Table of Contents
- Background and Significance of the Problem
- Literature Review
- Statement of the Problem and Purpose of the Study
- Research Questions, Hypothesis and Variables
- Theoretical Framework
- Overview and Guiding Propositions
- Sampling Strategy
- Data Analysis Plans
- Ethical Issues
- Limitations of Proposed Study
- Implication for Practice
- Related Research essays
Self-management education provides patients with a possibility to cope with their problem and disease in a successful manner and it concerns enhanced self-help, appropriate monitoring, and management of lifestyle and the best quality of life, regardless of a chronic disease. Type 1 Diabetes appears to be an autoimmune condition during which the immune system opposes and ruins the insulin-generating beta cells in the pancreas. This type is also featured by the presence of particular auto-antibodies opposing insulin or other constituents of the insulin-generating system, including islet cells, tyrosine phosphates, together with glutamic acid decarboxylase (GAD). Type II Diabetes is a chronic condition that extorts lifestyle changes and management is needed to sustain glycaemia and long-range entanglement under control. Education should be adjusted and grounded on an assessment of such aspects that influence self-management as personal characteristics enhancing educational intervention. The current paper will analyze whether a more multi-disciplinary and comprehensive method of teaching can achieve higher compliance with diabetes control associated with conventional patient education.
Background and Significance of the Problem
Diabetes is a complicated chronic condition in which active incorporation of patients in their management is highly necessary. Diabetes self-management education and training (DSMT) is a continuous procedure of alleviating cognizance, skills, and capability that are required for pre-diabetes and diabetes self-help, and it is reviewed as a significant constituent of the inherent and integrated diabetes treatment and medication (Schmitt, et al., 2013, p. 139). It may be regarded as an intrusion through which patients explore and asses information about diabetes and methods of implementing self-management, which are regarded as vital to controlling the condition. The U.S. statistics demonstrates that approximately 29 million individuals suffer from diabetes, incorporating about 8 million of people who do not know that they have it (Bagnasco et al., 2013, p. 187). Furthermore, approximately 86 million people over 18 appear to have pre-diabetes, which actually exposes them to a bigger hazard of evolving type 2 diabetes, heart disease, and stroke, while merely 11 percent know they have it (Bagnasco et al., 2013, p. 188). Nevertheless, individuals suffering from diabetes are capable of taking steps to control this condition and impede entanglements, while people diagnosed with pre-diabetes might control or detain the beginning of type 2 diabetes via physical activity and weight lost (Johnson, Fuisinger, Bates & Barnes, 2014, p. 499).
Diabetes self-management programs provide several promising approaches to promoting changes in lifestyle. These programs could be adopted by FNPs (family nurse practitioners) in order to tackle health problems such as diabetes (both types) if the programs are also culturally sensitive.
The study conducted by Wilkinson, Whitehead, and Ritchie (2014) demonstrates that people who live with diabetes encounter numerous factors that encroach on their daily routine’s management of this condition (p. 111). Moreover, they appear to be aggravated by the individual’s susceptibility to broader cultural, situational, and societal issues. Self-care capability is defined by researches as a dynamic, developing process, which differs from individual to individual and incorporates a change from being controlled by diabetes to an ability to restrict the influence of the condition (Wilkinson et al., 2014, p. 113). The authors synthesize the argument and confirmation from qualitative studies, which provides an opportunity to identify numerous factors that impact the capability to self-control the condition. A lot of studies demonstrate that after decades of continuous increase in the ratio of new instances of diagnosed diabetes, the level of growth and expansion in regard to new cases might have leveled off (Wiley et al., 2013, p. 1786). Nevertheless, numerous randomized controlled trials concerning educational interventions, especially for type 2 diabetes in the U.S., have appeared to be inconclusive (Bagnasco et al., 2013, p. 187). Thus, proficient patient-education intervention trials demonstrate an enhanced glycaemic management, lowered general cholesterol levels, decreased levels of body weight, body mass index, lowered necessity for diabetes cure, increased knowledge level, self-control, self-management capabilities, and contentment