted community interventions, aiding both diabetic patients and healthcare providers in adopting effective stress management strategies.\\u003c/p\\u003e\"},{\"header\":\"Method of study\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStudy area and design\\u003c/h2\\u003e \\u003cp\\u003eA facility-based cross-sectional study was conducted in public hospitals of North Shoa Zone from September 1\\u0026ndash;29, 2023. This zone encompasses 23 districts and 9 cities, with Debre Berhan as its capital, located 130 km northeast of Addis Ababa. Within the North Shoa Zone, there are a total of 13 hospitals, including 2 private and 11 public facilities, all dedicated to providing comprehensive patient care and follow-up services for diabetes management [\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e].\\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eSampling and sampling procedure\\u003c/h3\\u003e\\n\\u003cp\\u003eThe sample size was calculated via the single population proportion formula, which is based on a stress management practice proportion of 51.2% in North Ethiopia [\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e]. A 5% precision level and a 10% contingency for nonresponse were included, resulting in a total sample size of 422. Patients were recruited from four local hospitals. Sampling frames were established via registration logbooks, and participants were proportionally allocated and selected through computer-generated random sampling. A waiting period of up to one month was allowed for each patient, as they had at least one appointment during that time. Diabetic patients over 18 years old who resided in the area were invited to participate. Those unable to communicate during the data collection period were excluded from the study.\\u003c/p\\u003e\\n\\u003ch3\\u003eMeasurement of study variables\\u003c/h3\\u003e\\n\\u003cp\\u003eThe dependent variable of the study is stress management behavior, while the independent variables are broadly organized into sociodemographic characteristics, treatment- and clinical-related factors, health service-related factors, and behavior-related factors. Stress management behaviors were evaluated through eight items adapted from established stress coping techniques and tools [\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e]. An overall average score was determined, with scores above average indicating better stress management practices.\\u003c/p\\u003e \\u003cp\\u003eKnowledge of diabetic self-care was evaluated via 29 questions across three main items, with correct answers scored as \\\"1\\\" and incorrect answers as \\\"0.\\\" A score above 50% indicated good knowledge, whereas a score below 50% indicated low knowledge. The perception of diabetes was assessed through eight questions with the same scoring system; respondents with scores above 50% were classified as having good perceptions.\\u003c/p\\u003e \\u003cp\\u003eHealth promotion services were evaluated on the basis of discussions and education with healthcare providers, utilizing 21 items related to diabetes management, including diet and exercise. Respondents scoring above 50% were classified as having 'good' health promotion services. Family and friend support in diabetes management was recognized when participants received emotional encouragement, practical assistance with medications and dietary choices, and involvement in lifestyle changes such as exercise.\\u003c/p\\u003e\\n\\u003ch3\\u003eData collection instruments\\u003c/h3\\u003e\\n\\u003cp\\u003eA survey instrument was initially created in English, translated into Amharic, and subsequently back-translated to ensure accuracy. It was modified to suit the study's purpose. A pretest was conducted on 5% of the sample from a different hospital to ensure clarity and consistency, allowing for adjustments on the basis of feedback regarding question acceptability, data collection methods, and collector performance.\\u003c/p\\u003e \\u003cp\\u003eFour nursing students, following comprehensive training, served as data collectors for the study. Daily checks conducted by the principal investigator and supervisors ensured the completeness and accuracy of the data. The questionnaire underwent content validation by health experts from Debre Berhan University, who assessed both its readability and content validity. The internal consistency of the stress management practices tool was confirmed, with a high reliability score and a Cronbach's alpha coefficient of 0.82.\\u003c/p\\u003e\\n\\u003ch3\\u003eData processing and analysis\\u003c/h3\\u003e\\n\\u003cp\\u003eThe data were entered into EpiData version 3.1 and subsequently exported to SPSS version 22 for analysis. Descriptive statistics summarize the frequency distributions of the variables, with continuous variables presented as the means\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;standard deviations and categorical variables as percentages. The relationships between the independent variables and stress management behavior were evaluated via binary logistic regression. Only variables with a p value less than 0.20 in the bivariate analysis were included in the final model to ensure robustness. The significance of the associations was assessed via p values and 95% confidence intervals (CIs) for odds ratios (ORs).