Improving Diabetes Self-Care among African-American Women 50 years and older
Diabetes is the fourth leading cause of death worldwide (International Diabetes Foundation, 2007). Diabetes is a condition that can cause serious side effects, in addition to the potential for death, if not managed properly. For a majority of patients management is not difficult. It requires monitoring of blood sugar levels on a daily basis and adherence to a diet and exercise regime. Yet, many do not manage their diabetes properly and experiences serious complications as a result.
Certain populations are at greater risk for diabetes and are at a greater risk of complications due to improper management. These tendencies towards lack of management can be culturally based, making certain populations prone to diabetes and the risk of complications due to lack of management. African-American women over the age of 50 represent one of these high-risk groups and must take special care to manage their diabetes.
Symptoms are outward signs of inward disease process. They represent signals from the body that can give clues into the effectiveness of management strategies. Symptoms can give the patient and caregivers information about what needs to be done in the care regime. This study will use the UCSF symptom management model and apply it to the management of type 2 Diabetes in African-American women aged 50 and older.
This study will examine the effectiveness and applicability of the UCSF symptom management model to the management of type 2 diabetes in African-American women aged 50 an older. The model was originally used to manage the symptoms of HIV infections in women. This study will help to determine its effectiveness in the management of type 2 diabetes in a population that is considered particularly at-risk for complications of the disease. The study will address the problem of whether the UCSF symptom management group model can be used for the management of symptoms of type 2 diabetes in African-American women over the age of 50.
The purpose of this investigation is to determine if the UCSF symptom management group model is an effective means to manage type 2 diabetes in the chosen population. The goal of the research is to aid in the development of better management practices in the management of type 2 diabetes in the chosen population. The investigation will help in the development of a tool that can be used to help type 2 diabetes patients in the target population to self-manage their diabetes more effectively through monitoring their symptoms and taking appropriate actions accordingly.
This research will focus on the application of the UCSG symptom management group model as a means for increasing diabetes management behaviors in a group of African-American women over the age of 50. Cultural constructs will play an important role in the effectiveness of the model in increasing this behavior. It will support the following hypothesis.
H1: The UCSF symptom management group model will have a positive affect on increasing diabetes management behavior in African-American women over the age of 50
with Type 2 diabetes.
However, another element of this study focuses on cultural aspects of African-American culture that affect the ability of healthcare providers to motivate their patients into self-care behaviors that help to control their diabetes. The following research questions will help to explore how cultural issues among African-American women affect the ability of the model to manage diabetes.
1. How do the social aspects of food in African-American culture limit the ability of African-American women with type 2 diabetes in controlling their diets?
2. How do social attitudes affect their willingness to reveal minor symptoms that provide clues into their ability to manage diabetes?
3. How do social attitudes affect the ability of African-American women to monitor the occurrence of seemingly minor symptoms of their diabetes?
4. How do social attitudes affect the willingness of African-American women to ask for help from their support network in monitoring their diabetes?
The symptom-focused model developed for this study was based on the University of California at San Francisco (UCSF) symptom management group model. The model was first developed at the Nursing faculty the University of North Carolina at Chapel Hill for the management of symptoms of HIV infections in women (Skelly, A.H., Leeman, J., Carlson, J., Soward, A.CM., & Burns, D., 2008). This research will examine the application of this instrument to a different disease for which it was developed.
Diabetes is one of the most prevalent diseases on a global basis. According to the World Health Organization, diabetes affects more than 180 million people worldwide (WHO, 2006). Diabetes is a special concern for the African-American population. Nearly 11% of all African-Americans over the age of 20 have diabetes (American Diabetes Association, 2005). This literature review will explore the problem of diabetes among the African-Americans, as well as symptoms and treatment options. It will then examine the usefulness of the instrument as a means of assessing and monitoring the effectiveness of diabetes regimes. This literature review will only use academic research articles within the past five years and studies based on academic research from credible organizations.
