Efficacy of Diabetes Self-Management Education Program in the Maintenance of Glycemic Control among Diabetic Elderly Population

Efficacy of Diabetes Self-Management Education Program in the Maintenance of Glycemic Control among Diabetic Elderly Population

The purpose of this evidence-based project is to demonstrate the efficacy of diabetes self-management education (DSME) program in the maintenance of glycemic control among diabetic elderly persons. The study setting of interest is Cornerstone FamilyHealthcare’s, a multicultural organization.The elderly diabetic patients of this institution, as the study population of interest, will receive DSME before evaluation for their glycemic control. Central to the collection of datafor determination of glycemic control will be the Diabetes Self-Management Report Tool (D-SMART) whose founding principles are envisaged in the American Association of Diabetes Educator 7 (AADE7) Self-carebehaviors. Finally, the project intends to use descriptive study design to demonstrate to determine efficacy of DSME in improving glycemic control among the elderly persons.

Key words:diabetes self-management education, elderly, glycemic control

 

 

 

Appendix A:Critical Appraisal Checklist

Citation: Authors, Date of Publication and Title Conceptual Framework Design/

Method

 Sample/Setting Major Variables Studied and Their Definitions

 

 Measurement of Major Variables Data Analysis Study Findings Strength of the Evidence (Level of evidence and quality study strengths and weaknesses
Lepard, M. G., Joseph, A. L., Agne, A. A., &Cherrington, A. L. (2015). Diabetes self-management interventions for adults with type 2 diabetes living in rural areas: a systematic literature review. Current diabetes reports, 15(6), 37. Varied conceptual frameworks (health belief model, social cognitive theory, stages of change model, adult learning theory, symptom-focused model, and the chronic care model) Systematic review Rural areas

15 studies met the inclusion criteria

 Independent Variable:

Dependent variables:

1.      Biologic outcomes (HbA1c, blood pressure, weight/BMI, waist circumference, blood glucose, and lipids)

2.      Changes in health behavior

3.      Diabetes knowledge

 1.      Biologic outcomes (standard measurement tools of HbA1c levels, blood pressure, weight/BMI, waist circumference, blood glucose, and lipids)

2.      Change of health behavior (Questionnaire)

3.      Diabetes knowledge (Questionnaire)

 Data abstraction Self-management interventions such as telehealth and in-person diabetes interventions promoted an increase in knowledge level. The high awareness level in turn led to an improvement of A1C levels, which depicts a good glycemic control. Level I and high quality
Nicoll, K. G., Ramser, K. L., Campbell, J. D., Suda, K. J., Lee, M. D., Wood, G. C., Sumter, R., &Hamann, G. L. (2014). Sustainability of improved glycemic control after diabetes self-management education. Absent Quasi-experimental design Only 43 patients out of 133 patients that attended DSME in 2009 at outpatient center of Regional One Health met the inclusion criteria Independent variable: DSME program

Dependent variable: A1C levels

 Hospital records for determination of A1C levels SAS 9.3 (SAS Institute, Cary, N.C.) Diabetes self-management education improves glycemic control to a certain degree and the effect of this kind of intervention would last for two years after rolling it out. Level II and high quality
Peña-Purcell, N. C., Boggess, M. M., & Jimenez, N. (2011). An empowerment-based diabetes self-management education program for Hispanic/Latinos: a quasi-experimental pilot study. Social Learning and Self-regulation Quasi-experimental study design 144 persons residing in 2 Texas

counties at the Texas-Mexico border

 

 Independent variable: DSME program

Dependent variables: Clinical (A1C), cogni-

tive, attitudinal, behavioral, and cultural assessments

 

 Standard measurement tools of HbA1c levels Questionnaires Descriptive statistics The A1C levels of studied participants significantly reduced by 0.5 percentage points Level II and high quality
Zareban, I., Karimy, M., Niknami, S., Haidarnia, A., &Rakhshani, F. (2014). The effect of self-care education program on reducing HbA1c levels in patients with type 2 diabetes. Absent Experimental study design 138 diabetic female patients in Zahedan city, in 2011 (69 cases and 69 controls) Independent variable: DSME program

Dependent variables: Clinical (A1C)

 Standard measurement tools of HbA1c levels Questionnaires SPSS The training programs resulted in improvement of knowledge, attitude and self-care. With the improved knowledge and skills, the glycemic control also improved given the increase in awareness Level I and high quality

 

APPENDIX B: The Transtheoretical Model

Stage I: Precontemplation Stage II: Contemplation Stage III:Preparedness Stage IV: Action Stage V: Maintenance
The targeted individuals do not believe behavioral change is important to them, and they feel incapable of the transition.

The elderly population targeted by the diabetes self-management education is not having considerationof refraining from personal behaviors that are contributing to the worsening of diabetes and embrace healthy habits due to the lack of understanding of the value of such a shift in the personal behaviors.

 Individuals start developing the desire to change their habits for the best in the next 6 months.However, motivation of these persons to change behavior at this stage is impossible.

The executors of the project will have to wait for the targeted audience, elderly persons, to initiate the desire for change and show preparedness for the same before motivating them to make the alterations

 The role of the project developers during this phase will be assisting the diabetic elderly persons to come up with ideas that will lead to the realization of the desired behavior change.

 

 Individuals set goals with the help of the executors of the project. Individuals have less temptation to relapse and increased confidence to continue with their changes.

The sustenance of the newly learned and adopted behaviors during the diabetes self-management education program is the focus of this phase.