\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cdiv id=\\\"Sec9\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e1.1. Sociodemographic characteristics of the respondents\\u003c/h2\\u003e \\u003cp\\u003eThe study included 422 individuals who were diagnosed with diabetes, with an average age of 52 years (SD\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;11.1). A slight majority of the participants were male (51.9%), and most identified as Orthodox Christians (79.9%). The majority lived in urban areas (60.0%) and were married (75.4%). Half of the participants reported a high household income, and most had received formal education. The family sizes predominantly ranged from 4 to 5 members, comprising 174 individuals (41.2%) (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eSociodemographic characteristics of the study participants at public hospitals in the North Shoa Zone, Amhara Region, Ethiopia, 2023\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"2\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVariables (n\\u0026thinsp;=\\u0026thinsp;422)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFrequency n (%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAge of the respondent (Mean\\u0026thinsp;\\u003cspan type=\\\"Underline\\\" class=\\\"Underline\\\" name=\\\"Emphasis\\\"\\u003e\\u0026plusmn;\\u003c/span\\u003e\\u0026thinsp;SD; 52\\u0026thinsp;\\u003cspan type=\\\"Underline\\\" class=\\\"Underline\\\" name=\\\"Emphasis\\\"\\u003e\\u0026plusmn;\\u003c/span\\u003e\\u0026thinsp;11.1\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAge group (15\\u0026ndash;47 years)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e130 (30.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAge group (48\\u0026ndash;63 years)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e223 (53.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAge group (\\u003cspan type=\\\"Underline\\\" class=\\\"Underline\\\" name=\\\"Emphasis\\\"\\u003e\\u0026ge;\\u003c/span\\u003e\\u0026thinsp;64) years\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e69 (16.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eSex of the respondent\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e219 (51.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFemale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e203(48.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eThe religion of the respondent\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOrthodox\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e337 (79.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMuslim\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e60(14.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eProtestant\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e25 (5.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eThe residential area of respondents\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eUrban\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e253 (60.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRural\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e169 (40.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eCurrent marital status of the respondent\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMarried\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e318 (75.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSingle\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e30 (7.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDivorce\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e40 (9.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWidowed\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e34 (8.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eEducational status of the respondent\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo formal education\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e185 (43.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAttending formal education\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e237 (56.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eEmployment status of the respondents\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGovernment employee\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e69 (16.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMerchant/Business/\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e97 (23.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHousewife\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e123 (29.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFarmer\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e133 (31.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eFamily monthly Income (Ethiopia Birr)\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLow-income level\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e105(24.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMiddle-income level\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e105(24.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHigh-income level\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e212(50.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eHow many household members including you live in your house?\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMean 4\\u0026thinsp;+\\u0026thinsp;2.2SD\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cspan type=\\\"Underline\\\" class=\\\"Underline\\\" name=\\\"Emphasis\\\"\\u003e\\u0026le;\\u003c/span\\u003e\\u0026thinsp;3house hold member\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e109 (25.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e4\\u0026ndash;5 house hold member\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e174 (41.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cspan type=\\\"Underline\\\" class=\\\"Underline\\\" name=\\\"Emphasis\\\"\\u003e\\u0026ge;\\u003c/span\\u003e\\u0026thinsp;6 house hold member\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1139 (33.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eDo you live with\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e1. Family member\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e399 (94.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e2. Live alone\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e23 (5.