Culture and Diabetes
Diabetes is a problem for almost every population around the globe. However, certain populations seem to be affected more than others. The number of African-Americans affected by diabetes is disproportionate when compared to the rest of the population. African-Americans are 1.8 times more likely to have diabetes as Caucasians (American Diabetes Association, 2005). African-Americans are more likely to experience complications such as retinopathy, kidney failure, and amputations (American Diabetes Association, 2005). In addition, women are much more likely to experience diabetes than men (National Diabetes Information Clearinghouse, 2002). These statistics are the key reason for choosing African-American women over the age of 50 as the target population for this research.
The goal of control in the diabetic patient is to maintain metabolic control. Patients that control their diabetes often can prevent or delay the onset of complications and prevent life-threatening consequences. Control of diabetes involves adherence to a strict dietary plan, regular exercise, medications, monitoring of blood glucose levels, and daily foot care. This regime is quote complex and time consuming. It is an inconvenience for many. Caring for one’s own diabetes takes time and effort. Many patients do not understand fully the consequences of failing to manage their diabetes until it is too late. Many individual variables can affect the willingness and ability of the patient to manage their own diabetes. The following will explore current literature regarding various programs to promote self-management and control of diabetes in the chosen population.
Symptoms and Diabetic Management
Symptoms are our body’s way of telling us about the condition of a disease state. Symptoms can provide valuable clues as to the worsening of a condition. Depression was found to be connected with the severity and duration of diabetes symptoms in type 2 diabetes patients (Ciechanowski, Katon, Russo, & Hirsch, I., 2003). Several studies reported a causal relationship between depressive symptoms and management of type 2 diabetes symptoms (Ciechanowski, Katon, Russo, & Hirsch, I., (2003); McKellar, J. Humphreys, K, and Piette, J. (2004)). However, the direction of the causal relationship remains a topic of debate.
It is not known whether mismanagement of the diabetes caused depressive symptoms, or whether depressive symptoms caused mismanagement in those patients. However, these studies do indicate that depressive symptoms can provide important clues for the physician as to an important risk factor in the management of symptoms and patient adherence to self-care regimes.
Symptom-based approaches have proven to be important in many conditions including the reduction of fatigue in older women post-bypass surgery, fatigue and sleep disturbance in multiple sclerosis patients, and reduction in chemotherapy patients (Given C, Given B, & Rahbar M., (2004); Wassam, R. & Dudley, W. (2003); Zimmerman L, Barnason S, & Schulz P, (2007)). Symptom-based management is becoming an important method for management and assessment of patient conditions in many nursing settings. A reduction in symptoms could be used as a motivator in the management of many disease conditions, including diabetes.
One of the problems with diabetic symptoms is that the symptoms can be so subtle that the patient hardly notices them. They are easy to dismiss in many, until they develop into serious complications, but by then it is too late. Alleviation these seemingly minor symptoms is the key to prevention of more serious complications in the future.
Some of the more common symptoms of diabetes include polyuria, polydipsia, polyphagia, visual blurring, numbness and tingling in extremities, calf pain when walking, and impotence (Stover, Skelly, Holditch-Davis, & Dunn, 2001). The problem with these symptoms is that they seldom cause enough discomfort to merit mention by the patient to the physician. They are also associated with many other conditions and can be easily attributed to other causes. However, patients and doctors must learn to recognize them as important clues to the patient’s condition and ability to manage their diabetes. For instance, obesity is closely related to diabetes in that they often occur simultaneously. Many of the same issues that arise in regards to diabetes, also apply to control of obesity as well (Tilghman, 2003).
The symptom-focused intervention model was developed by the University of California — San Francisco Nursing Symptom Management Faculty Group (1994). It has been adapted for use in older African-American women that have been diagnosed with type 2 diabetes in rural areas of the Southeastern United States. These findings were derived from a series of pilot studies that indicated key symptoms and their affects on the lives of women with diabetes (Skelly, A., Leeman, J., & Carlson, J.(2008).
The study by Skelly and associates included three primary strategies of self-care for diabetes. These included physiologic (Medical), behavioral (Self-care practices), and sociopsychological (coping, stress reduction, etc.). Outcomes were measured by monitoring metabolic control, symptom distress, and the patient’s self-reported quality of life as related to diabetes. It was found that symptom management correlated with medical monitoring of glucose levels.
