Author: Leonard Einstein, APRN , NP-C, FNP-BC
Adjunct Faculty of the BSN Program at Florida National University
Published date: June 7, 2021 at 1:00 AM
Type 2 diabetes is one of the most prominent public health concerns worldwide, particularly in the United States. Engagement in unhealthy lifestyles, such as consumption of junk food, smoking and alcohol abuse, sedentary habits, etc. are the main reasons for causing the development of type 2 diabetes amongst the American population. The condition is not curable but preventable, which is why the dissemination of knowledge about this disease with populations at risk is of paramount importance. That is why a continuous acquisition of scientific evidence for improvement of management and care for patients with type 2 diabetes is necessary. Synthesis of various studies plays a vital role in this regard as it enables to determine the most prominent and reliable findings that can be transitioned to practice. Education of patients is critical in regard to prevention and management of the disease, which is why synthesis of the research within this domain is essential as well.
The purpose of this paper is to determine and synthesize research as well as non-research evidence pertinent to the management of patients with type 2 diabetes throughout their education. It is imperative to understand what specific challenges and opportunities are now present in the practical sense of the problem. Patient education is not reported to be a burden for healthcare providers, meanwhile, involvement of patients in the process of learning is much more challenging. Thus, the determination of factors that can advance patient engagement in learning and adherence to self-management guidelines is the main objective for the synthesis of scientific evidence within this paper. For instance, the study by Fink et al. (2019) describes the importance of the learning styles of patients, so more diverse approaches are necessary. The research by Wijayanti et al. (2019) reflects on the importance of considering various patient inputs for more effective engagement in education. On a separate note, Smith et al. (2016) describe the overall impact of effective patient education on their physical activity. All in all, the synthesis of this evidence can help to prepare a reliable and clinically secure intervention that will facilitate patient engagement in education and self-management of their condition. In such a way, this paper intends to prepare sufficient evidential ground for launching credible evidence-based research.
Practice Problem Identification
Since education of patients is concerned, the main practice problems related to their active involvement and adherence to self-management guidelines. The matter is that the number of U.S. residents diagnosed with type 2 diabetes keeps growing despite any scientific progress in medicine: average growth of incidence is 2.59% per year, so the prevalence of type 2 diabetes does not decrease but even keeps elevating (Stokes & Preston, 2017). Unwillingness to engage in learning and self-management can be conditioned with poor health literacy, low socioeconomic status, or personal barriers in communication with healthcare providers. At any rate, healthcare organizations are expected to address this problem. The synthesis of studies pertinent to this problem can significantly help to distinguish what factors hinder patient engagement in learning and what appeals can be used to motivate the target populations to involve in learning about their condition for continuous self-management thereafter. Beyond a doubt, this problem is complicated, once a range of factors are relevant but the synthesis of the research evidence can reveal at least the most prominent trends to date.
Implications of The Practice Problem
The National Level
Type 2 diabetes is a significant problem at the national level, as long as its prevalence keeps growing by 2.59% per year since 1984 (Stokes & Preston, 2017). The current prevalence of the disease is 11% - 12.5% among the adult population of the United States for all genders (Stokes & Preston, 2017). This state of affairs indicates that the education of populations does not work sufficiently well as a preventative measure. Moreover, exacerbation of health disparities is one of the reasons why populations simply do not have access to any medical information that can best inform them about the prevention and management of type 2 diabetes. The total estimate of the cost burden equals $327 billion that includes $237 billion of direct expenses associated with continuous care for the target population (American Diabetes Association, 2018). Also, almost $90 billion are estimated as a loss due to the limited production of the U.S. populations with type 2 diabetes (American Diabetes Association, 2018). Hence, a need for more complex research of education strategies is necessary for ensuring that populations are sufficiently informed about the disease and know how to prevent it.
The Local Level
The local level presents many problems as well. The prevalence of type 2 diabetes in the average community ranges from 3.5% to 7.5% so that the significance of this problem cannot be denied, especially in communities with vulnerable populations (Stokes & Preston, 2017). At this point, the problem is the same as at the national level: lack of awareness and access to healthcare services causes low literacy amongst populations at risk, so the incidence of the disease continues to rise. As for the economic burden for an average community, $9,601 is spent per single patient for a single year (American Diabetes Association, 2018). This is 2.3 times higher than the average community member, so the economic burden is particularly persistent at the local level (American Diabetes Association, 2018). These facts only underline the importance of redesign of patient education strategies and a need for management of such complex issues as health disparities and social inequality.
