Evidence-based Practice Proposal (Literature Support)

Evidence-based Practice Proposal (Literature Support)

In the contemporary medical world, new health educational practices are coming up due to the demand for quality care improvement. A case in point of such health educational trends is the self-management educational program whose utilization is common in the management of diabetic patient. In essence, thispaper aims at establishing the practical details of self-management education program for the management of diabetes in the elderly population. Central to the realization of this objective is a review of literature that focuses on this aspect of diabetes management. Moreover, the analysis will also detail the search method for the literature, the validity of internal and external research as well as evaluate the strengths and limitation of the studies included in the review.

Literature Search Method

Of the essence to the utilized search strategy were two online databases. They included PubMed, which was the main source of evidence and CINACHL. Central to the search in both databases was the PICOT question, which offered the keywords utilized in the establishment of the evidence focusing on determining the efficacy of self-management education program in the maintenance of normal A1C levels among the elderly persons. The Medical subject heading (MeSH) terms used in the pursuit of supporting evidence in the PubMed database include self-management, A1C levels, diabetes and elderly population. On the other hand, the CINACHL search entailed use of general terms such as self-management education program, diabetes, A1C levels and elderly population. Lastly, the search strategy also entailed the use filtersfor the enhancement of validity and relevance. The filters used includestudies conducted between 2012 and 2017 and the English language. Fourout of the possible 20studies met the set criteria were therefore considered for the review.

Summary of Evidence

Central to the review of the evidence, were three key themes, namely, epidemiology of type II diabetes, efficacy of self-management education program in the maintenance of normal A1C levels, and commonly used self-management education techniques.

Epidemiology of Type II Diabetes

Prevalence. According to (), approximately 26 million people of the total USA population (8.3%) are victims of diabetes. Additionally, the condition is more prevalent in rural regions of USA than in urban areas. Such is the case given that the prevalence rate of diabetes in the rural areas is 17% higher than in the urban areas (Lepard, Joseph, Agne, &Cherrington,2015).

Socioeconomic Level.Both high and low socio-economic statuses are contributory to the developmentof type II diabetes mellitus. High socioeconomic status translates to a sedentary lifestyle depicted by poor nutritional practices and limited physical activity, which are among the risk factors of this condition. On the contrary, a low socioeconomic status is also a predisposing factor to diabetes due to lack of money for buying healthy foods such as fruits and vegetables. Instead, individuals end up consuming fast foods that are cheap but dangerous since they result in diabetes (Zareban, Karimy, Niknami, Haidarnia, &Rakhshani, 2014).

Age and Gender.Zareban, et al., (2014) are of the opinion that the risk of developing type II diabetes heightens with increased age. However, the distribution of type 2 diabetes along gender lines is equal in measure given the disease’s unselective nature.

Efficacy of Self-Management Education Program in Maintaining Glycemic Control

Lepard, et al., (2015) in their systematic review concluded that 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.

In another study, the researchers conducted an experiment study in which they established that the training program instituted had a positive outcome on various patients’ aspects that enabled me them to maintain a glycemic control. For instance, in their study, they established that 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 (Zareban, et al., 2014).

Additionally, the A1C levels of studied participants significantly reduced by 0.5 percentage points in a quasi-experiment conducted with aimof evaluating the effects of a culturally sensitive self-management education program (Peña-Purcell, Boggess, & Jimenez, 2011).Clearly, this is another proof depicting the efficacy of self-management education on maintenance of glycemic control.

Finally, Nicoll, et al., (2014) in their study also concluded that diabetes self-management education improves glycemic control to a certain degree. Moreover, the effect of this kind of intervention would last for two years after rolling it out.

Commonly Used Techniques in the Self-Management Education Program

Lepard, et al., (2015) in their systematic review established two mainself-management interventions were effective in the management of persons with type 2 diabetes living in rural areas. They include telehealth, social support and face-to-facediabetes interventions. Telehealth interventionsinclude videoconferencing technologies, videophones, telephone calls and internet. The social support services on the other hand entail motivational support and collaborative goal setting. Both interventions are effective in maintenance of the much-needed glycemic control in diabetic patients.

In another study,a group of experimental researchers established that the video tutorials and face-to-face interventions such as training were also significant in improving diabetes awareness among the patients.Consequently, these techniques were able to improve the efficacy of diabetes self-care, which is the sole focus of self-management education program (Zareban, et al., 2014).


Primarily, the internal validity of the reviewed studiesis intact. However, the external validity of all the reviewed studies is undesirable because of various reasons that are worth noting. A case in point, Peña-Purcell, Boggess, and Jimenez, (2011) utilized a small sample size (144), which hinders the external validity of their study given the difficulty in generalizing results.

As for the study by Nicoll, etal., (2014), the external validity of the results is in question given the high number of participants dropping out from the study.

Besides, one of the reviewed studiesalso depicts a limited external validity of the findings given the unwillingness of study participants to cooperate and join in the study (Zareban, et al., 2014).

Lastly, the limitation of the external validity in Lepard, et al., (2015) study is also inevitable. That is for sure given the element of publication biasness and challenges in comparing data from several studies.

Evaluation (Strengths and Limitations)

In overall terms, the reviewed studies possessed the strength of measuring the intended outcomes. However, they are not devoid of certain weaknesses that are worth noting. For instance, the control group wasvictim of unethical deprivation of the intervention (training program) and the study participants were uncooperative (Zareban, et al., 2014).

In the studyconducted by Peña-Purcell, Boggess, and Jimenez, (2011), the limitations included dropping out study participants and small sample size that limits generalizability of the results.

Other weaknesses noted included but not limited to bias, inability to ascertain the identification of all relevant literature and problems of comparing data from several studies (Lepard, et al.,2015; Nicoll, et al., 2014).


In closure, this paper aimed at establishing the practical details of self-management education program for the management of diabetes in the elderly population. Indeed, the discussion has achieved this objective and several conclusions are attainable from the analysis. For instance, based on the review, theefficacy of the self-management education program in maintenance of normal A1C levels among the elderly population is beyond reasonable doubt. As such, an implication drawn from this review is the need for institutionalizing this form of health education especially when dealing with diabetic patients. In the absence of such consideration, however, poor glycemic control among elderly patients will remain a challenge for the unforeseeable future.


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 reports15(6), 37.

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. Diabetes Spectrum27(3), 207-211.

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. The Diabetes Educator37(6), 770-779.

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. Journal of education and health promotion3.


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