Introduction
The research study examines the diabetes epidemic among African-Americans based on the various range of risk as well as structural factors contributing to the prevalence of the disease amongst women.
The study mainly emphasizes possible avenues which could be exploited to ensure equal application as well as implementation of the various health care interventions with a focus on disease populations and disease management considering chronic conditions which receive greatest disparities in health care (American Diabetes Association, 2009, pp 13-61).
Previous statistics reveal that the prevalence of diabetes amongst African-American is averagely 1.8 times more than that in whites of similar age. The studies further revealed that for every six whites suffering from diabetes, ten African-American are diagnosed with the same.
The mortality rate amongst African-American is also higher approximated to be around 27%. The number of African-American diagnosed with diabetes and at the same time suffering from severe complications which accompanies the disease is over three million, which is almost 13% of the population.
This shows that diabetes is one of the most costly health complications, but it can still be controlled through necessary preventive measures (American Diabetes Association, 2009, pp 13-61).
Problem Statement
Diabetes is considered epidemic amongst African American women with the rates amongst women 20 years and above recorded to be approximately 12% and 25% amongst women of 55 years and above (Kirk et al., 2007, pp 135-142).
Statistics from the National Women’s Health Information Center, Department of Health and Human Services (DHHS) 2002, shows that diabetes is more prevalent amongst African-American women compared to white women. Because of the high rates of mortality and morbidity recorded in diabetes-related cases, there is need for preventive measures amongst African American women population.
Complications brought by diabetes could well be controlled through self-management. However, despite the population knowing the various self-management methods, there have been cases of poor adherence to the various documented means of diabetes care.
These practices range from poor dietary beliefs to poor physical exercises, however, dietary beliefs have been found to be difficult to change owing to economic situation. Research from medical sources reveals that evidence-based practices enhance the quality of care given to patients and health improvement hence lowering medical costs (Burns and Grove, 2007).
Majorly physical exercise and poor diet have been found to be the major causes of diabetes. Change in the level of caloric intake and the various changes in lifestyle influences the prevalence of the disease (American Diabetes Association, 2009, pp 13-61).
Research Questions
- What difference exists in patient-provider services in diabetic-related cases amongst African-American and White patients?
- Is the concentration between serum glucose and glycated hemoglobin higher in African-American compared to whites?
- Do African-American women understand and utilize diabetes self-management activities?
Literature Review
Patient-provider perceptions and the correlation between random serum glucose concentration and glycated hemoglobin are some of the differences in diabetic-related cases in African Americans and Whites.
This research will show the differences between the perceptions of patients and providers on diabetes-related perceptions as well as examine its association if any with self-care behaviors and with particular comparisons between African-American and White patients.
The research will bring to the forefront the part played by ethnic variation in the correlation between random serum glucose concentration and glycated hemoglobin (American Diabetes Association, 2009, pp 13-61).
According to Dana et al. 2009, the manner in which a person experiences, understands and identifies diabetes is referred to as diabetes perceptions (Dana et al., 2009, p347). Research on patient-provider differences has found congruence with regard to diabetes-related attitudes, beliefs, and opinions.
Research also shows that patients and providers generally agree on the core components of effective care of diabetes but have entirely different understandings of diabetes and the priorities for self-management (Burns and Grove, 2007).
There is documented incongruence between patients’ and providers’ perspectives where self-management activities education priorities are concerned, continuity of care, barriers to self-care, treatment goals, quality of patient-physician communication, adherence to self-care regimen and diabetes-related attitudes (Tang et al., 2008, p341).
Kirk et al. 2007 found that both ethnic groups had significantly different perceptions from providers for at least six concepts. For African-Americans, the significant areas of difference from providers were on the ideas of having blood sugar testing, emotions about diabetes, complications arising from diabetes, taking diabetes pills, the availability of help from friends and paying for diabetes.
In contrast, the different perceptions held by White patients were in the concepts of controlling blood sugar, high blood sugar, diabetes diet, exercise, and diabetes, taking diabetes pills, and paying for diabetes. The first hypothesis is that African-American and White patients will differ in their diabetes-related perceptions compared with their care-givers.
African-American patients will have a higher number of patient-provider incongruence than White patients is the second hypothesis (Tang et al., 2008, p342).
Aside from differences in perceptions, we will also determine if the relationship between serum glucose concentration and glycated hemoglobin is different between the two ethnic groups in accordance with review by. In individuals with Type 1 and Type 2 diabetes mellitus, glycated hemoglobin is increasingly recognized as an essential measure of recent glycogenic control.
The premise that the relationship between glycated hemoglobin and serum glucose concentration is the same for both African-Americans and Whites has been relied on in epidemiological studies showing significantly worse glycaemic control in African-Americans vs. Whites.
