Predictors of Self-Assessed and Actual Knowledge about Diabetes among Nursing Students in Saudi Arabia

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Citation: Alsolais, A.M.; Bajet, J.B.;
Alquwez, N.; Alotaibi, K.A.;
Almansour, A.M.; Alshammari, F.;
Cruz, J.P.; Alotaibi, J.S. Predictors of
Self-Assessed and Actual Knowledge
about Diabetes among Nursing
Students in Saudi Arabia. J. Pers.
Med. 2023,13, 57. https://doi.org/
10.3390/jpm13010057
Academic Editors: Manuel José
Lopes, Luis Sousa and
César Fonseca
Received: 2 November 2022
Revised: 15 December 2022
Accepted: 18 December 2022
Published: 27 December 2022
Copyright: © 2022 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
Journal of
Personalized
Medicine
Article
Predictors of Self-Assessed and Actual Knowledge about
Diabetes among Nursing Students in Saudi Arabia
Abdulellah M. Alsolais 1, Junel Bryan Bajet 1, Nahed Alquwez 1, Khalaf Aied Alotaibi 1,
Ahmed Mansour Almansour 2, Farhan Alshammari 3, Jonas Preposi Cruz 4and Jazi Shaydied Alotaibi 2, *
1Department of Nursing, College of Applied Medical Sciences, Dawadmi Campus, Shaqra University,
Sahqra 11451, Saudi Arabia
2Department of Nursing, College of Applied Medical Sciences, Majmaah University,
Al-Majmaah 11952, Saudi Arabia
3Medical Surgical Department, College of Nursing, University of Hail, Hail 81481, Saudi Arabia
4Department of Medicine, School of Medicine, Nazarbayev University, Astana City 010000, Kazakhstan
*Correspondence: jalotaibi@mu.edu.sa
Abstract:
The aim of this study was to investigate the predictors of self-assessed and actual knowledge
of diabetes among undergraduate nursing students. Nursing education plays an important role in
preparing future nurses and ensuring that they are knowledgeable and competent in diabetes care. A
descriptive, cross-sectional study was conducted with a convenience sample of 330 undergraduate
Saudi student nurses. We collected data from October to December 2019 using the Diabetes Self-
report Tool (DSRT) and Diabetes Basic Knowledge Tool (DBKT). We performed a multiple regression
analysis to identify the predictors of self-reported and actual knowledge of diabetes. The students’
overall mean (SD) scores in the DSRT and DBKT were 48.31 (5.71), which is equivalent to 80.52% of the
total score and 22.54 (8.57), respectively. The students’ university, gender, year level and experience in
providing direct care to diabetic patients were the significant predictors of self-reported knowledge,
whereas their university, age and perceived diabetes knowledge were the significant predictors
of actual diabetes knowledge. The findings underscore the necessity to improve student nurses’
actual knowledge of diabetes and its management. Our findings provide a solid basis for planning
and implementing educational interventions with diabetes-related information to ensure adequate
diabetes knowledge among nursing students.
Keywords: diabetes; diabetes knowledge; nursing students; Saudi Arabia
1. Introduction
Diabetes is one of the world’s most common medical problems and its morbidity is
increasing at a disturbing rate [
1
]. The prevalence of diabetes worldwide is anticipated
to increase from 463 million in 2019 to 700 million in the 2045 [
2
]. In the Kingdom of
Saudi Arabia, the incidence rate of the disease is high and has become a leading public
health problem [
1
,
3
]. According to the current investigation by the Saudi Scientific Diabetes
Society, Saudi Arabia is among the top 10 nations in the world with the highest prevalence
of diabetes [
4
]. Approximately 17.9% of Saudi adults have diabetes and it is a strong
possibility that many more are undiagnosed or pre-diabetic, leaving many on the edge of
the disease [
4
]. This is a foremost concern due to its high prevalence, but the government
and health experts are implementing measures to address the lifestyle choices that lead to
diabetes and promote healthy ways of living.
