Evidence based practice Mar 29, 2013
After Extensive research, three programs were selected for comparison, to find one suitable for Type II Diabetes Prevention and Self-Management Skills
Program (TDPSMSP).
Program 1EFFECTIVENESS OF A COMMUNITY HEALTH WORKER INTERVENTION AMONG AFRICAN AMERICAN AND LATINO ADULTS WITH TYPE 2 DIABETES
A community based culturally tailored program was implemented in Detroit, Michigan, between September 2004 and July 2006. This program targeted African Americans and Latinos with type 2 diabetes and utilized a random sample of 164 people from both races. The intervention was for a period of six months, whereby the Community Health Workers (CHWs) were appointed to promote healthy habits and advocate for healthy lifestyle, by managing the participants. The CHWs educated the participants on self-management; they also visited them at home regularly to check on their progress and accompanied them to their clinic visits. The main objective of this program was to intervene on those people in the community who were already suffering from type 2 diabetes, by utilizing CHWs who helped them in managing their glucose levels in the blood (hemoglobin A1c-HbA1c) and subsequently reduce them to normal levels. IMPLEMENTERS: a group of researchers conducted the study. PARTNERS: The REACH Detroit FUNDED BY: This program was funded through grants by the National Institute of Diabetes and Digestive and Kidney Disease, Centers for Disease Control and Prevention (CDC), the Michigan Diabetes Research and Training Center and the Robert Wood Johnson Foundation Clinical Scholars Program. PARTICIPANTS: Participants were adults 18 years and older who had been diagnosed with type 2 diabetes. They were randomly selected by abstracting information from medical records and were identified as either African American or Latino. There were two groups of participants, one was intervention or for treatment group 45% and the other one was the control group 55%. All participants were exposed to equal resources in terms of good healthcare, healthy food, physical fitness, etc. The CHW intervention was however, delayed for six months for the control group, while within the same period of time, the intervention or for treatment group was receiving the CHW care. KEY RESULTS: The intervention group’s HbA1c reduced from 8.6% to 7.8% within 6 months while the control group’s Hb1c did not change from 8.5% in 6 months. TYPE OF EVALUATION: Use of medical records, clinic registry and follow up by CHWs. THEORETICAL FOUNDATION: Behavioral theory based. Critique This program is very unique. It utilized Community Health Workers (CHWs) to work with the people in the community and help them self-manage their diabetes. Using the local CHWs is a good way of reaching the local people using their own people who understood the culture of the target groups and knew their way around the area due to familiarity. This program will be great for my health issue, type 2 diabetes among the African Americans, but there is a major shortcoming. Having the CHWs following the target group around, through home visits and accompanying them to clinic visits feels like invasion of personal space. Also, six months was a short period of time, the program should have been 12 months or more to show greater scientific significant results. The material does not clearly indicate whether the CHWs were paid or not, but if they were paid, then this is an expensive program, because they had to travel with the patients to their clinic visits and pay them home visits. However, this program made a big difference in the lives of the target group as proved by the key results. This is my second choice of program I could have implemented to control diabetes among African Americans. |
Program 2EXPLORING THE USE OF COMPUTER BASED PATIENT EDUCATION RESOURCES TO ENABLE DIABETIC PATIENTS FROM UNDERSERVED POPULATIONS TO SELF-MANAGE THEIR DISEASE.
The program was implemented in a large urban community health center in Washington DC, with many Spanish speaking patients. The program focused on improving self -management among the underserved people with diabetes, by bringing awareness about the risks and complications associated with diabetes disease, by educating the patients, through computer based health resources. The impact of computer technology in controlling diabetes was the outcome of interest during the intervention. In addition, being able to reach the poor and underserved who had no computer access and provide the computer based education was an objective as well. During their clinic visit, patients were invited to enroll in the program by filling out a survey and they were randomly assigned to either the control group (58 patients) or intervention group (108 patients). Both control and intervention groups received diabetic related treatment but the intervention group received additional computer based education which the control group did not receive. The intervention program was performed for 12 months, by having the intervention group of patients watch diabetic related tutorials during each clinic visits. Each patient in the control group had at least 3 clinic visits within 12 months. MedlinePlus.gov website was also utilized to educate the patients in the intervention group. The tutorials and information from MedlinePlus were delivered in both English and Spanish languages. IMPLEMENTERS: Researchers FUNDED BY: Unity health Care. EVALUATION: Routine evaluation of clinical information collected at patient visits stored in registries. Short term follow up. Use of questionnaires KEY RESULTS: Decreased LDL Cholesterol of 9.9 mg/dl and a decrease of glucose in the blood (HbA1c) of 0.3% compared to an increase in LDL cholesterol of 0.5 mg/dl and an increase of HbA1c of 0.1% among the control group. These differences were not statistically significant. PARTICIPANTS: English and Spanish speaking patients with diabetes and had at least 3 clinic visits after diagnosis. Low socioeconomic status and little education. THEORETICAL FOUNDATION: Knowledge and Behavioral theory based. Critique This is a very good program which involved use of technology to educate diabetic patients. It is good because, while most people will not actually read the fliers or other paper related material, they will focus on a computer or any other video related media. On the other hand, this program has a language option other than English, Spanish speaking patients can also be educated. However, the disadvantage of this program is that it is time consuming. Participants spent a long periods of time every visit watching tutorials. Each day is different, there are days when there is hardly enough time to accomplish everything that need to be done. A day like that in a doctor’s clinic will make the participant dread the whole research idea. Another disadvantage is that not everyone will develop much interest in computers. In other words this might not be a good medium for many people. |
