Comparing Self-management Education in Type-two Diabetes Participants
To begin, diabetes has become more widespread impacting four-hundred and twenty-two million in 2014, which is an increase from 1980 with only one-hundred and eight million affected (World Health Organization, 2017). Diabetes puts an immense strain on the healthcare system because it causes macrovascular and microvascular complications ultimately leading to physical and psychological anguish (Chatterjee, Khunti, & Davies, 2017). Diabetes has continually increased, even though there are successful programs and an abundance amount of knowledge surrounding risk factors regarding type two diabetes (Chatterjee et al., 2017).
There has been increasing evidence that shows improved patient outcomes related to diabetes education (Smith, McNaughton, & Meyer, 2016). Research has shown that diabetes education is effective, but more research needs to be done to figure out the specific types. Slamah, Nicholl, Alslail, & Melville (2017) found that diabetes education helped with individuals with T2DM, but could not identify the most effective strategies. New (2010) also stated that there is a gap in the research pertaining to what are the most effective types of diabetes education. Since, diabetes is more prevalent it is important to learn about what type of diabetes education can help patients the most with their self-management of the disease. Therefore, nurses could be able to teach their patients an effective way to help them manage their diabetes.
Background
Karlsen, Bettina, and Oftedal (2018) have shown that individuals suffering from type-two diabetes mellitus (T2DM) find that it is difficult to achieve self-management. Individuals feel like they have no support and have a hard time attaining the goals of treatment (Karlsen, Bettina & Oftedal, 2018). Therefore, individuals are not able to obtain optimal blood pressure, glycosylated haemoglobin (Hb1AC) and cholesterol, thus requiring health-care professionals to step in (Karlsen, Bettina, & Oftedal, 2018). It requires health-care professionals to determine what would be an effective type of diabetes education to help with self-management of the disease. It can then lead to time and money being wasted trying to find a suitable education program.
By using a diabetes education program, it has shown to be effective in increasing an individual’s glycemic control and ability and skills to demonstrate positive self-management activities (Slamah et al., 2017). Adults who do not participate in any programs/teaching have poor glycemic control compared to afterwards when they obtain an ideal glycemic control due to teaching regarding self-management behaviours (Al-Khawaldeh, Al-Hassan, & Froelicher, 2012). Therefore, finding the right type of diabetes education would be important. Wiley et al. (2014), state that it has been shown that by just offering tailored education plans and peer-led diabetes education it could help improve patient outcomes. A tailored education plan is optimal because it is centered around the individual and can help lead to improved glycemic control (Donihi, 2017). Peer-led diabetes education has shown to be effective because the instructor can relate to the individuals and provide empathy and support that can be difficult for professionals to provide (Philis-Tsimikas, Fortmann, Lleva-Ocana, Walker, & Gallo, 2011).
Purpose and Problem
Research has frequently shown the positive impact of diabetes education on an individual to self-manage. Despite this, it is unclear which type of diabetes education would be the most effective. There has been research conducted to show the significant impact of diabetes education on individuals with T2DM, however researchers have not identified specific diabetes education programs which are the most effective. The purpose of this quasi-experimental study is to compare the impact of tailored education plans and peer-led diabetes education on self-management of adults with T2DM in the community setting. The research question is, “what is the most effective diabetes education when comparing tailored diabetes education and peer-led diabetes education on self-management behaviours with individuals with type-two diabetes in the community setting?”
Theoretical Framework
The theoretical framework that will guide this study is The Chronic Care Model that was developed in 1996 by Wagner (Philis-tsimikas, & Gallo, 2014). Philis-tsimkas and Gallo (2014) state this model has been proven to be effective in primary care settings and in the community in improving chronic disease care specifically diabetes. It can also increase the quality of care and decrease health care costs (Stock et al., 2014). The model consists of community resources, delivery system design and the self-management of the patient (Philis-tsimikas, & Gallo, 2014). The model can help assist the study since it looks at self-management of patients and how it is related to the chosen system of delivery.