Several issues and challenges related to the delivery of quality care for diabetes patients
have been identified in the literature. For example, a study conducted in Ethiopia reported
poor glycaemic control and poor blood glucose testing practices [
5
]. Other issues identified
were poor adherence to medication, diet and lifestyle modifications [
6
,
7
]. Educating patients
about diabetes-related information, including its pathology, management, complications
J. Pers. Med. 2023,13, 57. https://doi.org/10.3390/jpm13010057 https://www.mdpi.com/journal/jpm

J. Pers. Med. 2023,13, 57 2 of 11
and patient self-care, is a critical aspect in improving the quality of diabetes care. However,
the literature indicates that patients receive inadequate instructions and training regarding
diabetes-related information, which are essential in enhancing knowledge, modifying
behaviour, increasing compliance to a treatment regimen and self-care and increasing
quality of life [
8
]. Provider-related factors such as being unprepared to provide diabetes
education to patients, inadequate training or education related to diabetes, low priority
given to patient teaching and lack of time to conduct patient teaching were identified as
barriers in providing quality diabetes education to patients [8].
As one of the largest populations in health care and having the most frequent in-
teractions with patients, nurses play a critical role in diabetes education. However, this
dynamic role and responsibility in diabetes awareness are often not performed properly
by nurses [
8
]. Nurses acknowledge that ignorance, the large number of patients in their
care and self-doubt are some of the causes for this deficiency. Several research investiga-
tions have been undertaken to test the knowledge of nurses in various areas related to
diabetes and nursing care for patients with diabetes. A study from the Republic of Rwanda
reported a low knowledge level among nurses in terms of diabetes education, specifically
on diet, complications, insulin use and impact of stress [
9
]. A previous review indicated
the substantial knowledge inadequacies of nurses from developed and developing nations
in the core areas of diabetes care, including ‘insulin therapy, oral diabetes medications,
nutrition, BGM, diabetes complications and foot care, diabetes pathology, symptoms and
management’ [10].
The significance of education and training in improving nurses’ knowledge regard-
ing diabetes and its care has been emphasized in previous scholarly works [
8
,
10
]. The
foundation of nurses’ knowledge must start in the undergraduate nursing program. Nurs-
ing students are the future of the nursing profession; hence, nursing education plays an
important role in preparing future nurses and ensuring that they are knowledgeable and
competent in diabetes care. Moreover, nursing students are involved in providing direct
care to patients with diabetes during their clinical rotations. However, a previous study
argued that nursing students had a low level of awareness of the disorder and that adequate
education on the development and management of the disease is necessary to develop their
understanding about the disease and to assist in the management of problems associated
with diabetes [
11
]. Hence, nursing students must be equipped with adequate knowledge
regarding this topic. Research studies addressing the understanding of diabetes among
nursing students are scarce and inadequate. Therefore, it is imperative to investigate
student nurses’ level of knowledge of diabetes and to identify areas that need attention to
ensure a high level of diabetes knowledge. The aim of the present study was to investigate
the predictors of self-assessed and actual knowledge of diabetes-related information in
undergraduate student nurses.
2. Materials and Methods
2.1. Study Design
This study used a quantitative, cross-sectional design.
2.2. Setting and Sampling
Undergraduate student nurses enrolled in Shaqra University and Hail University were
surveyed in this research study. Shaqra University is located in Riyadh province, while
Hail University is located in Hail province. In this study, the convenience sampling method
was used for sample selection. The Baccalaureate of Science in Nursing (BSN) program in
the two universities is a 4-year program, with 1 year of intensive clinical internship. The
inclusion criteria for this study were second-year, third-year, fourth year and intern nursing
students of both sexes who were officially enrolled at the time of the investigation. The
exclusion criteria were non-nursing students and first-year nursing students (university
preparation). The latter were excluded because they did not have major nursing subjects
yet. A post hoc power analysis (G*Power v3.1) of the present sample size was performed.

J. Pers. Med. 2023,13, 57 3 of 11
The analysis revealed that the sample size achieved 100% power at a medium effect size and
5% significance level (n= 330). The questionnaires were distributed to 645 nursing students
at the college, of whom 330 completed and returned them, indicating a 51.16% response
rate. The study had no missing data, so the final sample included 330 nursing students.
