Diabetes type-2 is a chronic disease that affects a large segment of the world and the United States is no exception. Diabetes affects almost 200 million people across the world and the number is expected to reach 350 million by 2030 (Unger, 2012). The entire lifestyle of the patient with type-2 diabetes is disrupted in addition to facing certain complications. The gravity of the disease requires a patient to improve knowledge and develop relevant skills for its better management. Better management of type-2 diabetes can help make positive changes in lifestyle and delay or avoid the complications related to this disorder. Considering the increasing epidemic of diabetes, a diabetes educator plays a key role in providing self-management education with the overall objective of improving patient outcomes (Mazze & Bergenstal, 2011). In this context, a self-management education program is the foundation of treatment for patients with diabetes. It is thus necessary to develop a plan that will help a group of selected patients to manage and control diabetes. The main emphasis is to define the targeted population and discuss appropriate goals set in the plan.
The structure will consist of materials and human resources required to accomplish the participant and program goals. The target population for self-education and management of type-2 diabetes are patients within the age group of 50 to 60 years, English speaking, and with different ethnic backgrounds. The main criteria based on which the participants are selected is to identify and include patients newly diagnosed with type-2 diabetes but lack the necessary knowledge and skills to manage and control the disease. The main variables associated with the target population are; motivation and interest; previous instruction; current skills, knowledge, and behavior; family involvement; belief in the education program; level of self-confidence; and learning style. These characteristics were chosen because they were in line with self-management strategies for diabetes type 2.
The overall goal of the diabetes self-management and control program is to assist patients to comprehend and demonstrate self-care. This goal will be measured through a comprehensive educational program alongside subsequent evaluation.
Objectives of the self-management program include assisting patients to understand their conditions, improving knowledge and skills for managing type-2 diabetes, and open discussion of patients’ conditions. Group members will also be informed about importance of glycaemic control, regularly measurement of blood sugar, administering insulin if advised by the doctor; comprehending the importance of food pyramid and being aware of foods allowed and/or disallowed as well as complying with the exercise plan (Unger, 2012). The Diabetic Manual for the Doctor and Patient underlines the importance of educating patients to care for and manage the disease. Self-care is influenced by personal, interpersonal and external conditions. The framework and dynamics resources available affect the demeanor of self-care activities. The WHO has also given guidelines that emphasize the need the significance of educating patients with diabetes-2 so that they can lead quality and healthy lives. However, the daily management of diabetes seems to be a daunting task for some patients and they require psychological counseling, as well as education and motivation. Thus, self-management intervention diabetes is a useful resource for patients. It assists clients by facilitating self-management behaviors and disseminating information. Possession of knowledge about diabetes and a healthy lifestyle is crucial but not enough to trigger changes to the patient’s behaviors. Thus, there is a need to establish approaches that can strengthen a patient’s competency to control the disease through behavioral changes (Ramal, Petersen, Ingram & Champlin, 2012).
There are two main classifications of undertaking evaluations. These include formative and summative. An evaluation carried out at the internal level is referred to as formative. In other words, it judges the effectiveness or importance of a program during the onset and progress of a program. In the case of the self-management program for diabetes type-2, it is vital to mention that all the instructional goals are attained. If there are any deficiencies in the program, they will be easily identified and resolved through a formative evaluation. In addition, there are several learning materials that will be used in the program. Such materials will only be analyzed through a thorough formative evaluation. For example, the various groups of patients who will be taken through the self-management education program will have to be assessed in terms of the ability to comprehend and achieve the set goals and objectives. The individual patients will be taken as learners and therefore evaluated based on the key tenets and goals of the program. Medical personnel who will execute education on self-management of diabetes will also have to be appraised in terms of their effectiveness. This type of evaluation will basically be a core building process for the diabetes management program bearing in mind that a number of related components will be accumulated along the way. These will include challenges faced during the program, skills and competencies required as well as requisite materials. Needless to say, quite a huge segment of the population is unaware of several risk factors for developing Type-2 diabetes (Ramal et al., 2012). It is crucial for them to assess their level of risk regularly.
