Awareness and knowledge among prediabetes

Running head: EARLY AWARENESS

EARLY AWARENESS

Metabolic Syndrome/Pre-diabetes Early Awareness Education and Its Effects on BMI

Submitted by:

Nancy L. Gee

Direct Practice Improvement Project Proposal

Doctor of Nursing Practice

Grand Canyon University

Phoenix, Arizona

Chapter One: Introduction to Project

Introduction

In society today, obesity is really a recurrenthas become a widespread co-morbidity related toleading to excessive rise in bodyweight. Additionally, it is considered as one of the most essential and changeable risk factors within the pathogenesis of health problems like type-1 and type-2 diabetes, which has been

documented in most biochemical studies as well as cross-sectional research (Piven, 2014). In current times, there are many crucial biochemical studies in the inter-relationship amid body mass index (BMI) and its connection with advancement of diabetic issues (Innocent, Oweh, Sandra & Josiah, 2013). The Center for Disease Control (CDC) anticipates that one-in-threenearly 33% adults may have diabetes by the year 2050 (CDC, 2010; Robert Wood Johnson Foundation, 2016); as presently, more than twenty-nine million adults in America has been diagnosed with diabetic issues and an additional eighty-six million have pre-diabetes (Statistics about Diabetes, n.d; Robert Wood Johnson Foundation, 2016).

Pre-diabetes is a condition where blood sugar levels are elevated, however lesser than the established inception of diabetes level related to diabetes (Kowall et al., 2012). Kowall, et al (2012) writes “pre-diabetes is a result of Impaired Fasting Glucose (IFG), Impaired Glucose Tolerance (IGT), or perhaps a mixture of IFG and IGT (p. 828). Further, diabetes has numerous effects which might consist of several health disorders and, in a few instances, failure of bodily organs (Tabák, Herder, Rathmann, Brunner, & Kivimäki, 2012; Brown, 2017). Thus, Type-2 diabetes (T2D) puts individuals at risk for a variety of ailments like cardiac condition, amputations, renal malfunction, vision loss, as well as obesity. Weight reduction has been seen to stop the triggering of T2D and morbid obesity in individuals having pre-diabetes (Brown & Kuk, 2015). As a result, “early diagnosis and management of pre-diabetes can avoid its crossover to complete onset diabetes and thus reduce the related problems” (Brown & Kuk, 2015, p. 79).

Given that diabetes educational interventions have been a successLittle is known about how patients respond to Diabetes Self-Management Education (DSME), the goal of this study will be to measure the awareness and knowledge of metabolic syndrome/pre-diabetes risk factors among obese patients (BMI >30) in an internal medicine/family practice clinic with a BMI >30. Th. The study makes use of a adopts a quantitative approach using a descriptive method and pre-post test research structure to determine subjects' understanding and knowledge of metabolic syndrome/prediabetes, and T2D. The pretests will establish current knowledge and gaps about diabetes awareness and post-test will determine the information they gained from the intervention (DSME) and how they plan to use that information in their life. The results, will state the help in the advancement and improvement of the pre-diabetes and diabetes informative and knowledge-based self-management intervention programs.

Thereafter, tThis chapter places the research within the much larger framework of the scholarly materials and after that reaches up to a particular target audience while describing the idiosyncrasies of this DPI project such as background of the study, problem statement, purpose of the study, clinical question(s), advancing scientific knowledge, significance of the study, rationale for methodology, nature of the study, definition of terms, assumptions, limitations and delimitations and lastly, summary and organization of the remaining chapters.

Criterion

Learner Score

(0, 1, 2, or 3) Comment by Segovia, Julie H: Learner scores have not been completed – these table need to be completed as a self-assessment

Chairperson Score

(0, 1, 2, or 3)

Comments or Feedback

Introduction

This section briefly overviews the project focus or practice problem, why this project is worth conducting, and how this project will be completed. (3-4 paragraphs or approximately 1 page)

Not clear what the project intervention is or what the project design is

Practice improvement project topic is introduced.

Not clear what the improvement is

Discussion provides an overview of what is contained in the chapter.

Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.

Review sentence structure, grammar and choice of words for scholarly writing

NOTE: Once the document has been approved by your Chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.

Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).

Background to the Project

The frequency of identified diabetic issues amid U.S. adults has gone up twofold within the past four decades and seventy five percent in the past twenty-five years (NCD Risk factor Collaboration, 2016; Gregg et al, 2004; Centers for Disease Control and Prevention, 2006). The life-time danger of acquiring diabetes within the U.S. in 2000 had been 33% for males and 39% for females and this had been even greater amid U.S. minority communities (Narayan et al, 2003). Since 2000 research related to the life-time danger of acquiring diabetes could not be found in the literature.