2.3. Ethical Considerations
Owing to the absence of an institutional review board in the university during the
conduct of the study, the study was approved by the Scientific Research Unit of the College
of Applied Medical Sciences, Shaqra University, Saudi Arabia, on 6 October 2019 (approval
No. RU-0016). The Scientific Research Unit was responsible for ensuring that the conduct of
research activities in the college strictly adheres to the rules governing the ethics of scientific
research by the university. The students were given the information they needed about
the research and those who decided to participate in the study affixed their signatures
to the informed consent form. The researchers explained to the participants that their
participation is voluntary and will not affect their performance at the university in any way.
2.4. Instrument
The questionnaire was divided into three parts. Part one was designed to elicit
data on demographic variables, including the students’ university, age, sex, year level
and experience in providing direct care to diabetes patients; the courses, workshops and
conferences on diabetes assessment or management that they had attended; and their
perceived competence in diabetes nursing care.
The second part was the Diabetes Self-report Tool (DSRT) adapted from Drass et al.,
(1989) [12], which has 15 items that measure respondents’ self-reported knowledge of dia-
betes and diabetes care. The items asked about respondents’ knowledge of diabetes-related
information such as diabetes pathology, signs and symptoms, assessments, management,
nutrition and complications. Four response options were graded according to the following:
1, ‘strongly disagree’; 2, ‘disagree’; 3, ‘agree’; and 4, ‘strongly agree’. The total score was
computed, ranging from 15 to 60, to obtain the students’ perceived knowledge. According
to the authors, high scores denoted high levels of perceived knowledge [12].
The third part of the questionnaire was the Diabetes Basic Knowledge Tool (DBKT),
also by Drass et al. (1989) [
12
], which measures respondents’ actual knowledge. This
part contained 49 multiple-choice questions. The respondents were asked to choose the
correct answer from the options provided. Five conceptual dimensions were measured
using this tool: (1) diabetes pathology, symptoms and management (14 items); (2) blood
glucose monitoring (6 items); (3) diabetes medication (16 items); (4) diabetes diet/nutrition
(6 items); and (5) diabetes foot care and complications (7 items). The possible range of
scores was from 0 to 49, with higher scores denoting higher levels of actual knowledge. The
researchers were granted permission by the original authors to adapt the tool in the study.
The two tools distributed to the respondents were in the English language, as in the original
version. The validities and reliabilities of the DSRT and DBKT were previously reported
and found to be acceptable [
13
]. When used in Saudi Arabia, the entire questionnaire had a
content validity of 0.98 and excellent stability reliability (DSRT: r= 0.835, p< 0.01; DBKT:
r= 0.727, p< 0.01) [
14
]. In our sample, Cronbach’s alpha was 0.688 for the DSRT. For the
DBKT, a Kuder-Richardson 20 test was performed and an alpha value of 0.887 was obtained.
These results attest to the reliability of both the DSRT and DBKT when used among Saudi
nursing students [15].
2.5. Data Collection
Data were collected from October to December 2019. The respondents were given
a maximum of 1 h to answer the questionnaire. To ensure that their actual knowledge
was measured accurately, we collected the data in a quiet and comfortable classroom.
The students were not allowed to access their books, notes, or the internet or discuss the

J. Pers. Med. 2023,13, 57 4 of 11
questions with their classmates. After the allocated time, we collected the questionnaires
and kept them inside a secure cabinet until the end of the data gathering period.
2.6. Statistical Analysis
The data were analysed using SPSS version 22.0. Descriptive analyses were performed
on the demographic variables, self-reports and actual knowledge. Confidence intervals
(CIs) were also calculated as necessary. To identify the significant predictors of self-reported
and actual diabetes knowledge (dependent variables), multiple regression models were
performed on each dependent variable. The demographic variables were used as predictors.
For actual knowledge, the students’ perceived knowledge was also included as a predictor
variable to examine their association, considering a pvalue of ≤0.05 to be significant.
3. Results
A total of 400 questionnaires were distributed, of which 330 were retrieved and
entered for analysis (response rate, 82.5%). Other questionnaires were not included in the
analysis because of incomplete information and answers. The students’ mean (SD) age was
23.22 (3.85) years (range, 19–36 years). Most students were studying in University B (65.5%;
n= 216), were female (57.0%; n= 188), had experience in giving direct care to patients
with diabetes (87.0%; n= 284) and had not attended courses, workshops, or conferences on
diabetes and diabetes care (59.4%; n= 196). The fourth-year students comprised the highest
proportion (29.4%; n= 97) of the sample, whereas the second-year students comprised the
lowest proportion (20.9%; n= 69). More than a third of the respondents reported a fair level
of competence in diabetes care (43.0%; n= 142), 27.6% (n= 91) reported good competence,
22.1% (n= 73) reported excellent competence and 7.3% (n= 24) reported poor competence
(see Table 1).