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003e1.2. Patient clinical and behavioral characteristics\\u003c/h3\\u003e\\n\\u003cp\\u003eAmong the participants, 369 individuals (87.4%) reported no alcohol consumption, and 408 (96.7%) were nonsmokers. Additionally, 293 participants (69.4%) were diagnosed with diabetes mellitus in the past five years. Comorbid conditions were present in approximately 35.3% of the participants, with hypertension being the most common, affecting 113 individuals (75.8%). Diabetes-related complications were reported by 96 patients (22.7%) (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003ePatient clinical and behavioral characteristics among patients at public hospitals, North Shoa Zone, Amhara Region, Ethiopia, 2023\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"2\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eQuestions\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eResponses\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAre you drinking alcohol?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e53 (12.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e369 (87.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDo you smoke cigar ate?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e14 (3.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e408 (96.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHow long has it been since you diagnosed with DM?(year)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMean year 5\\u0026thinsp;\\u003cspan type=\\\"Underline\\\" class=\\\"Underline\\\" name=\\\"Emphasis\\\"\\u003e\\u0026plusmn;\\u003c/span\\u003e\\u0026thinsp;3.9SD\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cspan type=\\\"Underline\\\" class=\\\"Underline\\\" name=\\\"Emphasis\\\"\\u003e\\u0026le;\\u003c/span\\u003e five year\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e293 (69.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u0026gt; five year\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e129 (30.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDuration of treatment (Years)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMean year 4.5\\u0026thinsp;\\u003cspan type=\\\"Underline\\\" class=\\\"Underline\\\" name=\\\"Emphasis\\\"\\u003e\\u0026plusmn;\\u003c/span\\u003e\\u0026thinsp;4.0SD\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cspan type=\\\"Underline\\\" class=\\\"Underline\\\" name=\\\"Emphasis\\\"\\u003e\\u0026le;\\u003c/span\\u003e five year\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e313 (74.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u0026gt;Six year\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e109 (25.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDo you have family history of DM?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e130 (30.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e292 (69.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eHave you ever faced drug related side effect?\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e81 (19.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e341 (80.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eDo you have another comorbidity disease\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e149 (35.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e273 (64.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eIf yes, what type of comorbidity? (n\\u0026thinsp;=\\u0026thinsp;149)\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHypertension\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e113 (75.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAsthma\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e7 (4.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCVD\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e17 (11.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOther specify\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e12 (8.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eDo you ever face diabetic related complications?\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e96 (22.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e326 (77.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHow satisfied are you with the support you get from family and friends for dealing with your diabetes?\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHave satisfied with family support\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e310 (73.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDid not satisfied with Family support\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e112 (26.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e1.3. Stress management behavior among individuals with diabetes\\u003c/h2\\u003e \\u003cp\\u003eAmong the study participants, 204 individuals (50.7%) exhibited good stress management behaviors (95% CI: 46.9, 55.3). As indicated in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e, the most commonly reported strategies were allocating time for daily relaxation (42.7%), using specific stress control techniques (41.7%), and maintaining a consistent sleep routine (41.5%).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eStress management behavior among individuals with diabetes at public hospitals in the North Shoa Zone, Amhara Region, Ethiopia, 2023\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eItem/variables (n\\u0026thinsp;=\\u0026thinsp;422)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c5\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eFrequency (n= %)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNever\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eSometimes\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eOften\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eRoutinely\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGet enough sleep\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e29 (6.