Methodology 
The methodology of the discussed study is quantitative specifically, quasi-experimental. Quasi-experimental studies are used since the results can be generalizable and they are achievable and practicable (Lobiondo-Wood & Haber, 2013). The aim of the proposed study is to be to determine which diabetes self-management education is better and therefore can be used in the future. To add, quasi-experimental designs test cause-and-effect relationships (Lobiondo-Wood & Haber, 2013). By testing out both self-management education plans the researcher can see if they have any impact on the participants and which one would be the better of the two.
Setting and Sample
The setting of the study takes place at the at the Diabetes Care Center located in Sudbury, Ontario. The Diabetes Care Center is designed for outpatients to provide education and management of diabetes. The population of the study are individuals who have been diagnosed with T2DM between the age of 18-65 years of age. Participants with comorbidities or are cognitively impaired will not be included. Cognitively people may not have the capacity to understand what is happening. People with comorbidities will not be included to ensure that other diseases do not interfere with the research.
To acquire participants, there will be an online posting with the inclusion and exclusion criteria. The type of sampling used will be convenience sampling. Lobiondo-Wood and Haber (2013) state that convenience sampling is described as using the most available participants for the study. In Canada there are approximately eleven million people living with prediabetes and diabetes (Diabetes Center, 2018). There is no statistic found for the amount living with it in Sudbury, Ontario, therefore a study similar will be used. Hunt et al. (2012) used roughly 150 participants who lived in rural Alabama had type-two diabetes looking at self-management behaviours. For the purpose of this paper approximately 150 participants will be recruited. In the online posting it will list that this study is optional, and participants may withdraw at anytime. The participants will then be divided evenly into two groups to look at both types of diabetes management. Participants will also have the study explained to them and they will need to sign a consent form (Appendix A). The pros and cons will be explained to each participate and they can decide if they would like to join.
Data Collection
Data collection for the study will be by a survey and blood work. Participants will go once a week for six months to Diabetes Care Center. At the center they will be required to participate in a type of diabetes management and afterwards will fill out the survey. The surveys will be numbered to ensure anonymity and placed in unmarked envelopes. The surveys will be later on used for data analysis by the researcher. The purpose of doing a survey after each session will help to determine which diabetes self-management program is the most effective. A physician will be working to help tailor individual self-management plans and take blood work. The blood work is an indicator of self-management by looking at cholesterol and HbA1C levels. Koumpan, Vandenkerkhof, & Van Vlymen (2014) disclosed that HbA1C is used to evaluate glycemic control long-term over the last three to four months and can be managed through self-management activities.
The purpose of the survey is to gather data from the program to see if it has affected 
their self-management. The survey that will be used is The Multidimensional Diabetes Questionnaire (MDQ) [Appendix B] developed by Talbot, Nouwen, Gingras, Gosselin, and Audet (1997). The MDQ is comprised of three different sections which include: outcome and self-efficacy, negative and positive self-care activities and social support and diabetes perceptions (O’hea et al., 2009). To add, the MDQ can assist healthcare workers to find interventions that will enhance the patient behaviourally and emotionally with diabetes (O’hea et al., 2009).
Rigour is important to be addressed in studies since it means the data can be generalized and trustworthy (LoBiondo-Wood & Haber, 2013). LoBiondo-Wood and Haber (2013) state to measure rigour in a quantitative study, reliability and validity of measurement instruments are used to verify that the concepts/theories of a study are justified. O’hea et al. (2009) have determined that the MDQ has good internal consistency, construct validity and with HbA1C levels they are positively correlated.
Data Analysis
The data from the study will be analyzed using a quantitative approach. Descriptive statistics will be used and is described as organizing and compiling data by minimizing data through descriptive statistical techniques (Lobiondo-Wood & Haber, 2013). The MDQ will give researchers data about self-management techniques (Talbot et al., 1997). The interval level for descriptive statistics will be used that are compiled of mode, median and mean (Lobiondo-Wood & Haber, 2013). The mode, median and mode will be taken to analyze the difference between both tailored education plans and peer-led diabetes education using the data collection tools.