Table 1. Demographic data of the respondents (n= 330).
Variable Mean (SD) Range
Age, years 23.22 (3.85) 19–36
n%
University
University A 114 34.5
University B 216 65.5
Sex
Male 142 43.0
Female 188 57.0
School level
2nd year 69 20.9
3rd year 71 21.5
4th year 97 29.4
Internship year 93 28.2
Had experience in providing direct care to diabetes patients
No 43 13.0
Yes 287 87.0
Attended courses, workshops, or conferences on diabetes and
diabetes care
No 196 59.4
Yes 134 40.6
Perceived competence in diabetes care
Poor 24 7.3
Fair 142 43.0
Good 91 27.6
3.1. Self-Reported Diabetes Knowledge and Its Predictors
The overall mean (SD) score was 48.31 (5.71) (range, 15–60), which is equivalent to
80.52% of the total score. In the DSRT, item 3, ‘I can identify the long-term complications

J. Pers. Med. 2023,13, 57 5 of 11
associated with diabetes’, garnered the highest mean (mean (SD), 3.53 [0.77]), followed by
item 4, ‘I can explain/describe the action and effect of insulin’ (3.52 (0.76)) and item 8, ‘I
am generally comfortable teaching patients about insulin therapy’ (3.37 (0.76)). The lowest
mean was recorded for item 13, ‘I can list the steps of insulin administering’ (mean [SD],
2.99 (1.20)). Most students reported their agreement with all items on perceived knowledge
(Table 2).
Table 2. Results of the descriptive analysis of perceived diabetes knowledge (n= 330).
Item Strongly Disagree Disagree Agree Strongly Agree Mean (SD)
n(%) n(%) n(%) n(%)
1 21 (6.4) 37 (11.2) 127 (38.5) 145 (43.9) 3.20 (0.88)
2 44 (13.3) 38 (11.5) 101 (30.6) 147 (44.5) 3.06 (1.05)
3 14 (4.2) 14 (4.2) 86 (26.1) 216 (65.5) 3.53 (0.77)
4 12 (3.6) 17 (5.2) 88 (26.7) 213 (64.5) 3.52 (0.76)
5 9 (2.7) 19 (5.8) 248 (75.2) 54 (16.4) 3.05 (0.57)
6 5 (1.5) 25 (7.6) 152 (46.1) 148 (44.8) 3.34 (0.68)
7 10 (3.0) 30 (9.1) 182 (55.2) 108 (32.7) 3.18 (0.71)
8 11 (3.3) 24 (7.3) 128 (38.8) 167 (50.6) 3.37 (0.76)
9 36 (10.9) 21 (6.4) 110 (33.3) 163 (49.4) 3.21 (0.98)
10 13 (3.9) 27 (8.2) 134 (40.6) 156 (47.3) 3.31 (0.79)
11 52 (15.8) 37 (11.2) 90 (27.3) 151 (45.8) 3.03 (1.10)
12 22 (6.7) 44 (13.3) 89 (27.0) 175 (53.0) 3.26 (0.93)
13 71 (21.5) 24 (7.3) 71 (21.5) 164 (49.7) 2.99 (1.20)
14 17 (5.2) 66 (20.0) 100 (30.3) 147 (44.5) 3.14 (0.91)
15 18 (5.5) 72 (21.8) 98 (29.7) 142 (43.0) 3.10 (0.93)
Total score a48.31 (5.71)
Note. aRange, 15–60.
