Expert answer:Discussion Post U7D18060

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Instruments’ Validity and Reliability
Select and read one of the dissertations or project reports from the Studies for this unit.
Use the readings and media in this unit as guidance for finding additional information
about the specific instrument(s) used in the dissertation you selected.
For your initial post:
•
•
•
•
Cite and briefly summarize the dissertation or project report you selected.
Describe the instrument(s) you found in the dissertation or project you selected. Include
information about how the instrument’s measurements are reported.
Provide information about the instrument’s validity and reliability (hint: search the
Capella library databases linked in the Studies for this unit).
Provide an additional, recent, peer-reviewed article (within the last 5 years) that used the
specific instrument(s) you found in the dissertation.
In your initial post, include at least one APA-formatted citation (in-text, as well as a full
reference). The citation should be from materials you have read during this unit. It may
be from course textbooks, assigned readings, or an outside source. Your initial post
must be a minimum of 250 words in length.
Valparaiso University
ValpoScholar
Evidence-Based Practice Project Reports
College of Nursing and Health Professions
4-7-2015
The Effects of Nutrition and Physical Activity
Education on Knowledge and Glycemic Control
Among Persons with Type 2 Diabetes
Alexandra Harris
Follow this and additional works at: http://scholar.valpo.edu/ebpr
Recommended Citation
Harris, Alexandra, “The Effects of Nutrition and Physical Activity Education on Knowledge and Glycemic Control Among Persons
with Type 2 Diabetes” (2015). Evidence-Based Practice Project Reports. Paper 62.
This Evidence-Based Project Report is brought to you for free and open access by the College of Nursing and Health Professions at ValpoScholar. It has
been accepted for inclusion in Evidence-Based Practice Project Reports by an authorized administrator of ValpoScholar. For more information, please
contact a ValpoScholar staff member at scholar@valpo.edu.
© COPYRIGHT
ALEXANDRA HARRIS
2015
ATTRIBUTION-NONCOMMERCIAL (CC BY-NC)
ii
DEDICATION
Dag Hammarskjold once said, “Life only demands from you the strength that you
possess. Only one feat is possible; not to run away.” True strength and support from
those whom matter most to me, made my dreams finally become reality. I would like to
dedicate this to my children, McKenzi and Nolan, my parents, and my best friend, Lena
Modieh, for being supportive and helping me to reach my dreams. I am without words
that could describe how truly grateful and fortunate to have each of you in my life.
iii
ACKNOWLEDGMENTS
I would like to thank Dr. Brandy for being the calm, sound voice driving my sanity
through this project. I am thankful to have had an amazing advisor through one of the
greatest milestones of my life. I would also like to thank Dr. Easa Ghoreishi for believing
in me and supporting me through my project and journey. Lastly, I would like to thank the
staff at the clinical site where my project was performed.
iv
TABLE OF CONTENTS
Chapter
Page
DEDICATION……………………………………………………………………………iii
ACKNOWLEDGMENTS……………………………………………………..……….. iv
TABLE OF CONTENTS ………………………………………………………….…….v
LIST OF TABLES………………………………………………………………………vii
ABSTRACT……………………………………………………………….………..…..viii
CHAPTERS
CHAPTER 1 – Introduction …………………………………………………….1
CHAPTER 2 – Theoretical Framework and Review of Literature …..…….5
CHAPTER 3 – Implementation of Practice Change ………………………34
CHAPTER 4 – Findings……………………………………………………….44
CHAPTER 5 – Discussion…………………………………………………….50
REFERENCES………………………………………..…………………..……………64
AUTOBIOGRAPHICAL STATEMENT……………..…………..……………………67
ACRONYM LIST……………………………………..…………………..……………68
APPENDICES
APPENDIX A – Review of Literature for Nutrition and Physical Activity
Among Persons with Type 2 Diabetes……………………70
APPENDIX B – Informed Consent……………………………………………85
APPENDIX C – Project Manager Introduction……….……………………..88
APPENDIX D – Thank-you Letter to Participants…………………………..89
APPENDIX E – Staff Education Outline……………………………………..90
APPENDIX F – Demographic Questionnaire………………..……………..92
v
APPENDIX G– Participant Address and Provider Form………………….93
APPENDIX H– Participant Education Outline………………….…………..94
APPENDIX I – Reminder Letter………………………………………………95
APPENDIX J– Provider Letter………………………………………………..96
APPENDIX K– Diabetes Knowledge Test…………………………………..97
APPENDIX L– Participant Education Tools.………………………………..99
vi
LIST OF TABLES
Table
Page
Table 2.1 Review of Literature for Glycemic Control and Knowledge..……………15
Table 2.2 Review of Literature for Diabetes Knowledge Test.……………………16
