HomePublic HealthUsing a DSMES-Based Intervention for the African American Population

Using a DSMES-Based Intervention for the African American Population

Topic: Public Health
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Introduction

Diabetes is a global health problem that affects more people every day, but some populations are at higher risk than others. In the United States, almost 10% of the population has diabetes, and 95% of them have type 2 diabetes which is developed due to a combination of external and internal factors (Cunningham et al., 2018). One of the population segments, African Americans, has racial disparities in access to healthcare, proper nutrition, housing, and education (Khosla et al., 2021). As an outcome, the rate of African Americans with diabetes is higher than that of the overall population – 12.7% (Cunningham et al., 2018). Thus, the Black population of the US is also at a higher risk of developing diabetes, which is demonstrated by the higher rates of underdiagnosed diabetes and higher levels of hemoglobin A1c (Khosla et al., 2021). Therefore, this population is put at risk due to limited resources and potential misdiagnoses.

The evidence-based intervention that will be implemented is diabetes self-management education and support (DSMES) (CDC, 2021).

Brief Description of the Need for Change

The situation regarding higher rates of diabetes and increased dangers of developing type 2 diabetes raises the question of what nursing professionals can do to reduce adverse patient outcomes. Nurses can reach out to vulnerable individuals and communities and initiate change projects that educate, support, and provide resources to people who require medical help. According to the Centers for Disease Control and Prevention (CDC, 2021), diabetes self-management education and support (DSMES) is a potential set of tools for practitioners to apply to help people with or at risk of type 2 diabetes to improve their quality of life in regards to diabetes prevention. A change in how African Americans are approached to deal with prediabetes is urgently required to prevent the rate of Black people with diabetes from rising further in the future.

Purpose of the Project

The purpose of the proposed DNP project is to examine the potential effects of using a DSMES-based intervention for the African American population in a specific area. In particular, the health outcomes of Black people with prediabetes are examined, as they serve as one of the determining factors for confirming the diagnosis of type 2 diabetes (Rodriguez et al., 2022). Therefore, the project is concerned with whether an education and support program can lead to meaningful and quantifiable change and positively impact the prevention of diabetes development in underserved populations.

PICOT

In adult African Americans with type 2 diabetes what is the impact of implementing the Diabetes Self-Management Education and Support (DSMES) compared to usual care, on fasting blood glucose in 8-10 weeks?

Population

The population under examination is adult African Americans with prediabetes living in the state of Maryland. As noted above, Black Americans are among the groups with the highest risk of developing type 2 diabetes. Moreover, African Americans experience the most negative outcomes and face the most restrictions when accessing medical care and getting a diagnosis (Khosla et al., 2021). It is vital to note that prediabetes is not a diagnosis such as diabetes, but it is a serious condition that can be recognized in time to potentially lower the risk of type 2 diabetes. Prediabetes can be defined by a high glycated hemoglobin A1c level – 5.7% to 6.5%, but these levels are not high enough to become a symptom of diabetes (Khosla et al., 2021). At this stage, one may already experience the signs of diabetes, but the condition is not as severe or chronic.

Working with the sample, the following criteria will be used:

  • Inclusion criteria:
    • Age: adults over 18
    • Ethnicity/race: African Americans
    • Diagnosis: type 2 diabetes, or self-identification as having prediabetes confirmed with a hemoglobin level measurement
  • Exclusion criteria:
    • young age under 18
    • Other races but for African Americans
    • low or high hemoglobin levels indicating the absence of prediabetes diagnosis or a diabetes diagnosis
  • Estimated sample: 100 participants

Research Articles

Centers for Disease Control and Prevention. (2021). Diabetes Self-Management Education and Support (DSMES) toolkit: Background. Web.

Cunningham, A. T., Crittendon, D. R., White, N., Mills, G. D., Diaz, V., & LaNoue, M. D. (2018). The effect of diabetes self-management education on HbA1c and quality of life in African-Americans: A systematic review and meta-analysis. BMC Health Services Research, 18(1), 1-13. Web.

Khosla, L., Bhat, S., Fullington, L. A., & Horlyck-Romanovsky, M. F. (2021). HbA1c performance in African descent populations in the United States with normal glucose tolerance, prediabetes, or diabetes: a scoping review. Preventing chronic disease, 18(E22), 1-16. Web.

Morgan, J. M., Mensa-Wilmot, Y., Bowen, S. A., Murphy, M., Bonner, T., Rutledge, S., & Rutledge, G. (2018). Implementing key drivers for diabetes self-management education and support programs: Early outcomes, activities, facilitators, and barriers. Preventing Chronic Disease, 15, E15. Web.

Powers, M. A., Bardsley, J. K., Cypress, M., Funnell, M. M., Harms, D., Hess-Fischl, A., Hooks, B., Isaacs, D., Mandel, E. D., Maryniuk, M. D., Norton, A., Rinker, J., Siminerio, L., M., & Uelmen, S. (2020). Diabetes self-management education and support in adults with type 2 diabetes: A consensus report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. Diabetes Care, 43(7), 1636-1649. Web.

Rodriguez, L. A., Thomas, T. W., Finertie, H., Turner, C. D., Heisler, M., & Schmittdiel, J. A. (2022). Psychosocial and diabetes risk factors among racially/ethnically diverse adults with prediabetes. Preventive Medicine Reports, 101821.

The selected articles show the critical importance of implementing DSMES in African American adults. They outline the positive correlation between the tool and fasting blood sugar reduction.