Similarly, this relationship is assumed to be constant by clinical recommendations that target identical glycated hemoglobin values in African-American and white patients (Bleyer et al., 2009, p 128).
According to Bleyer et al. 2009, the correlation between glycated hemoglobin and serum glucose concentration will differ between white and African-American individuals after adjustment for age, gender and level of kidney function will form the third hypothesis of this investigation.
Glycaemic control has been shown in epidemiological studies to be significantly worse in African-Americans than in whites. The premise that the relationship between glycated and serum glucose concentration is the same for both races has been the basis for these studies.
In the same way, the relationship is assumed to be constant in clinical recommendations that target identical glycated hemoglobin values in African-American and white patients. Data that was almost exclusively obtained from white individuals has been relied on to establish the relationship between glycated hemoglobin and serum glucose in the initial large clinical trials (Bleyer et al., 2009, p128).
Sample Selection and Methodology
The study will focus majorly on health beliefs and self-care behaviors on those suffering from diabetes. The comprehensive research will focus on information and explanation from participant’s experiences in the process of managing and treating diabetes. Data collection will be based on cultural construction of health and illness as well as the belief model.
All these would be used as a guide towards data collection and Grounded Theory approach towards analysis of both coded and sorted data. Grounded theory will be used to provide the basis technique necessary for identifying concepts and groups from the interviews. The approach helps in linking concepts into derived and formal theories.
The chosen methodology would assist in providing the avenues used in discovering women’s self-management practices and behaviors, various beliefs on health, support systems, knowledge and education of the chosen sample (Burns and Grove, 2007).
The sample comprised of 68 African American women diagnosed with diabetes mellitus. Constructs related to diabetes self-management will be analyzed as provided by the seven self-management instructors as well as diabetes educational programs. The constructs to be used includes nutrition, physical exercises, changes in weight, stress management, blood glucose monitoring, and education on diabetes (Burns and Grove, 2007).
Qualitative and quantitative methods would be used for the purposes of obtaining data representing health beliefs, knowledge on diabetes as well as self-management behaviors. Questionnaires were prepared for quantitative reasons preceded by qualitative interviews.
Methodology for completing the study
The study is designed to reflect descriptive data provided and assist in providing qualitative inquiry into the means through which African American women suffering from diabetes manage their lives. At the same time, the research digs into establishing the perceptions of health practitioners concerned with diabetes self-management.
The research looks into the various variations established between women patients suffering from diabetes, diabetes self-management health practitioners as well as the identified programs. Self-management on diabetes will be based on factors such as; behaviors, various health beliefs and patient education.
The various self-management behaviors monitored included; physical exercises, patient education, monitoring level of glucose, changes in diet, adherence to medication, and interaction with social systems. The rate of epidemic is one of the problems identified for this study, the complications and risks associated with diabetes, particularly amongst African American women (American Diabetes Association, 2009, pp 13-61).
Since self-management is at the center of preventive measures on diabetes complication, it was identified as the important aspect of this study. Eight item tool included information such as; number of years providing diabetes self-management education, locality of classes, the number of time classes was conducted, educational level, nature of profession of the specialist, gender as well as ethnicity.
The study being descriptive would utilize the use of questionnaire. The study will illustrate in details the ways in which African American suffering from diabetes manage there lives. The preventive measures discussed would target high-risk groups, which are the African American group.
The research reveals the need for careful control of the blood glucose level and improved care brought by recommended self-management practices. The study will reveal the perceptions and views of health practitioners concerning knowledge and education on self-management.
Describe your variables
The study will utilize questionnaires and at the same time, apply efficient procedures in line with ethical methods for data collection. There will be an eleven item demographic showing participant profile, eight items dealing with health educator profile and questionnaire with thirty-nine articles.
Variables in the study include; health beliefs, knowledge of diabetes, nutrition, physical activity, health education classes, monitoring of glucose, support from social dimensions such as families, and finances involves.
Choosing participants for this study will be based on snowball sampling technique. The participants will be reached through word of mouth and also the study depended on the availability of participants in the various self-management education classes. The interview focuses on Africa American women diagnosed with diabetes.
The size of the sample will depend on the homogeneity of the population with respect to research characteristics. All participants will be required to possess characteristics matching the interest of the research study (Kirk et al., 2007, pp 135-142).
The participants were African-American women above the age of fifty-five to eighty years, with clear signs of diabetes and also self-management health educators. This is because according to literature review, diabetes is a common disease amongst middle-aged and those at later stages of life.
Owing to issues on age bracket, the study would establish the points on accessibility and availability of the target population. Participants will be recruited through various means such as; self-management education classes, interviewee referrals, friends of those suffering from the disease, and letters to institutions such as churches.