The pilot studies found several significant findings related to identified several symptoms in women with type 2 diabetes. However, many women did not associate these symptoms as being related to diabetes (Skelly et al., 2005; Stover et al., 2001). According to these researchers, symptoms of hyperglycemia, hypoglycemia, numbness, tingling and pain in the feet were found to be associated with improper management of diabetes in the study group. The aim of the intervention in the study was to raise awareness of the importance of these symptoms in relation to diabetes management. They also concentrated on educating women about which of their symptoms were of greatest concern, in terms of monitoring their diabetes and in making reports to their doctors.
It was also recognized that there is a significant need to develop culturally relevant teaching materials regarding the importance to recognizing and reporting symptoms to their doctors. As part of the intervention strategy, nurses interviewed patients to assess their attitudes towards symptoms and various aspects of the intervention. For example, family support can be an important part of the treatment strategy. However, patients may feel uncomfortable relying on their family for support because they may not wish to burden them (Skelly et al., 2005). The personality of the patient had an impact on the effectiveness of the treatment strategy. For instance, some are outgoing socialites with a large support system. While others are more solitary. The treatment strategy and its success depend on matching it to the particular needs of the patient and their social environment.
The model upon which this study is based highlights the need to make education and intervention strategies relevant to the patients individual preferences. One of the caveats that an exploration of this conceptual model highlighted, although it was not addressed by the authors, is that the material and intervention not only have to be relevant to the individual, but that they must address cultural influences as well. Cultural explanations can be found for many individual differences, but these concepts only apply when one is generalizing about a group. The approach must be relevant to the individual’s culture and to their personality as well. It is important to understand the influence of culture on individual personality in the design and implementation of a treatment strategy. This will be an important consideration in the adaptation of this conceptual model to the parameters of this research study.
Patient Compliance and Diabetes Care
The goal of this research study is to increase patient compliance with self-care and management of diabetes. We have established a connection between symptom management and disease management, as well as explored the conceptual model upon which this study is based, However, compliance with self-care regimes is a psychological and motivational issue. The key problem lies in motivating the patient to take the necessary steps to manage their own care. They can be informed of what they need to do and the reasons for these strategies. However, education alone is no guarantee that the patient will adhere to the needed treatment schedules and activities. The following will examine literature regarding motivation and how it affects the patient’s willingness to comply with prescribed treatment plans.
Diabetes care differs from other types of healthcare treatments in that it must be carried out by the patient when the healthcare provider is not present. Effective support systems have a positive outcome in helping patients to manage their diabetes and to stick to the required routines ( Glazier, Bajcar, & Kennie (2006); Heisler, (2009); Heisler & Piette (2005)). The importance of support systems outside the clinical setting is highlighted in these studies. Access to health care can be problematic for those in lower income brackets (Wyn, Ojeda, & Ranji, 2004).
Socioeconomic status was found to have a negative impact on the success of patients and their ability to manage type 2 diabetes (Brown, Etttner, & Piette et al., (2004); Glazier, Bajcar, & Kennie (2006)). Literacy was found to improve the likelihood that a patient would be successful in their diabetes management (Rosal, Carbone, & Goins, 2003). Patient morale and family beliefs were also found to be a key influence in patient attitudes towards self-care among diabetes patients (Chesla, Fisher, & Mullan, 2004). These factors represent external influences that have an impact on the ability of the patient to adhere to necessary self-care routines. However, they are beyond the control of the physician, and many times, beyond the control of the patient. The physician needs to consider these factors when designing an intervention for their patients.
Diabetes management among African-American women represents a separate sector of research. Much attention has been focused on this group, largely because they comprise a high likelihood of developing complications from diabetes and they are considered a high-risk group for non-compliance with self-care routines. Kirk, Bell, & Bertoni et al., (2005) found that ethnic disparities exist regarding the management of not only diabetes, but for other health issues such as blood pressure and LDL cholesterol. Ethnic minorities were found to have poorer outcomes than non-Hispanic whites and was most notable regarding control of diabetes. The degree of self-efficacy was found to be an important factor in the ability of the patient to manage their diabetes (Samuel-Hodge, DeVellis, & Ammerman et al., (2002).