Inferential statistics will be used in addition to descriptive statistics to assist in generalize and predict findings (Lobiondo-Wood & Haber, 2013). Parametric tests are used to assume the variables that are being studied (Lobiondo-Wood & Haber, 2013). T-tests are used to measure the difference between two groups since they are both independent from one another (Lobiondo-Wood & Haber, 2013). T-tests will be used to analyze the data even further to see any differences in the groups. Connelly (2011) states that after the t-test a researcher can see if the intervention has made a difference. The two different diabetes education plans are being compared to see which one is more effective. The MDQ will offer information to be able to compare both groups.
Ethical Considerations
In research, ethics is a critical component of the study. Ethics can be defined as a discipline or theory regarding the principles of moral conduct and value (Lobiondo-Wood & Haber, 2013). The Canadian Nursing Association (CNA) (2002) outlines fives rights pertaining to the protection of human rights and respect for participants (Lobiondo-Wood & Haber, 2013). These rights include: right to confidentiality and anonymity, right to fair treatment, right to protection from harm and discomfort, right to self-determination and right to dignity and privacy (Lobiondo-Wood & Haber, 2013). To ensure human rights are protected researchers need to have informed consent which consists of the participants being made aware of potential risks and benefits before joining (Lobiondo-Wood & Haber, 2013).
There are steps in place to make sure that the study is conducted in an ethical manner. Firstly, this study will consist of adults (age 18-65) who are diagnosed with T2DM and live in the community. To be included, individuals need to have been diagnosed with T2DM for at least one year. To recruit participants, it will be posted on a diabetes support website and it will be on a voluntary basis. Respect for people ensures that individuals have the freedom to be in the study or not (Lobiondo-Wood & Haber, 2013). There is no obligation to stay in the study and participants can leave anytime without consequence. This will be listed on the diabetes support website and also mentioned again when meeting for the study. Trained nurses and doctors will facilitate the peer-led education group and also help in the planning of each tailored self-management plan.
In a research study, participants need to be able to weigh the pros and cons of each study. This study will benefit health-care professionals as they will be able to learn what is the most effective type of diabetes education when working with type-two diabetics. This will also in turn benefit individuals with T2DM as they will be taught the most effective type of diabetes education. It is important to note that there is an improvement in psychosocial and glycemic control outcomes for type-two diabetics when incorporating diabetes self-management education (Slamah, Nicholl, Alslail, & Melville, 2017).
By incorporating a peer-led diabetes education session and tailored diabetes education plans there are some ethical implications. Both are patient-centered, therefore the people running the education sessions need to respect the individuals, preferences and beliefs (Shaw, & Fineberg, 2014). To help ensure that participants are respected, individuals will be required to read and sign a form to ensure they understand ethics in the study.
Limitations
The limits and possible obstructions of the study will be explored. Firstly, the cost of running this study would be expensive. To have employees and a center to run it would be costly. There would have to be funding allocated to be able to run this study. The benefit of conducting this study is that it will save the healthcare system money and also it will help aid in the health of people with T2DM. O’hea et al. (2009) have discussed that people with T2DM can control their disease with self-management techniques (ex: exercising, medications, taking their glucose level). This study has the potential to help people with their disease since they will be taught self-management behaviours. Lastly, the participants might not be truthful when answering the survey. This can lead to inaccurate information that could alter the data (Volino, Das, Mansukhani, & Cosler, 2014).
To conclude, the purpose is to discover which diabetes education program would be the most effective in participants with T2DM. The methodology of this study will be quantitative, specifically quasi-experimental. The data is to be collected by surveys and bloodwork at the Diabetes Care Center in Sudbury. The data will be analyzed using descriptive and inferential statistics. The participants will have the study described to them and will be able to leave at any time. After this study has been conducted researchers hope to understand what the most effective type of diabetes education is.
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