The other population understudy would be health educators well versed with diabetes self-management, seven in number. To ensure accuracy of the outcome results, two registered nurses, one specialist in nutrition, physiologist, and two physicians are to be included. Informed consent forms would be dispatched and collected form all those participating in the study.
Institutional Review Board/ Proposal Approval
The interview includes potentially new contacts who first of all, should be contacted to win their confidence in participation. Participants’ names and personal details would be optional to ensure privacy.
All participants will be required to confirm their participation through phone calls. Referrals will be used for the purposes of snowballing the sample to the required number of subjects.
Results
Data analysis provides combination literature review, explanation on various health models, methodology, research questions, and Grounded theory approach on data analysis. Analysis focuses on diabetes health beliefs, self-management behaviors, as well as education knowledge.
Explanatory model of illness ensures that all the information pertaining to individual’s beliefs are obtained. Health Belief Model applied in the analysis to verify the patient’s understanding of the issues of health and diseases. While Grounded theory ensured that all means of identifying categories are linked to the available theoretical perspectives.
The first section of the analysis would reveal both quantitative and qualitative findings, including the various experiences by the researchers. Demographics of the population of women are provided based on the cultural perspective of diabetes amongst women, and the various treatment behaviors focused on health beliefs.
The other section provides the results addressing positive and negative views dealing with diabetes and self-management behaviors amongst the professionals, women and the various programs.
Discussion
The study reveals various factors affecting the impact of diabetes in an African-American Woman. The results provided would explore the fact that multiple beliefs and practical behaviors contribute much towards health effects. The determinants are revealed as the secondary factors influencing management capabilities of women.
These include such issues as treatment costs which determine individuals response based on income level. The results would focus on the nature of communication or interaction between patients and healthcare providers as one of the significant barriers since most of the women are un-informed. Compliance to medication and self-management behaviors are crucial in the control and prevention of diabetes and other related diseases.
There’s support of the fact that an individual’s good management abilities, adhering to recommended behaviors and education contributes positively to patient’s self-management of blood glucose level.
Most of the primary behaviors prescribed by health professionals on diabetic management produced positive results on the sample population under study. Various factors affecting self-management were found to be similar across ethnicity, but the types of medication used varied greatly since more women prefer oral medication than injection of insulin.
The study would inform the public on the fact that managing diabetes amongst affected individuals requires more than biomedical approach. The whole issue on self-management requires individuals to be aware of the various societal and personal factors such as gender, education and family, which have direct effects on social life.
The study would provide information necessary for developing and monitoring individual treatment plan. The comparison of the epidemiological relationship between serum glucose concentration and glycated hemoglobin in African-American and white individuals was used in this present investigation.
The correlation between glycated hemoglobin and serum glucose concentration differs between white and African-American individuals after adjustment for age, gender and level of kidney function is the hypothesis for this study (American Diabetes Association, 2009, pp 13-61).
Limitations of this study will include such issues as inaccessibility to private medical records of the participants, which would have revealed blood glucose levels indicating clinical diabetes control measures.
Hence glucose control mechanisms cannot be established through this study. The sample for healthcare educators’ team was too small to represent the entire educators providing devices on diabetes self-management.
References
American Diabetes Association. (2009). Standards of medical care in diabetes—2009. Diabetes Care, 32 (1), 13–61.
Bleyer, A. J.,Hire D., Russell, G. B., Xu, J., Divers, J., Shihabi, Z, Bowden, D.W., & Freedman, I. (2009).Ethnic variation in the correlation between random serum glucose concentration and glycated hemoglobin. Diabetic. Medicine. 26, 128–133
Burns, N. & Grove, S. (2007). Understanding nursing research: Building an evidence Based practice (4th ed). St. Louis, MO: Saunders Elsevier.
Dana, L., Carthron, R.N., Tiny Marie Johnson, B. S, Tara, D., Hubbart, R. N, Courtney S. & Kimya, R. N. (2009). “Give Me Some Sugar!” The Diabetes Self-Management Activities of African-American Primary Care giving Grandmothers. Journal of Nursing Scholarship 42, (3), 330-337
Kirk, J. K, Graves, D. E, Bell, R. A, Hildebrandt, C. A, & Venkat Narayan, K., M. (2007). Ethnic Disparities in Self-Monitoring of Blood Glucose among US Adults: A Qualitative Review. Ethnicity and Disease 17, 135 – 142.
Tang, T. S., Stansfield, R. B., Oh, M., Anderson, R.M & Fitzgerald, J.T. (2008).Patient Provider perceptions of diabetes and its impact on self-management: a comparison of African-American and White patients. Diabetic Medicine 25, 341–348