Intervention

The proposed intervention is a set of measures to educate and support people with or at risk of diabetes. The diabetes self-management education and support (DSMES) toolkit combines program segments that address nutrition, exercise, disease education, quality of life, and lifestyle changes (Morgan et al., 2018; Powers et al., 2020). The curriculum includes instruction and a self-management support plan, which makes the intervention more proactive than an educational project. In particular, during the program, the participants will use apps to track glucose and record their foods’ nutritional information.

Therefore, the proposed intervention can be separated into two large segments – education and self-recording and support. First, the participants will learn about the pathophysiology of diabetes, common signs and symptoms, risks, and preventive strategies described above. Second, they will be provided with resources to track and record their progress based on the learned material. It is vital to encourage the individuals to use the applications throughout the project’s duration, although the use of the apps will remain voluntary.

Weekly summary:

  • 1st week: educating patients about DSMES
  • The participants should be informed about how to use the tool to control their states and blood sugar to ensure they can participate.
  • 2nd week: provision of participants with resources
  • Individuals will be provided with resources to track and record their progress based on the learned material
  • 3rd week: Self-recording
  • Participants will record information about the use of the tool and the change in results
  • 4th week: Self-reporting
  • Participants will provide information about the acquired changes and report on the tool’s effectiveness
  • 5th week: Support
  • If any difficulties emerge, the participants should be provided with necessary explanations and support
  • 6th week: Data collection
  • The data provided by the participants will be collected and structure
  • 7th week: Data analysis
  • The acquired data will be analyzed to answer the PICOT question
  • 8th week: Discussion and conclusion

Formulating the conclusion and its discussion by using acquired data

Project Feasibility

The proposed project is a small step in a major long-term battle against diabetes. It is challenging to estimate how much it can contribute to the overarching goal of diabetes education and management. Nevertheless, the intervention proposed as the foundation for the project can be completed in the span of 12 weeks. Participants may use the apps suggested to them long enough to understand why these aspects of their lives are essential. One of the barriers to the project’s successful completion is the lack of financial resources to assist every participant adequately. The given barriers can be addressed by finding sponsors or employing community resources used to improve the quality of people’s health and help them enjoy a higher quality of life. Furthermore, time remains an issue, as the project’s duration does not allow for post-implementation checks. This restriction implies that the project’s outcomes for several months following the implementation will not become a part of the data to make conclusions. The given barrier can be overcome by launching a new project aimed at investigating the problem and using the data acquired in the course of this research. Finally, a potential barrier is the lack of eligible participants, as the inclusion criteria set rigid boundaries on people’s ethnicity, age, and diagnosis criteria. It can be addressed by using social media or community resources to search for the participants meeting the inclusion criteria outlined above and necessary for effective data collection procedures.

Data Collection

The main focus of the project is the level fasting blood glucose in the participants’ blood. This data will be collected with the assistance of medical facilities and by taking a blood test prior to and following the end of the project’s duration to determine the potential change in the levels. The participants’ demographic data will be collected as well with the use of simple surveys to find possible correlations between the participants’ characteristics and their response to the intervention. For example, the survey may include the individuals’ age, gender, employment status, socioeconomic factors, family status, and more. In the case of this study, no instruments for data collection are applicable.

Measurable outcome Data collection process
Fasting blood glucose Blood test

Data Analysis

The data analysis will include calculating the mean level fasting blood glucose pre- and post-intervention. Then, the acquired numbers will be compared, and their difference will be assessed using a paired t-test. Finally, the p-value determining the significance of the change will be applied. Furthermore, the project can also use bivariate logistic regression to determine the correlation between the applied method and the results to conclude whether it can be considered effective or not.

References

Centers for Disease Control and Prevention. (2021). Diabetes Self-Management Education and Support (DSMES) toolkit: Background. https://www.cdc.gov/diabetes/dsmes-toolkit/background/background.html

Cunningham, A. T., Crittendon, D. R., White, N., Mills, G. D., Diaz, V., & LaNoue, M. D. (2018). The effect of diabetes self-management education on HbA1c and quality of life in African-Americans: A systematic review and meta-analysis. BMC Health Services Research, 18(1), 1-13. Web.

Khosla, L., Bhat, S., Fullington, L. A., & Horlyck-Romanovsky, M. F. (2021). HbA1c performance in African descent populations in the United States with normal glucose tolerance, prediabetes, or diabetes: a scoping review. Preventing chronic disease, 18(E22), 1-16. Web.

Morgan, J. M., Mensa-Wilmot, Y., Bowen, S. A., Murphy, M., Bonner, T., Rutledge, S., & Rutledge, G. (2018). Implementing key drivers for diabetes self-management education and support programs: Early outcomes, activities, facilitators, and barriers. Preventing Chronic Disease, 15, E15. Web.

Powers, M. A., Bardsley, J. K., Cypress, M., Funnell, M. M., Harms, D., Hess-Fischl, A., Hooks, B., Isaacs, D., Mandel, E. D., Maryniuk, M. D., Norton, A., Rinker, J., Siminerio, L., M., & Uelmen, S. (2020). Diabetes self-management education and support in adults with type 2 diabetes: A consensus report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. Diabetes Care, 43(7), 1636-1649. Web.

Rodriguez, L. A., Thomas, T. W., Finertie, H., Turner, C. D., Heisler, M., & Schmittdiel, J. A. (2022). Psychosocial and diabetes risk factors among racially/ethnically diverse adults with prediabetes. Preventive Medicine Reports, 101821.