Quantitative Study Extraction and 10 Strategic Points

Running Head: PROPOSAL

PROPOSAL

Ten Strategic Points

Broad Topic Area

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

Literature Review

Background of the problem/gap;

There is gap in the literature regarding how patients response to DSME that ought to be applied to acquire the advantages; and also on what these patients plan to do with the newfound knowledge gained via DSME intervention. (Brown, 2017; Islam et al., 2014). The demand for interventions aimed at enhancing patients’ understanding about diabetes is increasing (Islam et al., 2014). The population that stands the greatest risk of developing diabetes is between the ages of 25 to 65 years. If there are no proper interventions to reduce pre-diabetes occurrence there is a possibility that the lack of educational interventions may lead to a bigger financial burden in the health sector including a rise in morbidity (National Diabetes Statistics Report, 2014, para 8).

a. Theoretical foundations (models and theories to be foundation for study);

The health belief model (HBM) shaped the project. HBM (Hochbaum, 1958; Rosenstock, 1974) is an intrapersonal model laced around one’s knowledge theory and beliefs in the promotion of health (Jones, Smith, & Llewellyn, 2014). Applying HBM was meant to examine people’s behavior via observing their awareness responses, attitudes and perceptions they may hold towards diabetes and the effects of DSME.

b. Review of literature topics with key themes:

Theme One-Prediabetes and Obesity:

Health care institutions, including health centers, care giving organizations, nursing staff and other medical staff should facilitate awareness and education programs regarding predisposing causes of diabetes, and the need for lifestyle change in the population where they operate. Such efforts are more likely to yield positive outcomes as far as management, prevention and control of diabetes is concerned. Only then, will countries begin to see significant gains in the fight against the diabetes; a condition that has reached epidemic status in many developed countries

Subtheme 1: Prediabetes, Obesity and Type II Diabetes:

Several studies have linked obesity with the occurrence of diabetes. Obese people have significant amounts of adipose tissue. Studies show that fatty tissue in some parts of the body secrets hormones that play part in the development of IRS. Indeed, with poor body insulin response mechanism, the breakdown of glucose is severely inhibited. Indeed the weight dynamics have been shown to be important variables in the prediction of the occurrence of diabetes. While not all obese people are diabetic, obesity is a predictor of the occurrence of diabetes after some time; therefore, obesity has a potent connection to our study wherein we seek to investigate the knowledge and awareness of diabetes among patients that have been diagnosed with pre-diabetes in a family clinic.

Subtheme 2- insulin resistance and obesity:

Obesity is a precipitating IRS factor. Insulin resistance Syndrome (IRS) refers to the failure by the body organs to synthesize glucose because they do not respond appropriately to the action of insulin. Studies show that the connection between type 2 diabetes and obesity is resistance to insulin. With regard to obesity, the need to keep one’s body weight has been underscored in many studies including one involving infertile Mexican women attending infertility clinics. There is also a connection between pre-diabetes and insulin resistance. NAFLD is also strongly associated with type-2 diabetes and insulin resistance. Non-Alcoholic Liver Disease (NAFLD) is commonly associated with obesity and is a pre-diabetes symptom NAFLD. Obesity and insulin resistance can greatly increase the chances of acquiring diabetes and therefore has a potent connection to our study wherein we seek to investigate the knowledge and awareness of diabetes among patients that have been diagnosed with pre-diabetes in a family clinic.

Subtheme 3-weight loss:

These advantages, assimilated through the findings of various researchers, include: enhanced insulin sensitivity, improvement in mortality rates, better glycemic control, improvements in insulin resistance, better metabolic control, decreased medicine dependency, T2D prevention and onset delay, improvements in cardiovascular risk factors, restored ?-cell functioning and improved mobility, sexual functioning and overall quality of life (Wu, 2014, et al). Patient weight loss benefits can greatly assist in curbing the impact of diabetes and therefore have a potent connection to our study wherein we seek to investigate the knowledge and awareness of diabetes among patients that have been diagnosed with pre-diabetes in a family clinic.

Main theme 2- diabetic education:

DSME can greatly assist in curbing the impact of diabetes and therefore have a potent connection to our study wherein we seek to investigate the knowledge and awareness of diabetes among patients that have been diagnosed with pre-diabetes in a family clinic.

Subtheme 1-diabetic educational standards:

Research scholars have identified the need for establishing standards for measuring the outcomes of DSME initiatives. For the purpose of establishing effectiveness, it is necessary to assess outcomes. Evaluation of outcomes allows diabetes educators to determine initiative effectiveness, initiative impacts on participants, and areas for improvement. Diabetic self – care conduct processes ought to determine DSME efficacy at the level of respondents, individuals, groups and overall communities. A diabetes mentor may use core metrics for establishing efficiency with individual patients, groups and communities, link performance to established standards, and ascertain the unique effect DSME has within the overall diabetes care framework. Behavioral modification, in this context, represents a unique DSME outcome metric. Individual patient outcomes are applied for guiding medication and improving patient care while cumulative population outcomes help guide programmatic outcomes and ensuring continuous quality improvement activities to aid patients, providers and the initiative. Frequent, consistent outcome assessment at many instances is imperative, in addition to applying the information gleaned in the areas of instructional and clinical decision- making.

Subtheme 2- effectiveness:

Diabetes is a chronic disease and if not well managed may result in serious complications and in extreme cases may result in death. However, awareness among the patients on risk factors, quality of life psychology, self-care, glycemic control and cardiovascular disorders helps the patients manage their health more responsibly. The optimum health status of the patients is easily deterred by indulging in foods they should avoid or making unhealthy choices possibly negatively impacting their health condition. Creating awareness among such patients through education programs is deemed to create awareness among type II diabetic patients promoting informed decisions regarding possible health consequences or what routines they should observe to lead a healthy life.

Subtheme 3: Cost-Efficiency:

Following deductions from scholarly studies, it is possible to craft a program that increases the capacity of the patients in a single program and maintain professional standards while simultaneously remaining cost-effective. These strategies are purposed to increase and diversify access to self-management education.

c. Summary

This literature review chapter concentrated on assessing current literature on themes and issues related to creating DSME awareness among prediabetes patients. The results of this analysis points towards the significance of DSME and consider it paramount in controlling diabetes. Additionally, the literature points towards the effectiveness of DSME in controlling diabetes. Moreover, the literature also reveals the cost efficiency of DSME in controlling diabetes. The literature also has gaps particularly in the efficiency of diabetes educational interventions and therefore, this Direct Patient Improvement project focuses establishing the knowledge and awareness of diabetes among patients that have been diagnosed with pre-diabetes in a family clinic. 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. 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. This 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.

Problem Statement

Problem statement –

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 knowledge they gain from DSME educational interventions. 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.

Clinical/PICO Questions

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.

Sample

Sample and location

The DPI project is going to be completed at a Family Practice clinic where the weight measurement of the obese patients will be carried out. Given the timeframe available for this study and the resources at hand, a sample of 30 affected individuals who are obese and pre-diabetic will be utilized.

Since the clinic is in close proximity to the subjects under focus, purposive sampling will be selected. Recruitment of the subjects to participate will also be a straight forward process. Thus, accessibility will be a factor in selecting respondents. Purposive sampling is simple, less demanding and cost effective. The patients will have to be: a) a minimum of 18 years of age; b) understand written and spoken English; c) free from ailments such as severe stroke, visual impairment or kidney disease; and d) diagnosed with obesity and prediabetes to take part in the project.

Define Variables

Data Collection-

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.