A number of interventions for the control of diabetes were found to have been researched with varying degrees of success among African-American women. Transportation, cost, and commitment were found to be key barriers in the compliance of women with the necessary routines (Rimme, Silberman, & Brunschweig et al., 2002). Programs that required extreme, sudden modifications to the daily routine were found to be less effective than those that used a moderate, slow approach to lifestyle change (Keysering, Samuel-Hodge, & Ammerman et al., 2002).
Developing a culturally appropriate diabetes management program is essential when addressing the needs of African-Americans, or any other ethnic group. If the program is not culturally appropriate, it will not be as effective as one that is geared towards the target audience. A culturally appropriate program cannot be developed unless one is aware of the aspects of that culture that make it unique when compared to other cultures. This research targets a specific ethnic group, requiring the need to establish those cultural differences that may enhance or impede the ability to increase positive diabetes management behavior.
Adherence to dietary control standards is a key component in the ability to manage diabetes. However, American medical practice typically does not recognize the food choices and preferences of other cultures. The diet prescribed is often based on a standard American diet. This may seem unpalatable to those of different cultures (Liburd, 2003). For African-Americans, particularly those located in the South, eating is considered a ritual. They may not be aware that they are engaging in a ritual in the foods that they choose, the manner in which it is prepared, and the method and environment associated with it. However, a ritual is defined as a stylized, repetitive, and stereotyped behavior (Liburd, 2003). By these criteria, food is a highly ritualized characteristic of African-American culture.
Ritual associations with food may make it difficult for African-American women to make the necessary changes to manage their diabetes. This may be particularly true for older women where these cultural norms and values are more entrenched (Liburd, 2003). Traditions within African-Americans stems from their African roots and heritage. In African tradition, women play an important role in the preparation of food. Preparation of food takes on a new social realm within these cultures. Food is seen as a performance and women take great pride in their foods (Liburd, 2003). Food sharing and community collectivity is also connected with African-American traditions (Liburd, 2003).
Food is associated with social functions and reflects on the people that prepare it (Liburd, 2003). When a woman cooks food, particularly that for a special occasion or to share with others, they embody the food, and give it “soul” (Liburd, 2003). Soul food is not so much about the food or recipes as in the feeling that goes into its preparation. This is an issue that must be addressed in the development of programs to help African-American women with diabetes adjust to their new diet. They must find a way to give it “soul.” Food is associated with caring and love in African-American culture. To deny food because it goes against the diabetic diet can be taken as an insult to the preparer (Liburd, 2003). This create a significant cultural obstacle in the ability to maintain adherence to a diabetic diet.
The social role of older women within African-American culture also presents a challenge to women with type 2 diabetes (Samuel-Hodge, Skelly, & Headen et al., 2005). Women have many social barriers that prevent them from adhering to their diabetes management plans. Women are supposed to take on a caregiving role and may avoid behaviors that would make them appear to be dependent or needy (Samuel-Hodge, Skelly, & Headen et al., 2005). This may make them unwilling to ask for help or it many make them tend to minimize the minor symptoms of diabetes, making management much more difficult.
Cultural constructs play an important role in the management of type 2 diabetes in older African-American women. Literature suggests that several cultural characteristics may make them at a greater risk of problems managing their diabetes. Social associations with food and traditional women’s roles within the culture may play an important role in motivating women to take measures to control their diabetes.
The literature review suggested that symptoms of the disease can provide important clues as to the progress of the condition. Symptoms have the potential to help the patient self-manage their diabetes. The theoretical concept of the study relies on monitoring of symptoms as a clue to self-management of type 2 diabetes in African-American Women. The study found that many factors contribute to the ability and willingness of African-American women to engage in behaviors that will help to control their diabetes.