Table 2.3 Evidence Appraisal Using JNHEBP Research Appraisal………………17
Table 4.1 Demographic Data of Participants at Pre- and
Post-test Intervention………………………………………………………45
Table 4.2 Total Pre-Intervention Item Test Scores and Item Topics……..………46
Table 4.3 Total Post-Intervention Item Test Scores and Item Topics……………48
vii
ABSTRACT
Diabetes affects millions of people worldwide. Approximately 29.1 million people or 9.3%
of the United States population has diabetes (Centers for Disease Control (CDC), 2014).
Diabetes was the seventh leading cause of death in the United States in 2010 and is
projected by the World Health Organization (WHO) to be the seventh leading cause of
death globally by 2030. The purpose of this evidence-based project was to provide
nutrition and physical activity education in an effort to improve diabetes knowledge and
glycemic control among persons with type 2 diabetes. Hemoglobin A1c levels and
Diabetes Knowledge Test scores were compared from the pre-intervention phase of
nutrition and physical activity education to the post-intervention phase three months
later. For this project, Stetler’s Model was employed as the theoretical framework to
support implementation of the EBP, and Pender’s Health Promotion Model (HPM) was
used to guide the intervention. Participants were recruited from a private, primary care
office in Lake County, Indiana. Seventeen participants (n=17) were recruited and
completed the intervention phase of this project. Data was analyzed using the Wilcoxon
signed-rank test. Results demonstrated a statistically significant increase in diabetes
knowledge among participants three months following the intervention (z-score=-2.546,
p<0.05). However, due to several factors including health maintenance compliance from the participants or their healthcare providers, changes in glycemic control among the participants were able to be determined in only two participants. The findings suggest that implementation of diabetes education in primary care practice can improve diabetes knowledge. viii 1 EFFECTS OF NUTRITION CHAPTER 1 INTRODUCTION BACKGROUND Diabetes affects millions of people worldwide. Diabetes is projected by the World Health Organization (WHO) to be the seventh leading cause of death globally by 2030. On a national level, approximately 29.1 million people or 9.3% of the United States population aged 20 years or older have diabetes (Centers for Disease Control (CDC), 2014). Diabetes is currently the leading cause of kidney failure and is also associated with several serious complications including heart disease, stroke, blindness, and lower limb amputations (CDC, 2014). Additionally, diabetes lowers life expectancy by up to fifteen years and increases the risk of heart disease by two to four times. Furthermore, all populations are at risk of developing diabetes; however, certain populations are at greater risk than others. Due to the increased mortality and morbidity associated with diabetes, many organizations including the American Diabetes Association (ADA) and the American Academy of Clinical Endocrinologists (AACE) have established guidelines for health care providers in an effort to attain glycemic control in patients with diabetes. The ADA (2014) and AACE (2011) guidelines have recommended education on nutrition and physical activity as part of lifestyle interventions for diabetes management. Research has shown that an increase in physical activity and maintaining a balanced, healthy diet can prevent complications from type 2 diabetes and improve blood glucose levels for persons with type 2 diabetes (WHO, 2015). STATEMENT OF PROBLEM In a national effort to address the alarming trends and problems associated with diabetes, the United States Department of Health and Human Services (USDHHS) EFFECTS OF NUTRITION 2 established Healthy People 2020 goals. The Healthy People 2020 goals aim to reduce the disease and economic hardship associated with diabetes and to improve the quality of life for those who have or who are at risk for diabetes. Healthy People is a federal program that reflects input from a diverse group of individuals and organizations to establish science-based, ten year national objectives to improve the health of all Americans (HealthyPeople, 2014). According to Healthy People 2020, from 2005 to 2008, 17.9% of adults aged 18 years of age or older with diagnosed diabetes had a hemoglobin A1c value greater than 9%, 53.9% percent had a hemoglobin A1c value less than 7%, and only 56.8% reported ever receiving formal education about diabetes in 2008. Specific Healthy People 2020 objectives correlating to the previously mentioned statistics include: reducing the number of persons with diabetes with a hemoglobin A1c value greater than 9% by 