thanks to medication for both pre-diabetes and diabetes 2 types (Bagnasco et al., 2013, p. 187). However, the study has not revealed any general enhancements in quality of life at the follow up period (14 months) (Bagnasco et al., 2013, p. 189). On the other hand, a different trial of diabetes education and self-control program did not illustrate any discrepancy in HbA1c despite the fact that participants of the intervention category acknowledged positive enhancements in opinion and persuasion concerning their condition. However, Johnson et al. (2014) demonstrate that patients suffering from diabetes who come face-to-face with a clinical pharmacist as an element of an employer-sponsored pharmacist-guided diabetes self-management program obtained essential enhancements in HbA1c, LDL-Cholesterol after a year contrary to the previous information (p. 501). This research demonstrates relative decrease in all parameters, despite the fact that HbA1c valuables sustained above the ADA (American Diabetes Association) directive objective after one year of program participation (Johnson et al., 2014, p. 503). Contrary to the outcomes of previously presented studies, this reduction correlates with a downturn in planned direct patient medical spendings. Wiley et al. (2013) research outcomes illustrate that a high depletion ratio of young adults suffering from Type 1 is connected to the inability of recommended health services and procedures to meet the requirements and choices of their patients (p. 1794). The study reveals decreased health-service uptake, which is combined with poor health results about young adults suffering from Type 1 diabetes (Wiley et al., 2013, p. 1794). Thus, the outcomes of the study demonstrate that it is necessary to engage patients in a changed health-service design (Wiley et al., 2013, p. 1794). Nevertheless, the research provides numerous suggestions for enhanced health-service delivery and refined treatment outcomes. The study conducted by Schmitt et al. (2013) applied Development of the Diabetes Self-Management Questionnaire (DSMQ), which actually demonstrated highly successful psychometric attributes and characteristics (p. 138). It presupposes that the questionnaire is an effective implement that provides dependable and well-founded data on diabetes self-management, while assessing four well-outlined particular self-management operations concerning glycaemic monitoring (Schmitt et al., 2013, p. 139). The study has been particularly developed to promote scientific studies of psychosocial hurdles in self-management, self-control, and glycaemic monitoring. Nevertheless, the questionnaire can be regarded as helpful and beneficial for the clinical application in a form of a screener or as a diagnostic implement because good metabolic control is the most essential objective of diabetes medication (Schmitt et al., 2013, p. 139). Furthermore, the research conducted by Stetson et al. (2011) reveals that effective and continuous usage of self-control and sequential decision-making should be grounded on appropriately and adequately provided instructions and guidance, review of analyzed and controlled outcomes, and close cooperation with providers (p. 189). The researches also demonstrate that the entire diabetes education community should cooperate as it is necessary to ensure that the control is applied and used to its fullest benefit (Stetson et al., 2011, p. 196).
Statement of the Problem and Purpose of the Study
Diabetes self-management education can provide patients with a possibility to deal with their condition and associated problems in a successful manner due to the fact that it is provides enhanced self-help, relevant monitoring and self-management over their lifestyle and assists them in enjoying full life, regardless of a pre-diabetes state. The purpose of the current research is to define whether patients with type 1 and 2 diabetes who have better knowledge and self-management would have better levels of hemoglobin A1c (HbA1c) and total cholesterol. The paper will demonstrate whether a diabetes self-management program implemented by an FNP and aimed at encouraging positive lifestyle behaviors and improving health outcomes is effective at treating or preventing diabetes. If the participatory gardening program is found to be effective then it may be possible for these or similar methods to be implemented by individual FNPs to prevent or treat diabetes.
Research Questions, Hypothesis and Variables
The following research question will guide this study: does a more multi-disciplinary and comprehensive method of teaching patients achieves higher results in controlling the disease associated with conventional patient education? The null hypothesis suggested that there was no statistical connection between knowledge and self-management because people with knowledge might still not be active in self-care management.