BMI is a highly effective strongand flexible, yet controllable, risk element for diabetes (ADA, 2017; Ford, Williamson and Liu, 1997; Diabetes Prevention Program Research Group, 2002). Nevertheless, the outcome link between of prediabetes knowledge on and BMI hasn't been extensively examined (Arayan, James, Theodore et al, 2007). Medical experts use the Body Mass Index to determine whether a person is overweight, obese, normal or underweight. It’s a determination of the ratio between a person’s weight and their height (Lo, Wong, Khalechelvam and Tam, 2016).

The following are details of the findings from research, with regard to the relationship between the BMI ratio and diabetes. Relationship between BMI and Diabetes: Iit was found by Narayan et al (2007) that one’s risk of developing diabetes in their lifetime is one in three, at the point of birth. He further noted that the risks of developing the condition across the categories of BMI over a lifetime are still unclear. The study sought to demonstrate the specific lifetime risks for the various BMIs for people in the US, based on sex, ethnicity and age subgroups (Narayan et al., 2007).

The survey data for the National Health Interview n=780, 694, from 1997 to 2004 was the basis for indicating race, sex, age, ethnicity and the prevalence of BMI-linked occurrence of diabetes in the US in 2004 (Narayan et al., 2007). The data from the US Census Bureau including age, sex-specific mortality, population rate projections and race were used along with two earlier studies relating to mortality, to project the mortality rates related to BMI ratios (Narayan et al., 2007).

The findings and estimates informed the Markov Model projection of the lifetime risks of diabetes diagnosed by race, sex baseline age and BMI. According to the results, the lifetime risk of developing diabetes at the age of 18 for underweight people was shot from 7.6 to and those who were obese was 70.3% between underweight people and those who were significantly obese. The figures also increased from 12.2 to 74.4 for women in the same weight categories. The difference in lifetime risk was lower at advanced ages. For example, at age 65, normal weight males had their lifetime risk difference rise from 3.7 to 23.9 points in percentages between overweight people and the ones regarded as very obese. The figure increased by 8.7 percentage points to 26.7 for women (Narayan et al., 2007a). It was also noted that the effect of BMI on the duration of diabetes compounded with an increase in one’s age (Narayan et al., 2007b).

The risk of developing diabetes type II diabetes was investigated in a case control research by Ganz et al (2014) by studying its incidence versus BMI ratios. The rising effect of BMI, basing on BMI categories was also assessed. Those who recorded weights between 25 and 29.9 were labelled as overweight. And then there was the Obesity Class I who measured between 30 and 34.9. Class II Obesity group registered BMI index from 35 to 39.9. Obesity Class III on its part recorded figures equal to or over 40 (Ganz et al., 2014).

Relative risks and ratios regarding the odds were calculated from a range of logistic regression outcomes. Age, cardiac history, sex and hyper-inflammatory identified by erythrocyte sedimentation and C- reactive protein states and use of psychiatric medications were used to select group, memberssubjects. (Ganz et al., 2014). Measures of BMI were taken a year preceding the first diagnosis of type II diabetes. BMI was obtained from dates that were randomly assigned for those that were in the control. The relationship between BMI and the incidence of diabetes was not only found to be strong but that the risk increased with large higher levels of BMI figures (Ganz et al., 2014).

There is a significant correlation between diabetes and being overweight. A number of studies have established a strong link between the two factors. In one study, for instance, Akbari et al (2017) found that patient education regarding type II diabetes can help reduce barriers. The core aim of the study was to establish the impact of an education program intervention, using the model BASNEF on awareness barriers, adaptation, lifestyle and support for patients living with type-II diabete (Akbari, 2017). It has been noted that removing the barriers associated with the diabetes condition is a reasonable step towards empowering patients of diabetes to manage their lives with the condition, and to recognize what really affects the barriers. The findings indicated that there was a clear difference between a score derived from living barriers such as lifestyle, awareness, protection and adaptation components, and the BASNEF model variable, i.e. enabling factors, attitude, subjective norm, knowledge, and behavioral intention.

Criterion

Learner Score (0, 1, 2, or 3) Comment by Segovia, Julie H: As above, self-assessment is not completed

Chairperson Score (0, 1, 2, or 3)

Comments or Feedback

Background of the Project

The background section explains both the history of and the present state of the problem and project focus. This section summarizes the Background section from Chapter 2. (2-3 paragraphs)

Unclear that the problem/project focus is. Pre-diabetes is not discussed. Education for pre-diabetes not discusses. In other words, tie the project focus in within this section.