10% nationally; to increase the proportion diabetes persons with a hemoglobin A1c value of less than 7% by 10% nationally; and to increase the number of individuals diagnosed with diabetes who receive formal education by 10%. With the Healthy People 2020 goals in mind, health care providers can modify their care to encompass enhanced quality care standards to assist in meeting the target goals and to improve the diabetes management of their patients. While the impact of diabetes on a global and national level is well noted, the problem is also apparent on a regional level. In 2010, an estimated 462,000 people aged 18 years or older were diagnosed with diabetes in Indiana (CDC, 2011). The number of individuals diagnosed with diabetes each year in Indiana is steadily increasing. This could be attributed to an increased awareness of diabetes and enhanced screening measures by healthcare providers to identify persons with the disease or the worsening lifestyle behaviors by individuals, resulting in the development of type 2 diabetes. With these statistics and trends, further interventions and improvements are needed on an outpatient care setting to reach Healthy People 2020 goals. Because a need for diabetes EFFECTS OF NUTRITION 3 education intervention was identified on a regional level, the clinical agency selected for this evidence-based practice project was a private, primary care office in Lake County, Indiana where a significant portion of the patient population has prediabetes or even type 2 diabetes. The primary care physician of the clinical agency noted a need for diabetes education for his patients with diabetes due to poor glycemic control; therefore, an effective education intervention was required. Significant research has been conducted on diabetes prevention and management, resulting in evidence-based clinical practice guidelines for use by health care providers. It is essential for primary care providers to follow the evidence-based clinical practice guidelines established by the ADA and AACE in order to improve the quality of care and education provided to their diabetic population. Significant changes and interventions must be established within their practices to improve glycemic control and diabetes knowledge, including initial and ongoing diabetes education during office visits with their patients. PURPOSE OF EBP PROJECT The purpose of this evidence-based practice project was to provide nutrition and physical activity education in an effort to improve diabetes knowledge and glycemic control among persons with type 2 diabetes. The PICOT question addressed was: “What is the effect of nutrition and physical activity education on knowledge and glycemic control among individuals with type 2 diabetes during a three month period?”. SIGNIFICANCE OF THE PROJECT As type 2 diabetes is associated with increased mortality and many complications including: heart disease, stroke, hypertension, blindness, diabetic retinopathy, kidney disease, neuropathy, and nontraumatic lower limb amputations if poorly managed; thus, intervention and preventative measures are needed. The total EFFECTS OF NUTRITION 4 estimated cost of care for Americans with diabetes in 2012 was $245 billion dollars. The cost of care for Americans with diabetes is astronomical compared to other diseases and conditions. For instance, an estimated $36.5 billion dollars is spent annually for individuals who have had a stroke and $108.9 billion dollars annually for individuals with coronary heart disease (CDC, 2014). In 2008, the cost of care for adults with obesity was $147 billion dollars (CDC, 2014). Due to the significant societal cost of diabetes care and the increased mortality and morbidity, primary care providers need to be aware of the best clinical practice recommendations for management of diabetes in order to maximize the health of this population, and in turn, this may also reduce the total annual cost of care for diabetes and the other conditions previously mentioned. The goal of this evidence-based practice project was to improve diabetes knowledge and glycemic control through the provision of nutrition and physical activity education. The implementation of nutrition and physical activity education to persons with type 2 diabetes can assist them in making better educated choices regarding meals and physical activity levels; thus, it can potentially improve their overall diabetes knowledge and glycemic control. 