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Firstly, the demographic variables that will be considered regard age measured in years. Secondly, they will be measured in accordance with gender as male, female, or LGBT. Thirdly, they will be measured in regard to culture/race as African American, Asian, Hispanic, Native Hawaiian, Guamanian, Chamorro, Samoan, Tahitian, Tongan, Tokelauan, Marshallese, Palauan, Chuukese, Fijian, Guinean, Solomon Islander, Micronesian (not specified), Polynesian (not specified), White, Mixed, etc. It is important to mention that exercises will be managed in a form of time in minutes per day for categories of walking, medium physical operations (bicycling, carrying light loads), and solid physical activity (heavy lifting, digging, aerobics, fast bicycling). The standard diet will incorporate all foods consumed in 24 hours on the basis of one typical day.
The independent variable for this study is a diabetes self-management program. The dependent variable for this study is a change in baseline HbA1c and total cholesterol levels.
The development of the Diabetes Self-Management Questionnaire (DSMQ) has been utilized in a form of a categorization tool for analyzing diabetes self-care as it helps to assess the behavior associated with metabolic control within common treatment regimens for type 1 and type 2 diabetes in adult patients (Bagnasco et al., 2013, p. 187). In addition, the AADE has been used as an additional implement for analyzing behavior of patients suffering from type 2 diabetes (Schmitt et al., 2013, p. 138). Five of the behaviors have been adapted from the self-care behavior framework, including healthy eating, being active, monitoring, taking medication, and reducing risks.
The questions were categorized to get information about all aspects: healthy eating consisting of particular diet, general diet and diet days, being active encompassing exercises, monitoring behavior incorporates blood glucose management, lowering hazards concerning foot care, and the activity of taking medications encompassed medication application and usage (Bagnasco et al., 2013, p. 188).
Overview and Guiding Propositions
The questionnaire advocates self-care directives, which appears to be a “self-care behavior framework” in seven elements. They encompass such behaviors as healthy food consumption, active lifestyle, control, medication consumption, problem resolving, lowering hazards, and healthy coping (Schmitt et al., 2013, p. 138). All of them can be used in order to alter lifestyle, gain self-control, enhance individual management and skills education, which might appear to be helpful for controlling the condition be beneficial for the overall diabetes prevention at the same time. The final assortment of items consisted of the following categories (Schmitt et al., 2013, p. 138). Firstly, it encompassed systematic nature of consuming medication (four items). Secondly, it included diabetes-connected elements of diet (for instance regular intake of foods with regard to glycaemic management and control) (Schmitt et al., 2013, p. 138). Thirdly, it checked dedication to diet regime recommendations together with directions concerning alcohol consumption (Schmitt et al., 2013, p. 138). Fourthly, it encompassed regular self-control of blood glucose (Schmitt et al., 2013, p. 138). Fifthly, it asked about the regularity of physical activities and particular self-care activities (Schmitt et al., 2013, p. 138). Sixthly, it included the review of appropriate treatment of hypoglycaemic/ hyperglycaemic episodes (Schmitt et al., 2013, p. 138). Finally, the questionnaire checked the level of blood glucose (Schmitt et al., 2013, p. 138).
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All questions were organized in a form of behavioral patterns from patients’ personal point of view. The participants are asked to rate the scope to which each of the above-mentioned statements appears to be relevant to the individual self-management. In addition, there was a necessity of selecting a specific timeframe in accordance with specific time-dependency of HbA1c valuables. Finally, the rating scale has been created in a specific four-point scale to impede neutral reaction and generate accurate and precise responses.
A quantitative research paradigm has been chosen in order to answer the research question about the effectiveness of a diabetes self-management program. Quantitative research appears to be an objective approach to research that applies numerical data in order to measure study variables. This approach provides the researcher with a possibility to conduct a data analysis, using inferential statistical tests, thus individual bias is less likely to affect the analysis of data together with the final research result. A regression analysis has been applied in order to test the statistical significance of the two independent variables, namely the self-management and diabetes knowledge.