Provides an overview of the history of and present state of the problem and project focus.

See comments above

Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.

Check grammar and sentence structure

NOTE: Once the document has been approved by your Chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.

Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).

Problem statement

Type II diabetes, previously referred to as non-insulin-dependent diabetes (NIDDM), makes up most cases associated with type II diabetesof diabetes mellitus globally. It's approximated that in 2000 there had been roughly a hundred and fifty million people with the illness and that this quantity is most likely to increase twofold by the year 2025 (Kaveeshawar &Cornwall, 2014; King, Aubert, & Herman, 1998). Type II diabetes will be the fourth or perhaps fifth prominent cause of demise in many developed nations and there's expanding proof that this has attained epidemic dimensions in quite a few developing and recently industrialized nations (Amos, McCarty, & Zimmet, 1997). All-time low levels of type II diabetes are generally noticed in places where individuals retain traditional life-style (Gray, 2015; Bennett, 1999). Dramatic modifications in the frequency or occurrence of type II diabetes happen to be noticed in places where there have already been significant modifications in the kind of foods utilized, from the conventional native diet plan to a common “western” diet plan (Hu, 2011; Bennett, 1999; Lako and Nguyen, 2001; Hetzel and Michael, 1987). Changing illness levels are revealed by modifications in a number of dietary elements along with modifications in other life-style associated elements, notably a decrease in physical exercise (Sami, Ansari, Butt, Rashid, & Hamid, 2017; Steyn et al, 2004).

Because of these facts, the objective of this study is to assess the awareness and knowledge of diabetes amongst patients with prediabetes in an internal medicine/family practice clinic. After carrying out DSME pre-intervention assessments on patients with prediabetes, gaps are going to be recognized in awareness and understanding of diabetes amongst the subjects. The pre-assessment outcomes will be utilized to enhance and modify the educational plan to satisfy the individual requirements of patients with prediabetes.

Absent from the literature is information on how patients respond to self-management methods that should be adopted to attain the preferred benefits; and precisely what they will do with the understanding knowledge they develop gain from DSME educational interventions. There's an expanding demand for interventions that enhance patients’ understanding and knowledge of diabetes (Islam et al., 2014). The “substantial population at an increased risk for or with diabetes is actually within the age bracket of 25 - 65 years. Insufficient steps to decrease occurrence of pre-diabetes might result in a consequential boost in health investment, morbidity, as well as other associated health circumstance” (National Diabetes Statistics Report, 2014, para 8).

To manage an increased incidence of diabetes diagnoses, health interventions will be essential to avoid diabetic issues or postpone their development (Islam et al., 2014). Such endeavors can consist of complete life-style change for all those at an increased risk for metabolic syndrome/pre-diabetic issues and timely treatment for patients suffering from the disorder. An aAmbitious self-management methods focusing on individuals at an increased risk of diabetes is definitely an important public health strategy targeted at reducing the threat elements for diabetes (International Diabetes Federation, 2013).

Criterion

Learner Score

(0, 1, 2, or 3)

Chairperson Score

(0, 1, 2, or 3)

Comments or Feedback

Problem Statement

This section includes the problem statement, the population affected, and how the project will contribute to solving the problem. (2-3 paragraphs)

States the specific problem proposed for research by presenting a clear declarative statement that begins with “It is not known if and to what degree/extent...,” or “It is not known how/why and…”.

Unclear – please see above

Identifies the need for the project.

Not clear as yet what the intervention is

Identifies the broad population affected by the problem.

Suggests how the project may contribute to solving the problem.

Unclear what the patient or practice outcome is

Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.

NOTE: Once the document has been approved by your Chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.

Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).

Purpose of the Project

The objective of this study is to evaluate awareness and understanding concerning metabolic syndrome and diabetes in pre-diabetic individuals and the effects on BMI. To determine if the patients qualify for prediabetes stage, the researcher will utilized patients’ healthcare records to choose individuals with an increased fasting glucose (IFG), and hypertension in the healthcare facility Copperview Medical Center. In addition, the individuals will be recognized as obese if they have a body mass index (BMI) of more than 30kg/m2. The independent variables will be the DSME intervention plan and the dependent variable will be patients’ awareness level about the threat of acquiring T2D and awareness concerning risk lowering habits and treatments; and these factors will be assessed utilizing adopting a a qualitative surveyquantitative method and using a descriptive design. The Other dependent variables will be BMI assessment. The BMI will be measured by weighing the patient before awareness education and eight weeks after receiving the intervention. Additional independent variables are how awareness and understanding levels amongst individuals differ based on education level and lastly the health belief model will be utilized as the theoretical foundation of this study.