 

 

 

Appendix C: Project timeline 6 months

Tasks 1 2 3 4 5 6
Month 1

·         Obtain guidelines for initiation of work on the capstone project proposal

          
Month 2

Prepare and submit capstone proposal for chair to review

  

 

 

 

  

 

 

 

      
Month3

·         Defend proposal

·         Apply for IRB approval

·         Make final revisions in the capstone proposal for submission  to chair and committee member for review

  

 

 

 

 

 

 

 

 

 

  

 

 

 

 

 

 

 

 

 

      
Month 4

·         Identify volunteers to participate in Capstone Project

·         Organize Capstone Proposal for implementation

·         Implement Capstone Proposal

          
Month 5

·         Collect data for project

·         Data analysis

  

 

 

  

 

 

      
Month 6

Evaluation

 

         X

 

 

 

 

Appendix D: Resources

Type of Resource Example
Man Healthcare personnel
Material Ink

Paper screen

Whiteboard

Lock box

Educational material based on American Association of Diabetes Educator 7 (AADE7) Self-carebehaviors curriculum
Money Zero budget given the readily availability of resources
Machine Computer

Projector

Printer

 

 

 

Appendix E: Method and Instrument

  1. What number of days during the last 7 days did you fail to take your diabetes medications as prescribed? {0–7, reverse scored}
  2. What number of days during the last 7 days did you fail to check your blood sugar? {0–7, reverse scored}
  3. What number of days during the last 7 days did you fail consume foods deemed unhealthy for your diabetes? {0–7}
  4. What number of days during the last 7 days did you fail to comply with the appropriate amount of food? {0–7, reverse scored}
  5. What number of days during the last 7 days did you engage in at least 30minutes of light physical activity (such as walking, light gardening)? {0–7}
  6. What number of days during the last 7 days did you engage in at least 30 minutes of moderate physical activity (such as riding a bicycle, playing golf)? {0–7}
  7. What number of days during the last 7 days did you engage in at least 20 minutes of vigorous physical activity (such as running)? {0–7}
  8. In the past week, how much difficulty did you have with: {A great deal, A lot, Moderate, A little, No}
  9. monitoring your blood sugar?
  10. giving yourself your diabetes medications as your doctor instructed?
  11. managing your weight?
  12. periods of uncontrolled eating?
  13. feeling hungry?
  14. food cravings?
  15. being physically active?
  16. coping with frustration and worry related to your diabetes?
  17. In the past week (last 7 days), how frustrated have you been with trying to manage your diabetes? {Not at all, Slightly, Moderately, Very, Extremely}
  18. In the past week (last 7 days), how worried have you been about your future health because of your diabetes? {Not at all, Slightly, Moderately, Very, Extremely}
  19. Overall, how confident have you felt during the past week (last 7 days) about being able to manage your diabetes? {Not at all, Slightly, Moderately, Very, Extremely}
  20. How important is it for you right now to: {Lot, Moderate, Little, No}
  21. monitor your blood sugar?
  22. take your diabetes medications as your doctor instructed?
  23. manage your weight?
  24. manage your diet?
  25. manage your physical activity?
  26. manage frustration and worry related to your diabetes?

 

(This Form is Adapted from the American Association of Diabetic Educators Patient

Self-Assessment Tools (D-SMART))

 

 

 

 

 

Appendix F: Data Collection

  1. What number of days during the last 7 days did you fail to take your diabetes medications as prescribed? {0–7, reverse scored}
  2. What number of days during the last 7 days did you fail to check your blood sugar? {0–7, reverse scored}
  3. What number of days during the last 7 days did you fail consume foods deemed unhealthy for your diabetes? {0–7}
  4. What number of days during the last 7 days did you fail to comply with the appropriate amount of food? {0–7, reverse scored}
  5. What number of days during the last 7 days did you engage in at least 30minutes of light physical activity (such as walking, light gardening)? {0–7}
  6. What number of days during the last 7 days did you engage in at least 30 minutes of moderate physical activity (such as riding a bicycle, playing golf)? {0–7}
  7. What number of days during the last 7 days did you engage in at least 20 minutes of vigorous physical activity (such as running)? {0–7}
  8. In the past week, how much difficulty did you have with: {A great deal, A lot, Moderate, A little, No}
  9. monitoring your blood sugar?
  10. giving yourself your diabetes medications as your doctor instructed?
  11. managing your weight?
  12. periods of uncontrolled eating?
  13. feeling hungry?
  14. food cravings?
  15. being physically active?
  16. coping with frustration and worry related to your diabetes?
  17. In the past week (last 7 days), how frustrated have you been with trying to manage your diabetes? {Not at all, Slightly, Moderately, Very, Extremely}
  18. In the past week (last 7 days), how worried have you been about your future health because of your diabetes? {Not at all, Slightly, Moderately, Very, Extremely}
  19. Overall, how confident have you felt during the past week (last 7 days) about being able to manage your diabetes? {Not at all, Slightly, Moderately, Very, Extremely}
  20. How important is it for you right now to: {Lot, Moderate, Little, No}
  21. monitor your blood sugar?
  22. take your diabetes medications as your doctor instructed?
  23. manage your weight?
  24. manage your diet?
  25. manage your physical activity?
  26. manage frustration and worry related to your diabetes?

 

(This Form is Adapted from the American Association of Diabetic Educators Patient

Self-Assessment Tools (D-SMART))

 

 

 

Appendix G: Budget

Note: Zero budget given the readily availability of resources

Item 1 month Two months 3 months 6months
Materials (Ink, Paper screen, Whiteboard, Lock box and Educational material based on American Association of Diabetes Educator 7 (AADE7) Self-carebehaviors curriculum ) 0 0 0 0
Machine (Computer, Projector and Printer) 0 0 0 0

 

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