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e111(26.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e107 (25.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e175(41.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTake some time for relaxation each day\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e112 (26.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e180 (42.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e97 (23.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e33(7.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAccept those things in my life which I cannot change.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e145 (34.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e153 (36.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e93 (22.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e31(7.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eConcentrate on pleasant thoughts at bedtime.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e138 (32.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e149(35.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e117 (27.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e18(4.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eUse specific methods to control my stress.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e130(30.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e175 (41.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e92 (21.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e25(5.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBalance time between work and play.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e155 (36.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e166 (39.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e82 (19.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e19 (4.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePractice relaxation for 15\\u0026ndash;20 minutes daily.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e169 (40.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e171 (40.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e62 (14.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e20 (4.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePace me to prevent tiredness\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e82 (19.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e171 (40.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e132 (31.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e37(8.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c5\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eStress management behavior\\u003c/b\\u003e Mean score\\u0026thinsp;\\u003cspan type=\\\"Underline\\\" class=\\\"Underline\\\" name=\\\"Emphasis\\\"\\u003e\\u0026plusmn;\\u003c/span\\u003e\\u0026thinsp;SD 17.3\\u0026thinsp;\\u003cspan type=\\\"Underline\\\" class=\\\"Underline\\\" name=\\\"Emphasis\\\"\\u003e\\u0026plusmn;\\u003c/span\\u003e\\u0026thinsp;4.7\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" morerows=\\\"1\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eHaving poor stress management behavior\\u003c/p\\u003e \\u003cp\\u003eHaving good stress management behavior\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c5\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003e208 (49.3); 95% CI; (44.7, 53.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c5\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003e214 (50.7); 95% CI; (46.9, 55.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec12\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e1.4. Factors associated with stress management behavior\\u003c/h2\\u003e \\u003cp\\u003eIn the bivariate analysis, older individuals (COR\\u0026thinsp;=\\u0026thinsp;0.44, 95% CI: 0.24, 0.81) and those with low to moderate incomes reported poorer stress management practices. In contrast, individuals with formal education (COR\\u0026thinsp;=\\u0026thinsp;2.44, 95% CI: 1.67, 3.62), support from family and friends (COR\\u0026thinsp;=\\u0026thinsp;1.88, 95% CI: 1.21, 2.92), strong diabetic self-care knowledge (COR\\u0026thinsp;=\\u0026thinsp;1.92, 95% CI: 1.27, 2.90), effective health promotion services (COR\\u0026thinsp;=\\u0026thinsp;1.62, 95% CI: 1.08, 2.43), and no comorbidities (COR\\u0026thinsp;=\\u0026thinsp;2.00, 95% CI: 1.34, 3.01) were more likely to practice effective stress management.\\u003c/p\\u003e \\u003cp\\u003eAfter adjusting for confounding factors, individuals with formal education were nearly twice more likely to engage in stress management practices than those without formal education (AOR\\u0026thinsp;=\\u0026thinsp;1.77, 95% CI: 1.29, 2.77). Furthermore, patients with a strong understanding of diabetic self-care (AOR\\u0026thinsp;=\\u0026thinsp;1.90, 95% CI: 1.22, 2.99), those receiving effective health promotion services (AOR\\u0026thinsp;=\\u0026thinsp;2.02, 95% CI: 1.30, 3.14), individuals without comorbidities (AOR\\u0026thinsp;=\\u0026thinsp;2.09, 95% CI: 1.33, 3.28), and urban residents (AOR\\u0026thinsp;=\\u0026thinsp;2.06, 95% CI: 1.29, 3.28) were also more likely to practice stress management (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eFactors associated with stress management practices among diabetic patients at public hospitals in the North Shoa Zone, Amhara Region, Ethiopia, 2023.