This project will make use of diabetes associated queries in the pre-assessment to evaluate and classify individuals according to their understanding and knowledge of diabetic issues. Dedication of a towards increasing patients’ their understanding and awareness of diabetes as well as their risk of acquiring type II diabetes might encourage them to alter their life-style and embrace new treatments to decrease the threat of diabetes. This project will target inclusion criteria for this study will be adults of both sexes with a BMI of more than 30kg/m2. Furthermore, the results might be helpful in the advancement of future interventions towards decreasing diabetes risk in communities with higher risk of acquiring type II diabetes.

Criterion

Learner Score

(0, 1, 2, or 3)

Chairperson Score (0, 1, 2, or 3)

Comments or Feedback

Purpose OF THE PROJECT

The purpose statement section provides a reflection of the problem statement and identifies how the project will be accomplished. It explains how the proposed project will contribute to the field. (2-3 paragraphs)

Not clear what the intervention is therefore it’s missing as to how the project will be accomplished. With the way it’s worded it’s currently understood that the project is to measure awareness of a pre-condition and if that awareness impacts BMI? The intervention appears to be missing.

Presents a declarative statement: "The purpose of this project is...." that identifies the research design, population, variables (quantitative) or phenomena (qualitative) to be studied, and geographic location.

Research design missing

Identifies project method as qualitative, quantitative, or mixed, and identifies the specific design.

Missing

Describes the specific population group and geographic location for the project.

Clarification needed for inclusion

Defines the dependent and independent variables, relationship of variables, or comparison of groups (quantitative). Describes the nature of the phenomena to be explored (qualitative).

Intervention appears to be missing. Qualitative survey wording used but no survey listed, or type of qualitative research design listed.

Explains how the project will contribute to the field.

Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.

Not flowing clearly what the project intervention is to impact the patient outcome of BMI.

NOTE: Once the document has been approved by your Chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.

Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).

Clinical Questions:

When promoting interventions to assist with prevention and control diabetes, awareness is definitely an essential resource (Demaio et al., 2013). There's a connection amid individuals with reduced levels of health understanding and increased diabetic problems (Maina, Ndegwa, Njenga, & Muchemi, 2011). Patients’ understanding of their health could be helpful in the assessment of the risks associated with developing diabetes, DSME interventions to reduce the risk, and their control over life-style changes including weight reduction. Consequently, outcomes of this research will promote stakeholders, within the healthcare sector to plan, create, and implement complete health campaigns focused at pre-diabetes-related awareness DSME interventions to understanding and awareness regarding pre-diabetes risk factors.

The project will analyzes the understanding and awareness of diabetes amongst patients with prediabetes in an internal medicine/family practice clinic with a BMI >30(P); The research query is: does early awareness-education related to pre-diabetes (I) among patients in an internal medicine/family practice clinic with a BMI >30 (P) have an effect on BMI (O) compared with no early awareness (C) over a 12-week period. The independent variables will be the DSME intervention plan and the dependent variable will be patients’ awareness level about the threat of acquiring T2D and awareness concerning risk lowering habits and treatments; and these factors will be assessed utilizing a closed-ended questionnaire and a quantitative research design. Other dependent variables will be BMI assessment. The BMI will be measured by weighing the patient before awareness education and eight weeks after receiving the intervention. Additional dependent variables are how awareness and understanding levels amongst individuals differ based on education level and lastly the health belief model will be utilized as the theoretical foundation of this study. The independent variables will be the patients’ awareness level about the danger of acquiring T2D and understanding concerning risk lowering habits and treatments; and these factors will be evaluated utilizing a qualitative survey. The dependent variable is BMI>30.

Additional independent variables are how understanding and awareness levels amongst patients differ primarily based on education level and lastly the health belief model will be utilized as the theoretical foundation of this study. Further, this project is aimed at addressing the following two sub-questions:

R1. Will the awareness and understanding of diabetes differ primarily based on the subjects' education level?

R2. Does an early awareness intervention programs strengthen obese individuals with prediabetes’ understanding and knowledge of diabetes?

Criterion

Learner Score

(0, 1, 2, or 3)

Chairperson Score (0, 1, 2, or 3)

Comments or Feedback

Clinical Question(s)

This section narrows the focus of the project and specifies the clinical questions to address the problem statement. Based on the clinical questions, it describes the variables or groups for a quantitative project or the phenomena under investigation for a qualitative project. (2-3 paragraphs)

A new variable was introduced for the first time. Measurement tool not identified.