The purpose of this study is to explore the ability of the UCSF group model to help African-American women monitor their diabetes. This model has proven helpful in the monitoring and management of other diseases and has been applied to the study group chosen for this research. However, the ability to help women with type 2 diabetes was only marginal. It is suspected that this model did not take into account the cultural constructs identified during this literature review. It is suspected that the model was developed with a non-Hispanic white population in mind. Literature regarding the model suggests that it is highly affective in those populations. It is suspected that cultural aspects affect its effectiveness in relation to African-American women. This study will fill a gap in the existing literature regarding the ability of the UCSF group model to help African-American women over the age of 50 with their management of diabetes. The hypothesis for this study was developed with these concepts in mind.
The literature review suggested that cultural influences may be responsible for the difficulties discovered with African-American women and their ability to manage their diabetes. This research will use the research questions to gain insight into the cultural aspects of African-American culture that could have an affect on the effectiveness of the model in helping African-American women to manage their diabetes more effectively. The literature review found that social rituals regarding food and the role of the woman as caregiver have an affect on the willingness of African-American women to engage in more careful monitoring and care of their diabetes.
This study will examine diabetes management in a group that is at high risk for complications from the disease. It will use the UCSF group model as the test instrument to affect the outcome of diabetes management in the group. The methodology chosen will tie the conceptual model to the research questions of the study. It will use a quasi-quantitative method to assess the outcome of the data.
Skelly and associates (2007) concentrated on the identification of symptoms associated with diabetes in African-American women. They used the UCSF symptom-focused group model to attempt to identify the symptoms associated with diabetes and to develop a prioritized list so that patients could use them to monitor their own daily progress in self-management of the disease.
In this strategy, the patients learned to recognize and assess their own symptoms. Nurses served as guides to help patients devise strategies to help them manage their symptoms, Patients would meet with the nurses every 1 1/2 weeks to assess their progress and devise further strategies to cope with them. The study by Skelly and associates concentrated on development of the model and on finding a way to operationalize it in a clinical setting. This study will take their research and will test its effectiveness in a chosen group of women.
The sample population for this study will consist of 50 African-American women who have been previously diagnosed with type 2 diabetes. It will use women that are over the age of 50, as this population represents a group that is at high risk for developing complications due to mismanagement of their disease. The study will take place at a local area hospital that has an active, community-based program for the management of diabetes.
Participants will be randomly selected from the patients currently enrolled in the diabetes management program at this facility. The participants will be randomly selected and the researcher will have no control over the final sample population. The sample population will be partially dependent upon the willingness of the patients to participate in the study.
This study will rely on the UCSF symptom-focused group model developed by Skelly and associates. Once the sample population has been selected, the group will be given a questionnaire to assess their level of management, their knowledge of symptoms related to diabetes, and the effectiveness of their current level of control. The group will then proceed through the symptom-focused model program developed by Skelly and associates. At the end of a three-month period, the groups will be given another questionnaire to assess the effectiveness of the model in helping them to self-manage their diabetes. In addition to the questionnaires, blood samples taken during their regular office visits will be taken to assess the clinical progress of their diabetes.
The test instrument for the study will be the UCSF symptom-focused group model. Effectiveness of this intervention will be measured through standard blood tests administered as a part of their routine visits. The study will use a pre-test/post-test method for measuring the variables. The pre-test and post-test will be identical in order to allow for a direct comparison and to track changes during the test period.
Survey questions will be based on the symptoms discovered during the pilot study conducted by Shelley and associates (2007).
Patients will be asked questions regarding the severity and frequency of symptoms, their success with the management techniques implemented as a result of the UCSF model, and cultural factors that may influence their ability to stick with the plans developed during nursing sessions. The reliability and validity of the measures will be assessed using Cronbach’s Alpha and cross-tabulation among various subgroups.
All participants in the study will be required to sign an informed consent that outlines the procedures that will be used in the study. They will be informed that participation is voluntary and that they may withdraw from the test at any time that they feel it to be necessary. Participants will not be expected to experience any undo discomfort, other than minor pain associated with the blood tests. However, these are a routine part of their visits beyond the scope of this research. Participants are not expected to experience any additional discomfort as a result of participation in this study.
