Introduction
One of the increasing health crises in the world is diabetes mellitus. The studies have indicated that 30 million people having been affected by the disease in the past one decade. The number has arisen to 135 million today, most of them having attained 5o years and above. The challenge posed by DM is more evident due to dramatic changes across the globe.
There is a high possibility of diabetes mellitus 1or 2 patients getting a stroke, heart disease, blindness, high blood pressure and kidney failure complications.
The development of diabetes mellitus causes substantial suffering to the patient and the family members, leaving them with massive economic burdens. Complications that develop in the long run have an immense role in causing premature death, disability and morbidity (Delamater, 2006).
These losses will continue to accumulate if no action is taken. “In response to these challenges, several countries have already adapted their MDG targets and indicators to include chronic disease” (Delamater, 2006).
This study focuses on such goals to ascertain whether the patients have shown any marked improvement in the Hemo A1C levels, upon receiving education on the possible interventions. The global increase in chronic disease is driven largely by lack of adequate information on how to handle the situation as it arises, and the rapid aging of populations.
These determinants contribute to the three primary risk factors common to most chronic disease — unhealthy diet, physical inactivity, and tobacco use.
However, the population should be educated on complications, risk factors and management practices of diabetic mellitus cases. The WHO estimates that 80% of all cardiovascular disease and type 2 diabetes, and 40% of all cancer cases can be prevented by eliminating these risk factors (Delamater, 2006).
Literature Review
Diabetes mellitus (DM) is a chronic disease that can go undetected for several years before permanent target organ tissue damage is caused to the human body, such as diabetic retinopathy, end stage renal disease, peripheral, small vessel disease, limb amputation and even death. Uncontrolled and less managed diabetes can cause rapid deterioration of the patient’s health.
It will lead to an acute exacerbation of life-threatening conditions that can only be managed in an expensive hospital emergency room. Education on early detection and high quality management of Diabetes mellitus can reduce healthcare costs and prevent further healthcare complications to patients.
In relation to the identification of the diabetic population and educating them based on Wojcik et al (2010) recommendation, another study was conducted to evaluate the efficacy of education on hemoglobin A1C level (HgA1c).
Castillo et al (2010) study examined the efficacy of community based “Diabetes Empowerment Educational Programs” geared toward Hispanic/Latino neighborhoods in the Southeast area of Chicago. It was observed that Hispanic/Latinos have high incidences of diabetes when compared to non-Hispanic whites.
The latter may be due to the inability to gain employment, low educational levels and language barriers, lack of social support, and cultural barriers. The implementation of the program involved the participation of community health workers who were culturally educated and, had undergone exhaustive training in human subjects’ protection.
It is worth noting that all community health care workers are knowledgeable in blood pressure monitoring, blood glucose meter usage and, the DCA 2000+ analyzer, which measures pre and post blood glucose levels, a key outcome of this study (Wojcik, Gjelsvik, & Goldman, 2010).
According to Castillo, et al (2010), a total of 108 Hispanic participants were interviewed by community health care workers whereby knowledge of diabetes, self-care management, self-efficacy and, Hemoglobin A1C was tested. Based on these results, 70 residents with a mean age of 58.2 years officially enrolled in the 12 course module held during the months of May 2006 throughout March 2007.
The educational piece utilized participatory techniques and consisted of (1) two-hour weekly session within a 10 week time frame. Classes of 10-15 members were conducted in Spanish. Friends and family members were also invited to share the experience.
Weekly topics such as diabetes knowledge, self-empowerment, recording of daily physical activities, proper diet intake and, depressive symptoms were discussed. Each group determined the location and time of the class to accommodate work schedules, transportation needs and family participation.
Castillo, et al. (2010) concluded that diabetes self-management programs held in community settings and led by community health workers are feasible and effective based on the results of their study, which demonstrated a significant reduction in the Hemoglobin A1C value.