Qualitative Designs: States the clinical question(s) the project will answer, and describes the phenomenon to be studied.

Qualitative survey mentioned but the outcome measures don’t align with the methodology

Quantitative Designs: States the clinical questions the project will answer, identifies the variables, and states the hypotheses (predictive statements) using the format appropriate for the specific design.

This section includes a discussion of the clinical questions, relating them to the problem statement.

Problem statement and clinical questions do not yet align

Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.

NOTE: Once the document has been approved by your Chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.

Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).

Advancing Scientific Knowledge

There is a controversy in existence, relating to the BMI mortality diabetes paradox in which the BMI optimal category is higher in patients that are non-diabetic. It has also been noted by Bays et al (2007) that not all obese or overweight cases develop diabetes, and that not all with the diabetic conditions were necessarily obese or overweight (Bays et al., 2007). A paradox regarding BMI ratios and diabetes still exists, and needs a solution. Controversy is still rife with regard to the relationship between BMI and the occurrence of diabetes. Physicians will be empowered to minimize the risk factors for diabetes sooner if there is full understanding of the relationship between the two. Modern day is well known for the diabetes epidemic. Numerous pre-condition indicators have been identified for medics to use to reduce the risk factors. It is foolhardy to wait to treat diabetes when there are ways it can be stopped on the way. There is a need for early screening of potential patients. These potential populations need to be educated about the risks and how they can self-manage it to avoid its inception or reduce its symptomseven as early interventions are made by medical experts. Indeed, BMI screening provides a good start.

One can find an increase in frequency of pre-diabetes as well as obesity within the U.S. Additionally, there happens to be higher chance of further advancement to T2D for individuals with pre-diabetes (Tabak et al., 2012). Type II diabetes raises the danger of acquiring other problems like high blood pressure, kidney issues, and loss of sight along with growing the price of therapy and loss in efficiency. Therefore, there is certainly a need for an DSME intervention method to improve the levels of understanding and knowledge concerning pre-diabetes and weight problems amongst the patients and to assure premature diagnosis of the higher levels of successful Self-Managed casesillness. This study utilizes the health belief model that is undoubtedly one of the most frequently utilized theory in health learning and health intervention campaign (Glanz, Rimer, and Lewis, 2002; National Cancer Institute, 2003). It had been designed during the 1950s in an effort to describe the reason why healthcare screening programs proposed by the U.S. Public Health Services, especially for tuberculosis, just weren't successful (Hochbaum, 1958). The root notion of the initial HBM was that health conduct is independent upon individual beliefs or views with regards to a disorder as well as the methods accessible to reduce its prevalence (Hochbaum, 1958). Individual insight is affected by the complete array of intrapersonal elements impacting health conduct (Jones and Bartlett, 2008). It can be therefore presumed that health of prediabetic obese individuals is directly affected by the quality of their thinking and decision-making. HBM as a theory can be helpful in identifying the beliefs holding back individuals to adopt diabetes self-management strategies successfully. TThe results from this study can help in realizing public awareness gaps and practices concerning pre-diabetes and weight problems, which may help in the creation of obesity and diabetes self-management campaigns. Medical care services and professionals will find the outcomes of this study essential to use in dealing with people who have obesity and prediabetes.

Criterion

Learner Score

(0, 1, 2, or 3)

Chairperson Score

(0, 1, 2, or 3)

Comments or Feedback

ADVANCING SCIENTIFIC KNOWLEDGE

This section specifically describes how the project will advance population health outcomes on the topic. It can be a small step forward in a line of current project, but it must add to the current body of knowledge in the literature in the learner’s program of project. It identifies the “gap” or “need” based on the current literature and discusses how the project will address that “gap” or “need”. This section summarizes the Theoretical Foundations section from Chapter 2. (2-3 paragraphs)

See above – gap unclear, patient outcome unclear

Clearly identifies the “gap” or “need” in the literature that was used to define the problem statement and develop the clinical questions.

Not tied together in this section

Describes how the project will address the “gap” or “identified” need in the literature.

Identifies the theory or model upon which the project is built.

Theory listed but not connected to the project design

Describes how the project will advance the theory or model upon which the project is built.

Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.

NOTE: Once the document has been approved by your Chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.

Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).