Synthesis of Evidence
Taking into account the evidence from the articles, reporting about specific studies being conducted, the following messages can be retrieved. The study by Fink et al. (2019) reports a need for greater sensitivity in the design of patient education programs, as long as different types of learners have a different aptitude for information acquisition. Moreover, the initial health literacy of the target populations does vary, so a more sensitive approach is necessary. Likewise, Wijayanti et al. (2019) agree with this finding by saying that such a course of action will make the target populations act more openly towards the acquisition of information related to their condition. On a separate note, Smith et al. (2016) reveal that greater and regular physical activity does increase the persistence of type 2 diabetes symptoms and its further exacerbation. At the same time, non-research sources present almost the same statements. For example, Coppola et al. (2016) argue that more specific options should become available for the education of patients with type 2 diabetes: length of training sessions, number of members in a group training, etc. In such a way, a variety of options will facilitate motivation amongst patients to engage in learning. The same opinion has been expressed by Świątoniowska et al. (2019) who argue that a patient's willingness to learn about their condition depends upon the socio-economic status and a variety of variables pertinent to a nurse practitioner such as empathy, reciprocity, empowerment, etc. Nevertheless, Lawal and Lawal (2016) argue that there is no observable disadvantage in group education in comparison with individual learning programs. To this end, all the sources agree about the fact to make patient education more sensitive regarding the presentation of information and its acquisition by target populations.
As it has been already discussed, the central commonality of all sources involved is a focus on a need for adjusting educational programs to patient inputs such as learning style, health literacy, and socio-economic status that considerably shape the ways they can engage in the acquisition of information about type 2 diabetes. Concerning the main differences, each source emphasizes different aspects that they consider to be unimportant to the engagement of target populations in education about their condition. In such a way, Fink et al. (2019) argue that a level of responsibility is not a mediating factor, once even the least responsible patients have taken the responsibility for their disease. Also, Lawal and Lawal (2016) assert that group or individual formats of patient education do not impact the acquisition of the knowledge shared with the patients. Thus, the sources are generally congruent with each other in their key messages, except one devoted to the role of the physical activity.
The aforementioned evidence exhibits a strong consistency, which is why a need for optimization of patient education towards greater sensitivity is a prominent issue for the management of type 2 diabetes. Whilst the efficacy of regular physical activity has been proved with numerous studies, the ways how target populations should be taught about its importance still vary. That is why the expansion of parameters for patient education appears to be more important than its content. It is difficult to ignore that the knowledge necessary for regular self-management of diabetes mellitus condition is sufficiently comprehensive and easily achievable, meanwhile, the main challenge for health providers is to motivate target populations to engage in the process of learning and use the new knowledge regularly. Therefore, the evidence presented in the articles under analysis is relevant to the current problems of type 2 diabetes management across the entire healthcare continuum.
Appraisal of Evidence
Level of Evidence
The sources involved in the synthesis of evidence contain different levels of reliability. The study by Fink et al. (2019) has a III level evidence, Wijayanti et al. (2019) II level evidence, and Smith et al. (2016) has an I level evidence. As for non-research studies, all of them have IV level evidence, since they are based on the expert opinion of the authors, so that no scientific evidence has been produced and collected to research the subject. Even though such a selection of sources may demonstrate an insufficient level of evidence, it is informative to note that the major part of them demonstrates consistency in results: a more sensitive and diverse approach to type 2 diabetes patient education is necessary.
Quality Rating of Evidence
In the same vein, the quality of evidence also varies. As for Fink et al. (2019), its quality rating can be determined as moderate. At the same time, the research by Wijayanti et al. (2019) has a high level of evidence as well as the research by Smith. et al. (2016). Concerning non-research sources, all of them present a very low level of evidence, since only expert opinions are involved. Variations of quality rating are explained by different levels of the evidence, but again it is necessary to place the emphasis on the fact that most of the studies demonstrate similar messages and practical implications.
Concerning the suitability of the studies selected, the major part of them is suitable to the clinical problem identified. All studies, including research and non-research, except the article by Smith et al. (2016), focus on the importance of redesigning patient education and consideration of diverse patient inputs. The research conducted by Smith et al. (2016) provides an account of the importance of the physical activity to a patient's condition improvement and prevention of co-morbidities. This study has devoted to the content of patient education, whilst the rest of the sources discuss issues pertinent to the more effective involvement of target populations in education and adherence to self-management guidelines.
It is appropriate to make a general comment on the fact that the issue of patient education regarding management and prevention of type 2 diabetes makes a serious impact on both the local and national levels. The prevalence of the disease keeps growing each year, and the economic burden exacerbates current health disparities, thereby making access to healthcare more challenging for vulnerable populations. Both local and national levels demonstrate that education strategies do not work well enough to engage populations at risk. The research evidence gathered within this paper presents different levels and quality ratings, but its synthesis demonstrates that the major part of the sources is devoted to investigation of the problem from the perspective of education strategies redesign. The evidence synthesized underlines the importance of greater sensitivity to the learning style of patients as well as individual patient inputs such as socioeconomic status, initial health literacy, and ability to communicate with health providers.
American Diabetes Association. (2018). Economic cost of diabetes in the U.S. in 2017. Diabetes Care, 41(5), 917-928. https://doi.org/10.2337/dci18-0007
Coppola, A., Sasso, L., Bagnasco, A., Giustina, A., & Gazzaruso, C. (2016). The role of patient education in the prevention and management of type 2 diabetes: an overview. Endocrine, 53(1), 18-27. https://doi.org/10.1007/s12020-015-0775-7
Fink, A., Fach, E. M., & Schröder, S. L. (2019). ‘Learning to shape life’–a qualitative study on the challenges posed by a diagnosis of diabetes mellitus type 2. International Journal for Equity in Health, 18(1), 1-11. https://doi.org/10.1186/s12939-019-0924-3
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