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eCharacteristics\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eStress management Behavior\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eCOR 95%CI\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eAOR 95%CI\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eHaving good SMB\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eHaving Low SMB\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eAge of the respondent\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eYoung age group (15\\u0026ndash;47 years)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e69(16.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e61(14.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMiddle age group (48\\u0026ndash;63 years)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e122(28.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e101(23.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.07(0,67-1.65)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.15(0.71\\u0026ndash;1.88)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eElder age group (\\u003cspan type=\\\"Underline\\\" class=\\\"Underline\\\" name=\\\"Emphasis\\\"\\u003e\\u0026ge;\\u003c/span\\u003e\\u0026thinsp;64)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e23(5.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e46(10.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.44(0.24\\u0026ndash;0.81)*\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.61(0.31\\u0026ndash;1.20)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eThe residential area of respondents\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eUrban\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e150(35.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e103(24.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2.39(1.6\\u0026ndash;3.56)*\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2.06(1.29\\u0026ndash;3.28)**\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRural\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e64(15.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e105(24.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eFamily monthly Income (EBirr)\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLow-income level\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e41(9.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e64(15.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.40(0.25\\u0026ndash;0.65)*\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.63(0.37\\u0026ndash;1.07)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMiddle-income level\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e43(10.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e62(14.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.44(0.27\\u0026ndash;0.71)*\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.54(0.33\\u0026ndash;0.91)**\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHigh-income level\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e130(30.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e82(19.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eEducational status of the respondent\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo formal education\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e71(16.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e114(27.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAttending formal education\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e143(33.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e94(22.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2.44(1.67\\u0026ndash;3.62)*\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.77(1.29\\u0026ndash;2.77)**\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eFamily and friends support on dealing with diabetes\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHave family and support\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e170(40.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e140(33.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.88 (1.21\\u0026ndash;2.92)*\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.2(0.73\\u0026ndash;2.01)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHaving low Family and friend support\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e44(10.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e68(16.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eDiabetes self-care knowledge\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePoor knowledge\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e55(13.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e83(19.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGood knowledge\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e159(37.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e125(29.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.92(1.27\\u0026ndash;2.90)*\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.90(1.22\\u0026ndash;2.99)**\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eGot Health promotion service at health facility\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePoor health HP service\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e63(14.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e84(19.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGood health HP service\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e151(35.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e124(29.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.62(1.08\\u0026ndash;2.43)*\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2.02(1.30\\u0026ndash;3.14)**\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eDuration of treatment (Years)\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cspan type=\\\"Underline\\\" class=\\\"Underline\\\" name=\\\"Emphasis\\\"\\u003e\\u0026le;\\u003c/span\\u003e five year\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e165(39.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e148(35.