Significance of the study

The occurrence of clinically diagnosed diabetes amongst U.S. grownups has increased twofold within the past 4 decades and 75% in the past tTwenty-five years (Gregg et al, 2004; Centers for Illness Control and Prevention, 2007). The life-time danger of diabetes within the U.S. in the year 2000 had been 33% males and 39% females and had been even greater amongst U.S. minority communities (Narayan et al, 2003). BMI is known as a potent strong, yet changeable and changeable risk element with regard to diabetes (Ford, Williamson and Liu, 1997; Diabetes Prevention Program Research Group, 2002). Nevertheless, the outcome link between of diabetes knowledge on and BMI has not been extensively examined (Arayan, James, Theodore et al, 2007).

The growing urbanization, westernization and mechanization happening practically in most areas around the globe is associated to modifications in the eating routine to one of higher fat, higher energy-packed meals and an inactive way of life resulting in increased degrees of BMI (WHO, 2000; Popkin, 2001). This change is additionally linked to the present rapid modifications in childhood as well as grown-up weight problems. Even in several low-income nations around the world weight problems are now dramatically rising, and frequently coexists within the same populace with persistent under-nourishment (Popkin, 2001). Life-span has risen because of improvement in nourishment, cleanliness and the control over contagious ailment. Transmittable illnesses and nutritional insufficiency diseases are, consequently, being substituted in developing nations by unique health risks similar to obesity, cardio disorder and diabetic issues (WHO, 2000; Swinburn, Caterson, Seidell and James, 2004).

Even though treatment of diabetic subjects is costly, medical care establishments face a far more complicated problem in dealing with issues on account of T2D like heart stroke, cardiac arrest, and kidney malfunction that also hinder economic efficiency and boost the price of social treatment (C3 Collaborating for Wellbeing, 2011). Awareness and knowledge are key assetsin controlling and preventing diabetes (Demaio et al., 2013). Lack of understanding and awareness about diabetes increases the chances of acquiring this disease (Maina, Ndegwa, Njenga, & Muchemi, 2011). Patients’ personal awareness assists in risks assessment of developing diabetes. Therefore, DSME interventions can reduce the risk, and their control over life-style changes including weight reduction.

Consequently, prevention, efficient therapy, premature prognosis of T2D, as well as knowledge of diabetes along with effective DSME strategies amongst over weight prediabetic individuals are essential strategies in lessening the damaging influences of the disorder to both people and the community. This study will adopt a quantitative research design to will measure the knowledge and understanding concerning diabetes in prediabetic individuals and their response to DSME using a pre-post assessment questionnaire. The results of this study will can be integrated into campaigns to deal with weight problems, such as increased BMI and diabetic issues for the exact purpose of developing a tradition of understanding/increasing awareness about diabetes amongst overweight people within the society. The effectiveness of such an educational effort intervention might lead to considerable self-control over morbid obesity, BMI and diabetes that would improve the standard of life for diabetic individuals. Additionally, it might decrease health treatment expenses. By creating knowledge and providing awareness, the study's results might affect the local community favorably. For example, the results might also be utilized to teach the neighborhood about the risks of weight problems and just how individuals can handle prediabetes as well as T2D. For the general public, the details on understanding and knowledge about diabetic issues will be utilized to organize public health guidelines targeted at preventing and managing diabetes.

Criterion

Learner Score

(0, 1, 2, or 3)

Chairperson Score

(0, 1, 2, or 3)

Comments or Feedback

Significance of the Project

This section identifies and describes the significance of the project and the implications of the potential results based on the research questions and problem statement, hypotheses, or the investigated phenomena. It describes how the project fits within and will contribute to the current literature or body of research. It describes potential practical applications from the project. (3-4 paragraphs)

Not tied together in the section – the connection between the project, the research questions, problem statement and hypothesis. As far as the reader can tell, the project proposal is to measure baseline understanding of diabetes (no tool identified though) and then BMI at an unknown point of time in the future. Much clarity needed to better understanding project design.

Provides overview of how the proposed research fits within other research in the field, relating it specifically to other studies.

See aove

Describes how the project will contribute to the research being done in the field of project. Describes how addressing the problem will impact and add value to the population, community, or society

Not clear what the project design is

Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.

NOTE: Once the document has been approved by your Chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.

Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).

Rationale for the methodology

The objective of this project is to measure the effects of knowledge and awareness related to pre-diabetes and diabetes amongst overweight people who are at risk or have been diagnosed with metabolic syndrome/prediabetes who happen to be patients in a family practice clinic. The study makes use of a descriptive research design quantitative descriptive research method to determine subjects’ understanding and knowledge of prediabetes and T2D. A descriptive study offers information for analyzing and monitoring policies and plans. These type of study models focuses on the best way to respond to these kinds of queries as: How much? How many? How effective? How successful? How sufficient? (Indiana University, n.d.). Furthermore, descriptive study designs are an approach that offers a description of the individuals getting involved in the studysubjects. The key methods for conducting a study employing a descriptive investigation design and style are: Case study, Survey along with observational scientific studies (Shawyer et al., 2014).