According to Fukunaga, Uehara, & Tom (2011), there is limited research on existing barriers and social support needs for the Hawaiian adult working class population diagnosed with diabetes. This study was aimed at identifying the components needed for successful patient DM self-management.
The aim of the study was to explore whether clinical interventions and social service support systems, would assist in improving the overall self-management of diabetes. Finally, it sought to assess if the process would prevent loss of employment due to DM disease related complications.
In the research article, by Wojcik, Gjelsvik, & Goldman (2010), four of the world’s five largest geriatric diabetic populations are located in India and Pakistan. The focus of the study was to provide medical and educational guidelines to health care professionals treating the geriatric population (Fukunaga, Uehara, & Tom, 2011).
The World Health Organization (WHO) estimated that about 79.4 million diabetics would reside in India by 2030, with (53%) being older than 60 years of age. Due to health complexities associated with this age group, family members and caregivers require cultural and educational assistance. Emphasis should be on dietary, physical activity, signs and symptoms of the disease process.
Hemoglobin A1C test should be utilized in three month intervals. According to Delamater (2006), hemoglobin A1C tests is considered the “gold standard” that is meant to gauge control of high blood glucose levels and the complications associated with diabetes mellitus. The focus of the study was to provide a better understanding of Hemoglobin A1C testing and patient knowledge and comprehension of Hemoglobin A1C results.
Delamater (2006) conducted several studies with regard to patient knowledge of Hemoglobin A1C. Findings from one Norwegian study revealed that (86.2%), from 201 diabetes 1 sample size, knew what their last A1C reading was. Another research conducted in the United States consisted of 663 ethnically diverse type 2 diabetes patients.
The results demonstrated that (66%) of the patients had no knowledge of their last A1C result. Delamater (2006) was able to demonstrate the importance of patient, clinician communication. The ability to engage and motivate a patient is crucial when trying to overcome language, educational and cultural barriers (Castillo, Giachello, Bates, Concha, Ramirez, & Sanchez, 2010).
This was the first report to show knowledge of diabetes among Saudi non-diabetic population in Island of Oahu. Our data show that, non-diabetic population in Island of Oahu has enough knowledge of the general knowledge of diabetes regarding risk factors and symptoms. However, they are not exceptionally well aware of the diabetes associated secondary complications.
Furthermore, the majority of young age population has the misconception that diabetes can be cured. Therefore, our study suggests that more efforts should be put in to widen knowledge on DM and how to manage patients with such condition (Fukunaga, Uehara, & Tom, 2011).
There are a few factors that influence home self management of diabetes. These include: quality of the education received, regular diabetes educator-patient follow up, the high quality self management of the patient at home, and a supportive home environment. There are a number of barriers to access to proper health care including medical charges, communication barriers and inaccessibility of specialty providers among other.
The frequent interaction between educated medical providers and patients during home visits and medical follow up helps to keep the patient alert of the condition and what is required of them in order to maintain good health. The role of social workers in helping the patients to manage themselves while at home is very significant.
These social workers bridge the gap between outpatient clinical setting and the patients’ home setting.
The social workers have a variety of involving tasks including: educating the patient about community diabetes resources and access to healthcare; involving and educating the patients’ family in the care necessary; and increasing the awareness of the patients and people around them, on the chronic disease and ways to achieve reduced A1C results (Fukunaga, Uehara, & Tom, 2011).
Research Methodology
This chapter describes the methodology used in the research. It describes the place of study, design and population of the study, and sample used. It also describes the instrument used to collect data and methods implemented to ensure the information is valid and reliable.
Research Approach and Design
The researcher employed a qualitative approach to the study. The study examined the cause and effect of interactions among the variables. We selected descriptive survey in order to portray accurate characteristics of the population.
Examples of the characteristics that were studied are beliefs, knowledge, opinions, and behavior of an individual. The design was chosen with the main objective of meeting the study objectives. The objective was to determine what opinions the patients, family members and medical personnel had regarding diabetes mellitus and its treatment
Research Setting
The study targeted residents of the Island of Oahu who lived with DM in Hawaii. The region has an average of three million people with a quarter living with DM. The researcher identified the subjects who met the sample criteria. The sample size of 362 DM diagnosed patients was chosen. They were willing to take part in the research during the period of data collection approximated to be six months.