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u0026gt; five year\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e49(11.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e60(14.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.73(0.47\\u0026ndash;1.14)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.73(0.44\\u0026ndash;1.19)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eHaving comorbidity disease\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e59(14.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e90(21.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e155(36.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e208(49.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2.00(1.34\\u0026ndash;3.01)*\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2.09(1.33\\u0026ndash;3.28)**\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c5\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eStatistically significant variables are indicated at p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05 in the multivariable analysis. CI represents the 95% confidence interval; COR is the crude odds ratio; and AOR is the adjusted odds ratio, with 1 as the reference variable; SMB; Stress Management behavior\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eThe study revealed that 50.7% of the participants demonstrated effective stress management practices. The key factors associated with successful stress management included formal education, a strong understanding of diabetic self-care, and access to adequate health promotion services, urban residency, and the absence of comorbidities.\\u003c/p\\u003e \\u003cp\\u003eThe current study revealed that 50.7% of the participants exhibited effective stress management behavior (95% CI: 46.9\\u0026ndash;55.3), which was slightly lower than the 51.2% reported in a previous study conducted in the North Shoa Zone [\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e]. However, this finding is greater than that of a study conducted at Mekelle University (42%) [\\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e]. Despite the limited research available, this study and prior findings highlight the critical importance of stress management practices for diabetic patients [\\u003cspan additionalcitationids=\\\"CR28 CR29\\\" citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e]. Previous studies [\\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e] have shown that effective stress management is linked to improved self-care behaviors in diabetes management, suggesting that managing stress enhances overall diabetic care.\\u003c/p\\u003e \\u003cp\\u003eThe study revealed that participants commonly practiced stress management through adequate sleep, positive thinking, and daily relaxation. Implementing these techniques is essential for managing stress effectively, enabling individuals with diabetes to cope better with their condition and enhancing their overall well-being [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]. Thus, adopting stress management behaviors is crucial for individuals with diabetes, helping them cope effectively with life demands and challenges.\\u003c/p\\u003e \\u003cp\\u003eThis study revealed that patients with formal education were nearly twice as likely to engage in stress management practices than were those without, which is consistent with findings from Mekelle University [\\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e] and other studies [\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e]. Education enhances access to information about stress management and fosters critical thinking, problem-solving, and coping skills, which are essential for handling stress.\\u003c/p\\u003e \\u003cp\\u003eThis study revealed that patients with good knowledge of diabetic self-care are nearly twice more likely to engage in stress management than those with less knowledge. Adequate self-care knowledge equips patients with tailored stress management techniques, helping them navigate diabetes-related stressors. Overall, there is a positive association between self-care knowledge and stress management practices, but further research is needed to explore this relationship and its contributing factors.\\u003c/p\\u003e \\u003cp\\u003eThe study revealed a significant association between effective health promotion services and stress management practices, indicating that patients who receive these services are twice as likely to engage in stress management. These services are essential for equipping individuals with the knowledge, skills, and support necessary to effectively manage stress. The study indicated that patients without comorbidities are twice more likely to engage in stress management practices than those with additional health conditions. These findings suggest that individuals focusing solely on diabetes may have a greater ability to manage stress effectively. However, further research is needed to confirm this relationship.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec14\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eLimitations of the Study\\u003c/h2\\u003e \\u003cp\\u003eThis study highlights the importance of healthcare professionals addressing stress management in their patients to improve outcomes, quality of life, and overall well-being. However, there are limitations to consider. First, self-reported measures may introduce response bias, with participants potentially giving socially desirable answers or misinterpreting their own practices. Second, the tool used to assess stress management needs refinement to improve accuracy and reliability, particularly in considering the local context and culture. Finally, the sample may not reflect the broader community, limiting the generalizability of the findings. A more diverse participant pool is needed for a comprehensive understanding of stress management practices.