This study uses a descriptive design as the focus is on the effectiveness of DSME intervention programs. The study will monitor the efficiency of DSME plans and provide recommendations for improvement of future DSME programs. Hence this study adopts a quantitative approach using a descriptive method and pre-post test to determine subjects' understanding and knowledge of metabolic syndrome/prediabetes, and T2D. The pretests will establish current knowledge and gaps about diabetes awareness and post-test will determine the information they gained from the intervention (DSME) and how they plan to use that information in their life. The results, will help in the advancement and improvement of the prediabetes self-management intervention programs.

The results will state the advancement of educational intervention programs targeted at prediabetic individuals.

Criterion

Learner Score

(0, 1, 2, or 3)

Chairperson Score (0, 1, 2, or 3)

Comments or Feedback

Rationale for Methodology

This section clearly justifies the methodology the investigator plans to use for conducting the project. It argues how the methodological framework is the best approach to answer the clinical questions and address the problem statement. It uses citations from textbooks and articles on research methodology and/or articles on related studies. (2-3 paragraphs)

Research design not provided.

Identifies the specific project method for the project.

Missing

Justifies the method to be used for the project by discussing why it is the best approach for answering the clinical question and addressing the problem statement.

Missing

Uses citations from textbooks and/or literature on the research methodology to justify the use of the selected methodology.

Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.

NOTE: Once the document has been approved by your Chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.

Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).

Nature of the Project Design

This project will adopt a quantitative descriptive design and use a qualitative survey closed ended questionnaire to carry out DSME pre-assessment and also post-assessment on patients suffering from prediabetes. This study uses a descriptive design in order to measure the effectiveness of DSME intervention programs. Moreover, the study will monitor DSME’s efficiency and provide recommendations for improvement of future DSME programs. It To achieve these goals the study will also use a quantitative measurement of BMI involving pre-post--test and twelve weeks after awareness educations has been presented. The subjects will be requested to be weighed to determine if their BMI is >30 and then take part in the pre--assessment and post--assessment once they sign a consent form. The pre-assessment queries will be developed in such a manner that respondents can comprehend and fully grasp the questions (Shawyer et al., 2014; Indiana University, n.d.). The survey questionnaire will be carried out to measure the degree of knowledge and understanding concerning diabetes from the subjects. Making use of outcomes from the pre-assessments, the researcher will customize the educational intervention program to meet the requirements of the subjects. After the participants' DSME education is providedintervention has taken place, a post-assessment is going to be carried out utilizing an easy to understand questionnaire to ascertain the efficiency of the educational intervention.

One of the most productive approaches supporting this type of research is likely to be the survey approach. The survey method has, through the years, established itself to be probably the most efficient ways of measuring any social research. It assists the researcher to come up with, distribute, and/or ask relevant queries from the targeted subjects or sample. It enables the researcher to select from two different and all-encompassing strategies: 1) interviews and 2) questionnaires (Trochim, Donnelly and Arora (2015). Trochim, et al, (2015) in his research explains that a survey has the versatility to vary from a short-scaled easy written response to an all-inclusive face-to-face serious interview that is the thing that makes the survey such an essential research fragment. The standardized and exploratory closed-ended structure of survey, i.e. DSME questionnaire will be most valuable for this form of study.

Other scientists have also described some of the advantages of the qualitative form of study. Bouma and Carland (2016) in their study explains that the researcher has the freedom to constantly assess and evaluate the data that he/she has accumulated while he/she is accumulating it and alter or modify whatever he/she feels in the process. This study compares the strategies and theories that were developed and verified by previous studies which were completed in relation to the research matter. In this study, the connection being investigated is amid awareness concerning diabetic issues in prediabetic individuals and the way it impacts diabetes managementtheir willingness to self-manage diabetes. After awareness-level and knowledge-level assessment of diabetes amongst the subjects utilizing a quantitative descriptive methods, the researcher will make use of an educational intervention program for patients with prediabetes. This can be carried out to enhance clinical results amongst individuals, as well as, progression of more efficient educational intervention models (Funnel et al., 2010).