5 EFFECTS OF NUTRITION CHAPTER 2 THEORETICAL FRAMEWORK AND REVIEW OF LITERATURE The purpose of Chapter 2 is to present and evaluate the theoretical framework, the evidence-based practice model, and to appraise the literature pertaining to this evidence-based practice project. Nola Pender’s Health Promotion Model (HPM) was selected as the theoretical framework for this evidence-based practice project. Implementation of the project will be guided by the Stetler Model which will assist in addressing the PICOT question for this evidence-based practice project. The PICOT question is: What is the effect of nutrition and physical activity education on knowledge and glycemic control among individuals with type 2 diabetes during a three month period?”. The process for the search, selection, and critical appraisal of the literature will also be discussed based on the established PICOT question. Theoretical Framework Overview of Pender’s Health Promotion Model (HPM). The HPM is an “attempt to depict the multidimensional nature of persons interacting with their interpersonal and physical environments as they pursue health” (Pender, Murdaugh, & Parsons, 2006, p. 50). While working on her doctoral dissertation, Nola Pender examined how people make decisions. Her research resulted in her initial version of the HPM in 1982. The HPM assimilates numerous constructs from the Health Belief Model, Expectancy Value Theory, and Social Cognitive theories in order to “explain and predict how the complex interaction among perceptual and environmental factors influences the health-related choices that people make” (Sheenan, 2006, p. 457). With health promotion being the central concept to this theory, it has been utilized as a framework to promote many behaviors including: dieting; physical activity; vaccinations; oral hygiene; and smoking cessation. This theory has the potential to be applicable to any health EFFECTS OF NUTRITION 6 behavior which a threat is not proposed as the main motive for the behavioral change (Pender et al., 2006). The HPM presumes that: individuals actively seek to control their own behavior; individuals interact within their environment to transform over time; individuals are influenced across the lifespan by healthcare professionals who comprise a portion of the interpersonal environment; and individuals require self-initiated rearrangement of person-environment interactive patterns to facilitate behavior change (Sitzman & Eichelberg, 2004). The HPM considers individual characteristics and experiences, behavior specific cognitions and affect, and the behavioral outcomes of an individual in order analyze and determine the best methods to achieve better health; thus, this model proves its utility in supporting the evidence-based practice project. The HPM consists of three major propositional groups and several variables and concepts contributing to the health-promoting behavior. Further delineation of each major propositional group and related concepts to this evidence-based practice project will be discussed. Individual characteristics and experiences propositional group. The first propositional group is the individual characteristics and experiences. This group includes prior related behavior and personal factors. The purpose of this propositional group is to consider the unique characteristics and experiences of the individual that will affect their subsequent actions. Depending on the targeted health behavior, the individual’s characteristics and experiences may allow for the HPM to attain variables that are significant to the health behavior (Pender et al., 2006). Prior related behavior. Prior related behavior is proposed to directly and indirectly influence the likelihood of engaging in health promoting behaviors. The direct effects of prior related behavior pertain to habit formation and habit strength. Habit formation is a predisposition of the individual to participate in a behavior automatically but with little thought to how the action was executed. Habit strength relates to the intensity of a EFFECTS OF NUTRITION 7 behavior that builds with each time the behavior occurs, and it is enhanced by the focused, repetitive practice of the behavior (Pender et al., 2006). For persons with diabetes, habit formation and habit strength may be related to glycemic control and meals. For instance, habit formation can occur when the health care provider instructs the individual to check his blood sugar before breakfast, lunch, dinner, and bedtime. With the habit formation, the individual may initially forget to check his blood sugars and may need reminders to perform this task. Over time and habit formation, the individual will consistently check his blood sugar and will not need reminders. Habit strength will then build with habit formation because the individual will check his blood sugar as ordered regardless of his expectation of a given blood sugar value. The prior behavior is also proposed to indi ... Purchase answer to see full attachment

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