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eThe study demonstrated that stress management behavior were generally low among participants. However, individuals with formal education, good diabetic self-care knowledge, access to effective health promotion services, urban residency, and no coexisting health conditions were significantly more likely to exhibit better stress management behaviors.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec16\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eImplications for practice\\u003c/h2\\u003e \\u003cp\\u003eTo improve stress management behavior among diabetic patients, several key actions are recommended: implementing health education programs to increase self-care knowledge and promote effective stress management; launching targeted awareness campaigns aimed at middle-income individuals; integrating mental health support into diabetes care; strengthening and expanding accessible health promotion services; conducting regular screenings for comorbid conditions; and offering tailored counseling for affected individuals. Future research should employ mixed-methods approaches that consider cultural factors and individual differences, thereby providing a comprehensive understanding of the challenges faced by this population.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003cstrong\\u003e:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eEthical approval was obtained from the Ethics Review Committee of the Asrat Woldeyes Health Science Campus at Debre Berhan University (Approval No: IRB-088). All study methods were conducted in compliance with the institution\\u0026apos;s guidelines and regulations. Permission was also obtained from the appropriate administrators. All participants provided written informed consent. By removing identifiers from the questionnaire, confidentiality was maintained, and all the data were handled with strict confidentiality throughout the process.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication:\\u0026nbsp;\\u003c/strong\\u003eNot applicable\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAll data generated from this study are fully presented in the manuscript. Raw data are available upon request from the corresponding author at akine.eshete@yahoo.com.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare that they have no conflicts of interest.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study did not receive any funding from external agencies.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026apos; contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConceptualization, Investigation and Formal analysis:\\u0026nbsp;\\u003c/strong\\u003eAkine Eshete, Gizachew Kebebew, Wondesen Asegidew\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethodology:\\u0026nbsp;\\u003c/strong\\u003eAkine Eshete, Gizachew Kebebew, Wondesen Asegidew, Dr. Tewodros Kifleyohans, Dr. Tilahun Deress,\\u003cstrong\\u003eDr.Yibeltal Assefa\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eProject administration:\\u0026nbsp;\\u003c/strong\\u003eAkine Eshete, Gizachew Kebebew, Wondesen Asegidew\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eSoftware:\\u0026nbsp;\\u003c/strong\\u003eAkine Eshete, Gizachew Kebebew, Dr. Tewodros Kifleyohans, Dr. Tilahun Deress,\\u003cstrong\\u003eDr.Yibeltal Assefa\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eSupervision:\\u0026nbsp;\\u003c/strong\\u003eAkine Eshete, Gizachew Kebebew, Wondesen Asegidew\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eValidation and Visualization:\\u0026nbsp;\\u003c/strong\\u003eAkine Eshete, Gizachew Kebebew, Wondesen Asegidew\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eWriting \\u0026ndash; original draft:\\u0026nbsp;\\u003c/strong\\u003eAkine Eshete, Gizachew Kebebew, Wondesen Asegidew, Dr. Tewodros Kifleyohans, Dr. Tilahun Deress,\\u003cstrong\\u003eDr.Yibeltal Assefa\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eWriting \\u0026ndash; review \\u0026amp; editing:\\u0026nbsp;\\u003c/strong\\u003eAkine Eshete, Gizachew Kebebew, Wondesen Asegidew, Dr. Tewodros Kifleyohans, Dr. Tilahun Deress,\\u003cstrong\\u003eDr.Yibeltal Assefa\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthor\\u0026rsquo;s information\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003col\\u003e\\n \\u003cli\\u003eAkine Eshete (MPH, Assistant Professor), Department of Public Health, Debre Berhan University, Debre Berhan, Ethiopia, email: akine.eshete@yahoo.com\\u003c/li\\u003e\\n \\u003cli\\u003eGizachew Kebebew (MPH), Department of Public Health, Debre Berhan University, Debre Berhan, Ethiopia; email: gizatsd@gmail.com\\u003c/li\\u003e\\n \\u003cli\\u003eWondesen Asegidew (MPH, Assistant Professor), Department of Public Health, Debre Berhan University, Debre Berhan, Ethiopia, email: wondeasgw@gmail.com\\u003c/li\\u003e\\n \\u003cli\\u003eDr. Tewodros Kifleyohans (MD, Surgeon), School of Medicine, Debre Berhan University, Debre Berhan, Ethiopia, email. tewodroskif@gmail.com\\u003c/li\\u003e\\n \\u003cli\\u003eDr. Tilahun Deress, (MD, Surgeon), School of Medicine, Debre Berhan University, Debre Berhan, Ethiopia, email. tmaed83@gmail.com\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cstrong\\u003eDr.\\u003c/strong\\u003e\\u003cstrong\\u003eYibeltal Assefa (MD, MSc, PhD)\\u003c/strong\\u003e\\u003cstrong\\u003e,\\u0026nbsp;\\u003c/strong\\u003eSchool of Public Health, The University of Queensland, Brisbane, Australia; email: y.alemu@uq.edu.au\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eSabourin BC, Pursley S: \\u003cstrong\\u003ePsychosocial issues in diabetes self-management: strategies for healthcare providers\\u003c/strong\\u003e. \\u003cem\\u003eCanadian journal of diabetes \\u003c/em\\u003e2013, \\u003cstrong\\u003e37\\u003c/strong\\u003e(1):36-40.