Criterion

Learner Score

(0, 1, 2, or 3)

Chairperson Score (0, 1, 2, or 3)

Comments or Feedback

Nature of the PROJECT

This section describes the specific research design to answer the clinical questions and why this approach was selected. It describes the research sample being studied as well as the process that will be used to collect the data on the sample.

1 Project design needs to be identified

Describes the selected design for the project.

0 not clear

Discusses why the selected design is the best design to address the problem statement and clinical questions as compared to other designs.

1 not discussed – new variable introduced

Briefly describes the specific sample being studied and the data collection procedure to collect information on the sample.

0 – data collection procedures unclear

Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.

1 Flow of thought not clear

NOTE: Once the document has been approved by your Chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.

Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).

Definition of terms

Diabetes Knowledge: For this project we the researcher will use the definition employed by Fonseca et al (2012) who state that diabetes knowledge represents having abilities, data, and details concerning diabetic issues that is obtained via experience or education.

Pre -diabetes: For this project the researcher will we assume the definition put forward by ADA, (2011) which classifies prediabetes as a medical problem in which the degree of blood sugar is greater than the normal degree, although not enough to be classified as type two diabetes.

Type II diabetes: For this project, once again, the researcher will we assume the definition put forward by ADA, (2011) which classifies Type 2 diabetes as a disorder in which the body doesn't take advantage of the insulin released through the pancreas, resulting in higher blood sugar levels (ADA, 2011).

Obesity: The researcher will We will use the definition put forward by Haas and his colleagues (2013) who state that this is a health disorder where there's excessive unwanted fat that may be established when BMI, calculated by dividing a person’s weight from the height, which is powered square, exceeds 30 kg/m2.

Criterion

Learner Score

(0, 1, 2, or 3)

Chairperson Score

(0, 1, 2, or 3)

Comments or Feedback

Definitions of Terms

This section defines the project constructs and provides a common understanding of the technical terms, exclusive jargon, variables, phenomena, concepts, and sundry terminology used within the scope of the project. Terms are defined in lay terms and in the context in which they are used within the project. (Each definition may be a few sentences to a paragraph in length.)

Defines any words that may be unknown to a lay person (words with unusual or ambiguous means or technical terms) from the research or literature.

Defines the variables for a quantitative project or the phenomena for a qualitative project from the research or literature.

Definitions are supported with citations from scholarly sources.

Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.

Additional terms throughout will need definitions

NOTE: Once the document has been approved by your Chairperson and your committee and is ready to submit for AQR review, please remove all of these assessment tables from this document.

Score 0 (not present); 1(unacceptable; needs substantial edits); 2 (present, but needs some editing); 3 (publication ready).

Assumptions, limitations and delimitations

This project will be centered on the belief that individuals with prediabetes might have less understanding and knowledge of diabetes, consequently, the educational DSME intervention program will certainly enhance the patients’ understanding of diabetic issues. Additionally, it is presumed that growing awareness concerning diabetic issues as well as its associated challenges might lead to enhanced benefits when managing the health disorder. The sample for this study will be restricted to patients inside an internal medicine/family practice clinic. Consequently, the opportunity to make use of the results to the general populace at an increased risk of acquiring type II diabetes is restricted (Stommel and Wills, 2004).

Results generalization is reasonably limited because of the small volume of subjects and also the absence of a control group. Because the target populace, the obstacles to registering more subjects will include individuals travelling, working, or experiencing other scheduling restrictions, along with issues in reaching out to a few subjects. The limitations to acquiring all after-intervention information may include lapses in subject's insurance coverage, and absence of insurance coverage to get a 3 2 month BMI measurement. The project impact might be understated because of the timing involved in the awareness education intervention that will take place during the February-March after winter months sedentary activity related to determents of winter weather and participating in holiday season festivities and parities where people might be much more likely to drink alcoholic beverages and avoid eating healthy foods. The subjects may well improve their clinical health indicators indications much more if this DSME intervention takes place in another period of time.

The independent variables will be the DSME intervention plan and the dependent variable will be patients’ awareness level about the threat of acquiring T2D and awareness concerning risk lowering habits and treatments; and these factors will be assessed utilizing a closed-ended questionnaire and a quantitative descriptive design. Other dependent variables will be BMI assessment. The BMI will be measured by weighing the patient before pre-assessment and awareness education and eight weeks after receiving the intervention. This project will make use of diabetes associated queries in the pre-assessment to evaluate and classify individuals according to their understanding and knowledge of diabetic issues. Dedication towards increasing their understanding and awareness of diabetes as well as their risk of acquiring type II diabetes might encourage them to alter their life-style and embrace new treatments to decrease the threat of diabetes.