To identify the significant predictors of perceived knowledge, the demographic vari-
ables of the respondents and their overall perceived knowledge scores were entered as
predictor and dependent variables, respectively, into a regression analysis. The model was
significant (F
[9, 320]
= 23.72, p< 0.001), accounting for 38.3% of the variance of self-reported
diabetes knowledge (R
2
= 0.400, adjusted R
2
= 0.383). The students’ university, sex, year
level and experience in providing direct care to diabetic patients were recognized as sig-
nificant predictors of self-reported knowledge. As indicated in Table 3, the students from
University B had greater perceived knowledge than those from University A (
β
= 7.38,
p< 0.001; 95% CI, 6.02–8.74). Being female was associated with higher levels of perceived
knowledge (
β
= 1.16, p= 0.025; 95% CI, 0.15–2.17). The third-year students reported higher
levels of diabetes knowledge than the second-year students (
β
= 1.79, p= 0.031; 95% CI,
0.17–3.41). The students who had prior experience in providing direct care to patients
with diabetes reported higher levels of diabetes knowledge than those who did not have a
similar experience (β= 1.85, p= 0.026; 95% CI, 0.22–3.47).
3.2. Actual Diabetes Knowledge and Its Predictors
Table 4summarises the findings of the descriptive analyses of the students’ actual
diabetes knowledge from the DBKT. The overall mean (SD) score of the students was
22.54 (8.57), with scores ranging from 1 to 34. The mean (SD) scores for the dimensions
were as follows: diabetes pathology, symptoms and management (6.02 [2.33]); blood
glucose monitoring (2.29 [1.09]); diabetes foot care and complications (3.85 [1.95]); diabetes
diet/nutrition (2.27 [1.10]); and diabetes medication (8.11 [3.65]).

J. Pers. Med. 2023,13, 57 6 of 11
Table 3.
Results of the multiple regression analysis to identify the predictors of perceived knowledge
(n= 330).
Predictor Variable βSE-b Beta t p 95% Confidence Interval
Lower Upper
University 7.38 0.69 0.62 10.70 <0.001 *** 6.02 8.74
Sex 1.16 0.52 0.10 2.26 0.025 * 0.15 2.17
Age −0.02 0.08 −0.02 −0.29 0.769 −0.18 0.13
Year level (reference group: 2nd year)
3rd year 1.79 0.82 0.13 2.17 0.031 * 0.17 3.41
4th year 0.86 0.81 0.07 1.07 0.284 −0.72 2.45
Internship year −0.49 0.85 −0.04 −0.58 0.563 −2.16 1.18
Experience in providing direct
care to diabetic patients 1.85 0.83 0.11 2.24 0.026 * 0.22 3.47
Attended courses, workshops,
or conferences on diabetes
and diabetes care
0.39 0.53 0.03 0.75 0.456 −0.64 1.43
Perceived competence in
diabetes care −0.08 0.32 −0.01 −0.23 0.815 −0.71 0.56
Note. The students’ perceived diabetes knowledge was the dependent variable.
β
is the unstandardized coefficient;
SE-b, the standard error; and beta, the standardized coefficient. R
2
= 0.400; adjusted R
2
= 0.383. * Significant at
0.05. *** Significant at 0.001.
Table 4. Results of the descriptive analyses of actual diabetes knowledge (n= 330).
Variable Incorrect Answer Correct Answer Mean (SD) Score Range
n%n%
Diabetes pathology, symptoms and management 6.02 (2.33) 0–10
Item 1 145 43.9 185 56.1
Item 2 246 74.5 84 25.5
Item 3 291 88.2 39 11.8
Item 4 151 45.8 179 54.2
Item 5 123 37.3 207 62.7
Item 6 252 76.4 78 23.6
Item 7 134 40.6 196 59.4
Item 8 127 38.5 203 61.5
Item 9 139 42.1 191 57.9
Item 10 299 90.6 31 9.4
Item 11 142 43.0 188 57.0
Item 12 166 50.3 164 49.7
Item 13 303 91.8 27 8.2
Item 14 115 34.8 215 65.2
Blood glucose monitoring 2.29 (1.09) 0–5
Item 15 119 36.1 211 63.9
Item 16 128 38.8 202 61.2
Item 17 117 35.5 213 64.5
Item 18 282 85.5 48 14.5
Item 19 284 86.1 46 13.9
Item 20 295 89.4 35 10.6
Diabetes foot care and complications 3.85 (1.95) 0–7
Item 21 155 47.0 175 53.0
Item 22 135 40.9 195 59.1
Item 23 290 87.9 40 12.1
Item 24 110 33.3 220 66.7
Item 25 125 37.9 205 62.1
Item 26 130 39.4 200 60.6
Item 27 95 28.8 235 71.2

J. Pers. Med. 2023,13, 57 7 of 11
Table 4. Cont.