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The setting for this study will be a community-based health center on Oahu, in Hawaii. The center staff provides care to approximately 33,000 patients. The center is financed by both government and privately together with some funding from the State of Hawaii. The personnel consist of primary care providers including FNPs.
All adult patients who have been self-identified as NHPI will be invited to participate in the study. Using a nonprobability convenience sampling method, approximately 100 participants will be enrolled. The sample is considered moderate when compared to large sample size when conducting quantitative research. The first 100 adults who volunteer, sign a consent form, and commit to the terms of the study will be enrolled if they meet the inclusion criteria of being an adult of 18 years of age or older.
The principal researcher (PI), who is an FNP primary care provider at the health center, will be accountable for the identification and recruiting of 100 willing participants for the study, applying medical records to define which patients meet inclusion criteria. Letters will be sent to all eligible patients outlining the purpose of the study, criteria they have to meet if they volunteer, and how human rights will be sustained. Potential subjects will be instructed to call the PI within one week of obtaining the letter to discuss questions regarding the study and to set individual appointments to meet at the health center to sign the consent form. The enrollment will proceed until 100 participants agree to take part.
Regression analyses were completed in order to define the connection between self-management and knowledge together with impacts on laboratory valuables, particularly general cholesterol values and HbA1c. The questionnaire evaluated the constituents of diabetes self-management care and asked the participant to recall the last 8 days, the period the participant performed the above-mentioned activities divided into behavioral categories. The numerical value was assigned on a basis of responses ranged from 0–7. The participants were asked to rate the scope to which each of the above-mentioned statements appertained and appeared to be relevant to individual self-management. In addition, there was a necessity of selecting a specific timeframe in accordance with a specific time-dependency of HbA1c valuables. Finally, the rating scale was created in a specific four-point scale, particularly to impede neutral reactions and answers, and stimulate accurate and precise responses
At the initial pretest meeting, all participants who met the inclusion criteria and agreed to enroll signed a University of Hawaii Institutional Review Board-approved consent form. Afterwards, they were provided with two questionnaires. The participants were assigned identification numbers, and these numbers were utilized while performing data entry and throughout the statistical analysis. Moreover, the participant confidentiality was sustained in the findings report by applying codes instead of possibly identifiable data.
Data Analysis Plans
The data will be entered applying a double entry method as it helps to ensure precise and rigorous data entry (Schmitt et al., 2013, p. 138). The scoring of both questionnaires will be completed in accordance with previously defined methods (Wiley et al., 2013, p. 1789). The study demonstrates that it is important to apply multiple regressions in order to explore the connection between participants’ knowledge of diabetes type condition and self-management and the impact on the physiological measures of cholesterol and HbA1c levels.
The data collection will be performed with the help of cross-sectional questionnaires, which will be approved by the Ethics Committee of the medical institution. A written informed consent form will be signed prior to enrollment and participation.
Limitations of Proposed Study
The paper reveals a number of limitations in regard to the data collection methods. One limitation stands for the fact that participants’ most current medical records should be applied for the necessary laboratory tests. Due to the fact that laboratory work will not be provided on site, some of the participants enrolled in the study might miss the laboratories. Finally, the participants will answer the questionnaires in accordance with their memories, they way they recall information. This might presuppose that the information can be inadequate because of a masking behavior strategy.
Implication for Practice
This study will analyze the baseline knowledge and self-management behaviors in accordance with the HbA1c and total cholesterol. Nevertheless, future studies contrasting and comparing outcomes with post-supplementary education sessions lasting for 6 months or one year may lead to more precise results and help in changing and transforming self-management capacities and diabetes knowledge into better T1D and T2D control. Promotion of clinical and patient awareness regarding the fact that other prospects including group education sessions and combinational behavioral alterations is essential as it can produce better outcomes. The significance of such changes can perfectly elevate both the patients’ cognizance of the condition and the inclination to practice and perform self-management. Therefore, the patient care objective depends on the incessant desire for innovative techniques and evolvement of research. Finally, incessant research on underprivileged and high-risk groups should become the primary focus.
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