\\u003c/li\\u003e\\n\\u003cli\\u003eBerry E, Lockhart S, Davies M, Lindsay JR, Dempster M: \\u003cstrong\\u003eDiabetes distress: understanding the hidden struggles of living with diabetes and exploring intervention strategies\\u003c/strong\\u003e. \\u003cem\\u003ePostgraduate medical journal \\u003c/em\\u003e2015, \\u003cstrong\\u003e91\\u003c/strong\\u003e(1075):278-283.\\u003c/li\\u003e\\n\\u003cli\\u003eYu JS, Xu T, James RA, Lu W, Hoffman JE: \\u003cstrong\\u003eRelationship Between Diabetes, Stress, and Self-Management to Inform Chronic Disease Product Development: Retrospective Cross-Sectional Study\\u003c/strong\\u003e. \\u003cem\\u003eJMIR Diabetes \\u003c/em\\u003e2020, \\u003cstrong\\u003e5\\u003c/strong\\u003e(4):e20888.\\u003c/li\\u003e\\n\\u003cli\\u003eAmerican Diabetes Association:\\u003cstrong\\u003e 2. 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Diabetes Questionnaire.Reviewed 6/2013\\u003c/strong\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003eHailu GN: \\u003cstrong\\u003ePractice of stress management behaviors and associated factors among undergraduate students of Mekelle University, Ethiopia: a cross-sectional study\\u003c/strong\\u003e. \\u003cem\\u003eBMC Psychiatry \\u003c/em\\u003e2020, \\u003cstrong\\u003e20\\u003c/strong\\u003e(1):162.\\u003c/li\\u003e\\n\\u003cli\\u003eKim HR, Kim J-S: \\u003cstrong\\u003eStress, Depression, and Unhealthy Behavior Changes among Patients with Diabetes during COVID-19 in Korea\\u003c/strong\\u003e. \\u003cem\\u003eHealthcare \\u003c/em\\u003e2022, \\u003cstrong\\u003e10\\u003c/strong\\u003e(2):303.\\u003c/li\\u003e\\n\\u003cli\\u003eThomas JJ, Moring J, Bowen A, Rings JA, Emerson T, Lindt A: \\u003cstrong\\u003eThe influence of stress and coping on diabetes self-care activities among college students\\u003c/strong\\u003e. \\u003cem\\u003eJ Am Coll Health 2021;16:1-6 doi: 101080/0744848120211928142 Epub ahead of print PMID: 34133266 \\u003c/em\\u003e2021:1-6.\\u003c/li\\u003e\\n\\u003cli\\u003eAlkhormi AH, Mahfouz MS, Alshahrani NZ, Hummadi A, Hakami WA, Alattas DH, Alhafaf HQ, Kardly LE, Mashhoor MA: \\u003cstrong\\u003ePsychological Health and Diabetes Self-Management among Patients with Type 2 Diabetes during COVID-19 in the Southwest of Saudi Arabia\\u003c/strong\\u003e.\\u003cem\\u003e Medicina (Kaunas) 2022;58(5):675 doi: 103390/medicina58050675 PMID: 35630093; PMCID: PMC9146289\\u003c/em\\u003e.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Stress management behavior, Patients with diabetes, Public Hospital, North Shoa Zone\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-5191330/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-5191330/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003eDespite evidence supporting the positive impact of effective stress management on diabetes care, self-stress management remains a challenge for diabetic patients worldwide, including in Ethiopia, where research on self-stress management is lacking. This study examines stress management behaviors and their factors among individuals with diabetes.\\u003c/p\\u003e\\u003ch2\\u003eMethod\\u003c/h2\\u003e \\u003cp\\u003eA facility-based cross-sectional study was conducted in public hospitals of North Shoa Zone from September 1\\u0026ndash;29, 2023. The study included 422 diabetic patients randomly selected from four public hospitals. Data entry was performed via Epi Data V.3.1, followed by analysis via SPSS version 22. Continuous variables are presented as the means and standard deviations, whereas categorical variables are expressed as percentages. Descriptive statistics were employed to summarize the study variables. To identify factors associated with stress management practices, binary logistic regression models were utilized. A p value of \\u0026le;\\u0026thinsp;0.05 and an odds ratio (OR) with a 95% confidence interval (CI) were considered indicative of statistically significant associations.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eStress management practices were observed in 50.7% of the patients (95% CI: 46.5\\u0026ndash;55.6%). After adjusting for confounders, factors associated with greater engagement in stress management included formal education (AOR:1.77, 95% CI:1.29\\u0026ndash;2.77), good diabetic self-care knowledge (AOR:1.90, 95% CI:1.22\\u0026ndash;2.99), good health promotion services (AOR:2.02, 95% CI: 1.30\\u0026ndash;3.14), urban residence (AOR: 2.06, 95% CI: 1.29\\u0026ndash;3.28), and the absence of comorbidities (AOR:2.09, 95% CI:1.33\\u0026ndash;3.28).\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e \\u003cp\\u003eThe findings of this study reveal a significant gap in stress management practices, emphasizing the urgent need for healthcare providers in diabetes care to prioritize the implementation of strategies that strengthen patient education, expand self-care knowledge, and deliver holistic health promotion services.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Stress management behavior and its associated factors among diabetes patients: A cross-sectional study in the northern Shoa Zone, Ethiopia\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-10-21 07:35:47\",\"doi\":\"10.21203/rs.3.rs-5191330/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"b9a17bf7-08f6-4028-99f5-7ac2a6b5a7f4\",\"owner\":[],\"postedDate\":\"October 21st, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2024-11-19T05:23:58+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2024-10-21 07:35:47\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-5191330\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-5191330\",\"identity\":\"rs-5191330\",\"version\":[\"v1\"]},\"buildId\":\"qtupq5eGEP_6zYnWcrvyt\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}