Variable Incorrect Answer Correct Answer Mean (SD) Score Range
n%n%
Diabetes diet/nutrition 2.27 (1.10) 0–5
Item 28 268 81.2 62 18.8
Item 29 103 31.2 227 68.8
Item 30 136 41.2 194 58.8
Item 31 119 36.1 211 63.8
Item 32 312 94.5 18 5.5
Item 33 294 89.1 36 10.9
Diabetes medication 8.11 (3.65) 0–14
Item 34 108 32.7 222 67.3
Item 35 128 38.8 202 61.2
Item 36 301 91.2 29 8.8
Item 37 257 77.9 73 22.1
Item 38 138 41.8 192 58.2
Item 39 143 43.3 187 56.7
Item 40 118 35.8 212 64.2
Item 41 105 31.8 225 68.2
Item 42 98 29.7 232 70.3
Item 43 127 38.5 203 61.5
Item 44 132 40.0 198 60.0
Item 45 116 35.2 214 64.8
Item 46 302 91.5 28 8.5
Item 47 127 38.5 203 61.5
Item 48 129 39.1 201 60.9
Item 49 274 83.0 56 17.0
Total actual diabetes knowledge score 22.54 (8.57) 1–34
The regression model was statistically significant (F
[10, 319]
= 142.29, p< 0.001), explain-
ing an 81.1% variance in actual diabetes knowledge (R
2
= 0.817, adjusted R
2
= 0.811). The
university attended, age and perceived diabetes knowledge were significant predictors
of actual diabetes knowledge. Specifically, the students from University B attained scores
higher by 15.80 points than those of the students from University A (p< 0.001; 95% CI,
14.48–17.11). A year increase in the respondents’ age resulted in a 0.15-point decrease in
their actual knowledge score (p= 0.022; 95% CI,
−
0.28 to
−
0.02). Finally, a 1-point increase
in self-reported diabetes knowledge score resulted in a 0.11-point increase in actual diabetes
knowledge score (p= 0.020; 95% CI, 0.02–0.20; Table 5).
Table 5.
Results of the multiple regression analysis to identify the predictors of actual knowledge
(n= 330).
Predictor Variable βSE-b Beta t p 95% Confidence Interval
Lower Upper
University 15.80 0.67 0.88 23.68 <0.001 *** 14.48 17.11
Sex 0.29 0.43 0.02 0.66 0.509 −0.56 1.13
Age −0.15 0.07 −0.07 −2.31 0.022 * −0.28 −0.02
Year level (reference group: 2nd year)
3rd year −0.13 0.69 −0.01 −0.18 0.857 −1.48 1.23
4th year 0.75 0.67 0.04 1.12 0.265 −0.57 2.07
Internship year 1.12 0.71 0.06 1.59 0.114 −0.27 2.51
Experienced in providing
direct care to diabetic patients
0.18 0.69 0.01 0.26 0.798 −1.18 1.54
Attended courses, workshops,
or conferences on diabetes
and diabetes care
0.37 0.44 0.02 0.84 0.402 −0.49 1.23
Perceived competence in
diabetes care −0.16 0.27 −0.02 −0.59 0.558 −0.68 0.37

J. Pers. Med. 2023,13, 57 8 of 11
Table 5. Cont.
Predictor Variable βSE-b Beta t p 95% Confidence Interval
Lower Upper
Perceived diabetes knowledge
0.11 0.05 0.07 2.33 0.020 * 0.02 0.20
Note. The students’ actual diabetes knowledge was the dependent variable.
β
is the unstandardized coefficient;
SE-b, the standard error; and beta, the standardized coefficient. R
2
= 0.817; adjusted R
2
= 0.811. * Significant at
0.05. *** Significant at 0.001.