Program 3TESTING A PEER SUPPORT INTERVENTION FOR PEOPLE WITH TYPE 2 DIABETES
This program focused on using peer support in type 2 diabetes management. It was implemented through a clinic called BioMed Central family practice in England, United Kingdom. This was a two months intervention whereby, participants in the program met with the peer supporters twice within the intervention period. There were four groups based on four physician practices, which were electronically randomized and allocated. Only one was the control group, the other three were intervention groups. Peer supporters met with the peers (intervention group) at the local levels of their communities of residence to discuss the issues involved in living with diabetes, as well as educate the peers about diabetes control. During the meetings, one on one interaction lasted one hour, while the group session lasted one and half-hours. The peer supporters were expected to remain in contact with the peers, using the mobile phones issued to them. Peer supporters were to be good listeners during the intervention meetings with the peers. IMPLEMENTERS: Researchers FUNDED BY: Peers for Progress and Takeda KEY RESULTS: No scientific significance results due to a major weakness. Eight of the 16 peer supporters recruited withdrew from the program and 2 more during the training. COLLABORATORS: Nurses and clinicians. PARTICIPANTS: Were adults. Peers, the diabetic patients who needed guidance to manage the disease. The peer supporters were also diabetic patients but were good in maintaining their sugar levels by following the health professional’s guidance. EVALUATION: A process questionnaire was used at the end of the program to conduct a process evaluation. THEORETICAL FOUNDATION: Social support theory although not clearly stated in the material. Critique Using peer support is a great way to educate diabetic patients. This program uses people with the same experience as the target population to send the message. The message is that “we have gone through the same problem and we are still self- managing it and you can do the same and control your diabetes.” In addition, the peer support group will educate the target group on how to go about managing their diabetes through lifestyle changes from experience. The interactive discussion provides an opportunity for most people to open up and share the challenges they face. The peer supporters’ presence and their ability to listen to the peers is very encouraging to the peers. This program did not have significant scientific results when it was implemented in UK. However if properly modified, it is one of the best of my three programs, to use for diabetes intervention among my target group, the African Americans. Sometimes one needs to hear that “you can do it” to have the courage to try. Another major shortcoming of this program is that the intervention period was too short, only 2 months. To be able to tell whether a program is working it needs time and significant results. |
Program 3 most suitable to implement in type II diabetes interventions in African Americans to prevent and self-manage the disease. This programs involves peer support for diabetic patients and education to bring awareness in preventive measures. The programs is based on social support theory.
REFERENCES CITED
Simmons et al, (2013). Testing a peer support intervention for people with type 2 diabetes. BioMed Central Family practice. Retrieved from http://web.ebscohost.com.proxy2.ulib.iupui.edu/ehost/pdfviewer/pdfviewer?sid=df13c68c-ec81-416d-b75d-5c9322a53953%40sessionmgr113&vid=6&hid=122
Spencer, M.S. et al, (2011). Effectiveness of a community health worker intervention among African American and Latino Adults with Type 2 Diabetes. American Journal of Public Health. Retrieved from http://web.ebscohost.com.proxy2.ulib.iupui.edu/ehost/detail?sid=00e91566-333f-4af5-8143-cfba15af386%40sessionmgr112&vid=7&hid=122&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=f5h&AN=69733380
Zyskind A, Jones K.C, Pomerantz, K.L and Barker, A.L. (2009). Exploring the use of computer based patient education resources. Retrieved from http://web.ebscohost.com/ehost/detail?vid=5&sid=3dcd35d5-3fdd-46d8-98c6-0c541893c22f%40sessionmgr112&hid=124&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=aph&AN=43876740
Simmons et al, (2013). Testing a peer support intervention for people with type 2 diabetes. BioMed Central Family practice. Retrieved from http://web.ebscohost.com.proxy2.ulib.iupui.edu/ehost/pdfviewer/pdfviewer?sid=df13c68c-ec81-416d-b75d-5c9322a53953%40sessionmgr113&vid=6&hid=122
Spencer, M.S. et al, (2011). Effectiveness of a community health worker intervention among African American and Latino Adults with Type 2 Diabetes. American Journal of Public Health. Retrieved from http://web.ebscohost.com.proxy2.ulib.iupui.edu/ehost/detail?sid=00e91566-333f-4af5-8143-cfba15af386%40sessionmgr112&vid=7&hid=122&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=f5h&AN=69733380
Zyskind A, Jones K.C, Pomerantz, K.L and Barker, A.L. (2009). Exploring the use of computer based patient education resources. Retrieved from http://web.ebscohost.com/ehost/detail?vid=5&sid=3dcd35d5-3fdd-46d8-98c6-0c541893c22f%40sessionmgr112&hid=124&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=aph&AN=43876740