On the other hand, summative evaluation of the program exclusively entails the assessment of external parameters. This will involve evaluating the benefits or importance of the self-management program after all the goals and objectives have been attained. In other words, it summarizes the worth of the exercise. To begin with, a self-management program for individuals diagnosed with diabetes is a very effective approach for managing the condition owing to a number of reasons. First, it reduces the cost of managing diabetes type 2 owing to minimal hospital visits coupled with consulting medical experts. As already hinted, diabetes is a fast-growing epidemic across the globe. Owing to the chronic and complex nature of the condition, both self-management and clinical care can be of great help to patients. However, it is vital to mention that clinical care per se cannot be effective as a type-2diabetes management program. Unless patients and even the healthy segment of the population are educated about it, the scourge might eventually incapacitate the productive segment of the population. The focus of this self-management program for diabetes type-2 is in the results.
The success of diabetes self-management and education is primarily dependent on the need assessment of the target population. The resource and service area should be reviewed to identify the needs of group members. Needs assessment will help in the planning and managing of the program.
The process of providing knowledge and improving skills for better management of type-2 diabetes involves the integration of goals, individual assessment, implementation, evaluation, feedback, and follow-up. As every group member is unique, the need for education varies with the disease process, age, lifestyle, and culture. A collaborative effort between group members and participants should be made to identify individual needs for education.
A follow-up process should focus on changes made in the knowledge, attitude, skills, and lifestyle of patients. The desired results of the program include accomplishment of the above-mentioned goals and objectives and helping group members to improve outcomes. This project is important in my future advanced practice role because it will provide an in-depth insight into developing a systematic plan and design-related processes, and gain knowledge about how self-management and education work for diabetes patients.
This includes assessment methodologies of program effectiveness. It will mainly focus on a 2-step evaluation plan (before and after program implementation) of physiological parameters. Besides, assessment of glycated hemoglobin and evaluation of studies that address diabetes type-2 as well as exploring parameters such as weight, body mass index, waist circumference, blood pressure, lipid profile, and cholesterol will be crucial in the program. Other assessment measures will entail psychological parameters such as quality of life and self-efficacy, self-assessments of behavioral parameters, self-management and achievement of the set objectives. There are a number of selected studies that will primarily assist in assessing the implementation of the intervention program among individuals with type 2-diabetes. The latter are mostly quasi-experimental studies with the control group.
Results of the intervention program are also expected to be evident. In most studies, the results indicate improvements of the evaluated parameters when self-management of the condition is put into consideration. There are improvements in physiological and psychological indicators of blood pressure ophthalmic surveillance and the nephropathic condition of the feet as well as self-efficacy. Other positive health outcomes include better quality of life, enhanced diet, positive change of lifestyle, reduced body weight and waist circumference.
The evaluation plan should also be capable of assessing perceptive attitude indicators, overall health improvement, a sense of confidence in managing type-2 diabetes, making the right lifestyle choices, and reference to improving the understanding of diabetes. Behavior indicators decrease according to the number of days that participants reported eating high-fat foods.
Despite improvements, there are situations where the implemented program may not reveal results that are considered to be positive. The study by Tunis (2011) shows positive results in the variables indicated above. However, the intervention group has more negative outcomes than the control group in key indicators related to type-2 diabetes complications especially in regards to lipid profile and blood pressure. In addition, increased physical exercise and reviewing the instructions related to the diet may sometimes lack the desired effects.
Improving the quality of care aimed at managing diabetes type-2 demands refining metrics, setting specific priorities in healthcare settings and setting optimal targets for outcome measures. The evaluation criteria of methodological quality are not constituted as an exclusion criterion. As for the results (global and cross all analyzed texts) of this critical analysis of methodological quality, there were some gaps such as the insufficient description of the programs and the conditions for its operation, lack of randomization, incomplete description of the methodology used and lack of psychometric qualities of the instruments used. Thus, we must consider the results by taking into account the limitations in regard to the methodological quality of the program.
Mazze, R. & Bergenstal, R. M. (2011). Staged Diabetes management. New York: Wiley-Blackwell.
Ramal, E., Petersen, A. B., Ingram, K. M., & Champlin, A. M. (2012). Factors that influence diabetes self-management in hispanics living in low socioeconomic neighborhoods in San Bernardino, California. Journal of Immigrant and Minority Health, 14(6), 1090-1096.
Tunis, S. L. (2011). Cost effectiveness of self-monitoring of blood glucose (SMBG) for patients with type 2 diabetes and not on insulin. Applied Health Economics and Health Policy, 9(6), 351-365.
Unger, J. (2012). Diabetes Management in Primary care. Philadelphia, PA: Lippincot,Williams.
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