4. Discussion
This investigation examined the self-reported and actual knowledge of diabetes and
their predictors among Saudi undergraduate nursing students. The findings showed good
perceived knowledge, as indicated by the mean score of 48.31 from a possible total score
of 60. Surprisingly, the present finding is higher than the perceived diabetes knowledge
of nurses in the same country [
14
]. According to Alotaibi et al. nurses’ mean (SD) score
in the same tool was 46.9 (6.1), or 78.2%. The same study reported that nurses overrated
their knowledge compared with their actual knowledge [
14
]. This may also hold true in the
present sample. Most student nurses agreed on all statements in the scale. This implies that
the students thought that their knowledge in relation to diabetes-related information. The
students reported that their lowest level of knowledge was on how to administer insulin
and on the proper diet for patients with diabetes and self-care management. These three
topics are vital in teaching patients with diabetes. One responsibility of nurses is to teach
diabetic patients how to self-administer insulin, the type of diet appropriate for optimum
functioning and how to take care of themselves [
16
]. Hence, additional education related
to these topics is needed to ensure that nursing students acquire the right knowledge to
teach their patients effectively.
The poor diabetes knowledge of the students in our study is similar to the knowledge
reported previously among nursing students in Jordan [
17
]. In contrast, significantly
higher levels of diabetes knowledge were reported among nursing students from Japan
and Australia [
18
]. The barriers to obtaining high levels of diabetes knowledge include a
lack of education and training on diabetes pathology and management and a lack of access
to educational materials [14].
Int this study, the students had more knowledge on information related to diabetic
foot care and other diabetic-related complications and diabetes medications. The poorest
knowledge was related to diet or nutrition, followed by blood glucose monitoring and infor-
mation related to the pathology, symptoms and management of diabetes. Poor knowledge
on nutrition and the pathology, symptoms and management of diabetes was also evident
among the nurses in Saudi Arabia [
14
]. The results show gaps in the students’ self-reported
and actual knowledge. For example, the students perceived that their knowledge in identi-
fying the long-term complications of diabetes was excellent, but their actual knowledge
of the complications of diabetes was very poor. Another example was in relation to blood
glucose monitoring, where approximately 87.9% of the students agreed that they were
comfortable in instructing patients about glucose monitoring, but their actual knowledge
score in this area was very poor.
The good level of perceived knowledge among the students was related to being
enrolled in University B. This finding is also true with actual knowledge, where students
from University B scored higher than those from the other university. The differences in
self-reported and actual diabetes knowledge between the students from the two universities
may be related to several factors such as curricular content, teaching methodologies and
strategies and the expertise of faculty members [
19
]. The nursing curriculum and course
content in the two universities were not similar. In an earlier study, nursing students from
an Australian university showed better clinical diabetes knowledge than nursing students
from a Japanese university [
20
]. The authors justified that these differences in knowledge
may be due to the Australian students’ higher frequency of exposure in caring for diabetes
patients and knowledge of more people with diabetes [
20
]. This is also true in the present

J. Pers. Med. 2023,13, 57 9 of 11
sample, as indicated by the findings that students who had reported a direct involvement in
providing diabetes care had higher perceived diabetes knowledge than those who did not
have the same experience. A study involving 52 practice nurses in Australia reported that
nurses with
≥
2 years of experience exhibited greater knowledge than those with <2 years
of experience [
21
]. In relation to nursing students, clinical practice allows the application
of the theoretical learning component of nursing courses and solidifies the knowledge
acquired from the classroom by clinical application [22].
Another predictor of perceived knowledge was sex, where women perceived their
knowledge to be higher than that of men. Sex was also indicated as a predictor of diabetes
knowledge of student nurses in a study conducted in Jordan; however, it was not clear
which sex was associated with a higher level of knowledge [
17
]. In the study by Aloitabi
et al. male nurses reported higher levels of perceived diabetes knowledge than female
nurses; however, the female nurses achieved significantly higher levels of actual knowledge
than male the nurses [
14
]. Although the reasons for the sex differences in our study are not
clear, our findings imply that the female Saudi nursing students may have more confidence
in their knowledge than the male students, although this did not translate to actual diabetes
knowledge. Furthermore, academic level was also identified as a significant predictor of
perceived knowledge, where the third-year students reported better knowledge than the
second-year students. The concept of diabetes was taught under a third-year subject (Adult
Health Nursing 2) and the third-year students had more clinical exposure, giving them
more opportunities to care for clients with diabetes than sophomore students.