All participants in the study will be subject to the same treatment. It will not use a control group where one receives a sham treatment or such. This is not expected to be beneficial to the patients or their treatment plans. Patients may receive some benefit from participation in the study as it may help them to gain better control of their diabetes and symptoms of the disease. Patients are expected to receive varying degrees of benefit from the treatment.
As with any research study, certain limitations apply to the ability to generalize the research. In the case of this study, a select group of participants that have a particular set of characteristics will be selected to participate in this study. The study will be limited to African-American women over the age of 50. Although, the results of the study can be expected to be applicable to others with diabetes, one can only assume that they are valid for women that meet the test criteria. Others may benefit from the findings of this study, but definitive conclusions will only be valid for the selected study group.
Data will be analyzed using descriptive statistical techniques. The analysis method chosen will compare the results of the pre-test and the post-test among the study population. Differences between the severity and frequency of symptoms will serve as the primary components of the analysis. A significance level of p>.05 will be used to indicate a significant difference among the two surveys. A statistically significant improvement in the severity and frequency of diabetes symptoms will be measured by a reduction of those symptoms.
A variety of question formats will be used, as appropriate to the material being examined. For example, questions related to culturally significant foods will use a Likert scale, or frequency distribution format. Others may ask the participant to expand on their answers using an open-ended format that can be coded and then analyze by frequency distribution. The analysis methods chosen will be appropriate to the question format.
The UCSG symptom-focused group model is a relatively new method for helping patient to self-manage their condition through awareness of symptoms. It was originally developed to help HIV patients, but is now being examined as a potential means to help manage other conditions as well. Its conceptual model is based on the concept that symptoms can provide important clues as to disease states and the progress of improvements in the patients.
Only a limited number of studies have been conducted using this model. The primary focus to this point has been to develop an understanding of the symptoms most frequently related to diabetes. The purpose of this study is to evaluate the effectiveness of the model in helping a select group of patients to manage their diabetes through monitoring their symptoms.
African-American women are at a significantly greater risk of developing diabetes than the Caucasian population. In addition, certain cultural aspects make it difficult for them to manage their diabetes through proper diet and exercise. Women over the age of 50 are at greater risk for the influence of these cultural factors than are younger women. Traditional rituals regarding food and the woman as a caregiver can oppose the need for restricted dietary intake. African-American women of this age group are less likely to report symptoms, as they feel that they do not wish to be a burden on their family.
Patients play an important role in the treatment of their diabetes. They must take positive measures to limit their diet, exercise on a regular basis and to adhere to monitoring of their glucose levels. Doctors and medication and only go so far in controlling diabetes. The patient must be their own advocate. Cultural factors play a significant role in the willingness and ability of the patient to manage their own health condition.
This study will provide important clues as to how cultural factors affect the ability of the UCSG symptom-focused group model to improve the health of African-American women with type 2 diabetes. This study will provide a treatment structure that will help others with the same condition, or other conditions that require intensive self-management to attain greater ability to control their condition.
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Not at all. All papers are written from scratch. There is no way your tutor or instructor will realize that you did not write the paper yourself. In fact, we recommend using our assignment help services for consistent results.
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You fill all the paper instructions in the order form. Make sure you include all the helpful materials so that our academic writers can deliver the perfect paper. It will also help to eliminate unnecessary revisions.
Proceed to pay for the paper so that it can be assigned to one of our expert academic writers. The paper subject is matched with the writer’s area of specialization.
You communicate with the writer and know about the progress of the paper. The client can ask the writer for drafts of the paper. The client can upload extra material and include additional instructions from the lecturer. Receive a paper.
The paper is sent to your email and uploaded to your personal account. You also get a plagiarism report attached to your paper.
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Although you can leverage our expertise for any writing task, we have a knack for creating flawless papers for the following document types.
Although you can leverage our expertise for any writing task, we have a knack for creating flawless papers for the following document types.
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