Sampling Criteria
The subjects were supposed to meet certain criteria in the sampling guidelines. The highlights of the criteria that were to be met by the patients included one having had the disease for more than five years. The patient was to be of sound mind in order to give consent for participation in the survey.
Finally, the patient was to be of either male or female but no restrictions on the race. Patients with age below 16 years had to get consent from the parents or guardians before being allowed to take part.
Data Collection
The main data collection instrument was the questionnaire, a self-report form that is designed by the researcher to obtain information from the respondents. Data was collected with an aim of evaluating the patients and family member’s knowledge on DM. The choice of a questionnaire was based to the fact that it provides high response rate as they can be distributed to various respondents.
It takes a short time and less energy to get the information as the researcher moves around collecting the questionnaires. Finally, they gave the respondent a chance to remain anonymous or declare his identity.
However, the question of validity and accuracy was raised as a weakness to the use of questionnaires. It is feared that the responds do not give their true opinions, but aim to please the researcher. Some give views that are doctored towards their favor hence missing the objective of the study.
Collection Procedure
The researcher team distributed the questionnaires to patients and their family members. They helped nine respondents to fill the questionnaires owing to their inability to read and write. The data was collected over a period of six months. Some respondents were found in home while others in hospitals or home care facilities.
Reliability and Validity
Reliability
The questionnaires that were answered revealed adequate consistency in responses. Reliability of such a survey can be achieved by reducing sources of measurement errors like biases in data collection. This was achieved by the research team being the only ones that distributed the questionnaires. They exhibited similar personal attributes to patients and family members, without treating others differently.
Validity
The questionnaire included a number of questions on the patients’ background and about DM and its regimen of treatment. Questions were based on the information gathered during the literature review. They were presented in clear, understandable language for clarity.
Pretesting the Questionnaire
The research team pre-tested the questionnaire on the twenty respondents at the Hawaii Medical Centre and five families within the state. All the questions were answered, and no single questions were altered.
Limitations for the study
It is worth noting that no survey can be carried out without hindering objects. These are the factors that limit the speed or accuracy of data collection processes, not to mention the quality of data.
The research team had a number of barriers including limited amount of funds available for the survey and language barrier. Most of the locals do not understand the basic language-English. This forced the team to get a translator and an assistance team was created to help them fill the questionnaires.
Conclusion
The research team employed the use of qualitative, descriptive survey design. The research team administered all the questionnaires to ensure validity and reliability. The questions were open-ended and close-ended. The sample characteristics comprised of mentally sound adults who had live with DM for a period not less five years, and had the will to take part in the survey.
It also had members of the family who had patients suffering from the disease. The team obtained permission from the relevant authorities in Hawaii and the Island of Oas. The respondents provided consent by themselves. The team assured the subjects of anonymity, confidentiality and self-determination during dissemination of the questionnaires and report writing.
References
Castillo, A., Giachello, A., Bates, R., Concha, J., Ramirez, C., & Sanchez, C. (2010). Community-based Diabetes Education for Latinos: The Diabetes empowerment education program. The Diabetes Educator , 36(4), 586-594.
Delamater, A. (2006). Clinical Use of Hemoglobin A1c to Improve Diabetes Management. Clinical Diabetes , 24(6), 10.
Fukunaga, L., Uehara, D., & Tom, T. (2011). Perceptions of diabetes, barriers to disease management, and service needs: A focus group study of working adults with diabetes in Hawaii. Preventing Chronic Disease , 8(2), 32.
Wojcik, K., Gjelsvik, A., & Goldman, D. (2010). Identifying populations at risk for Diabetes with the behavioral risk factor surveillance system, Rhode Island. Preventing Chronic Disease , 7(4), 21-33.