Finally, self-reported diabetes knowledge was identified as a predictor of students’
actual knowledge. This means that higher levels of perceived knowledge are linked to
greater actual knowledge scores. The findings show that most students who self-rated
their knowledge as good achieved high scores in the DBKT. A previous study conducted
in Hong Kong also reported a positive association between nurses’ self-reported and
actual knowledge [
23
]. However, despite the positive link between self-reported and
actual knowledge, the gap between these two variables remains and previous studies have
concluded that more often, nurses are unaware of their insufficient actual knowledge,
which could eventually lead to poor care delivered to diabetes patients [14].
5. Conclusions
The study assessed the self-reported and actual knowledge on diabetes-related infor-
mation and examined their predictors among a sample of Saudi undergraduate nursing
students. The students in the study rated their perceived knowledge higher than their
actual knowledge. The gap between their self-reported and actual knowledge on diabetes
was evident. The University B students predicted better self-reported and actual diabetes
knowledge. The female students in the third year of nursing school, having experience in
giving direct care to diabetes patients, predicted higher levels of self-reported knowledge.
The higher levels of self-reported knowledge predicted higher levels of actual knowledge.
5.1. Recommendations
The findings underscore the necessity to improve the actual knowledge of undergrad-
uate student nurses about diabetes and its management. The findings provide a solid basis
for planning and implementing educational interventions on diabetes-related information
to ensure adequate diabetes knowledge among nursing students. Educational content
must be structured to include those aspects that received poor knowledge ratings, such
as nutrition/diet, blood glucose monitoring and diabetes pathology, symptoms and man-
agement. Additional information may also focus on diabetes medication, diabetes foot
care and diabetes complications. The individual learning needs of students in the area of
diabetes must be assessed and taken into consideration in planning and implementing edu-
cational interventions to avoid a knowledge gap between the sexes. There should also be a
systematic and intentional implementation of diabetes education in both theoretical and
clinical courses to ensure the development of knowledge as students progress in the nursing

J. Pers. Med. 2023,13, 57 10 of 11
program. The curriculum of all universities in the country must be examined to identify
gaps in their contents and to unify them across the country to ensure the achievement of
the same learning outcomes.
5.2. Limitations
Although this study provides valuable results regarding nursing students’ knowledge
of diabetes, it has several limitations. First, the study design may have implications on
how the results of the study could be generalized. Second, the study only surveyed
two universities, which might not represent all the universities in the country. Studies
in the future should use other research approaches and include more universities. The
convenience sampling technique used in this research is also a limitation because it is
prone to bias. Thus, future investigations should use random sampling to guarantee the
generalizability of results. The predictive variables were only focused on the demographic
variables, which limited the discussions on them. Future studies should explore other
variables that likely influence nursing students’ knowledge of diabetes.
Author Contributions:
Conceptualization, A.M.A. (Abdulellah M. Alsolais) and J.P.C.; methodology,
J.S.A. and K.A.A.; software, A.M.A. (Abdulellah M. Alsolais); validation,
A.M.A. (Abdulellah M. Alsolais)
and K.A.A.; formal analysis, J.P.C.; investigation, J.B.B.; resources, N.A.; data curation, F.A.; writing—
original draft preparation, A.M.A. (Abdulellah M. Alsolais) and J.P.C.; writing—review and edit-
ing, A.M.A. (Ahmed Mansour Almansour), J.S.A. and F.A.; visualization, K.A.A.; supervision,
A.M.A. (Abdulellah M. Alsolais)
and J.P.C.; project administration, J.S.A. and J.B.B.; funding acquisi-
tion, J.S.A., A.M.A. (Ahmed Mansour Almansour) and N.A. All authors have read and agreed to the
published version of the manuscript.
Funding:
The author extends their appreciation to the deputyship for Research & Innovation, Min-
istry of Education in Saudi Arabia for funding this research work through the project number
(IFP-2020-109).
Institutional Review Board Statement:
Ethical approval for the study was obtained from the Sci-
entific Research Unit of the College of Applied Medical Sciences, Shaqra University, Saudi Arabia
(approval No. RU-0016).
Informed Consent Statement: All participants provided informed consent.
Data Availability Statement: Not applicable.
Conflicts of Interest: The authors confirm no conflict of interest.
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