Perception of Diabetes in the Hispanic Population Thesis

Introduction

Human health is one of the frequently discussed topics nowadays. It is not enough for people to know about health complications or impairments at different ages, and what can be done to avoid such problems. It is expected to understand what may cause diseases and disorders, what populations are at higher risk and why, and when it is time to take preventive measures or promote some changes. In addition to possible health complications, millions of people are concerned about the diseases that may cause death and the necessity to elaborate effective healthcare systems in each country. Cause-to-death statistics introduced by the World Health Organization (2017) show that approximately 56 million deaths happen due to such diseases as ischemic heart disease, stroke, COPD, respiratory infections, dementia, diabetes, and tuberculosis globally. Diabetes is also defined as one of the leading causes of death among the citizens of the United States (Centers for Disease Control and Prevention, 2017). Each population has a list of health problems to be exposed to at high risk. In this paper, the perceptions of diabetes in the United States will be investigated. Despite the possibility to create certain measurements of this nursing research project, it is also required to narrow down the topic and focus on diabetes from one particular group of people, the Hispanic population.

Diabetes is characterized by a high level of glucose (sugar) in the blood (American Diabetes Association, 2014). However, a definition, classification, and diagnosis of diabetes are more complicated than they seem to be and have to be thoroughly studied. Ramachandran, Snehalatha, and Nanditha (2017) define diabetes as a group of metabolic diseases that result in defects that are usually observed in insulin secretion and action. The peculiar feature of diabetes is its hidden dangers. This disease is progressive by its nature and may lead to numerous dysfunctions, long-term damage to the body, and failure of different organs in a short period. People of Hispanic origin are at the risk of having diabetes due to the existing cardiometabolic abnormalities, chosen lifestyles, and certain physiological characteristics (American Diabetes Association, 2014). Diabetes may be of type 1 and type 2. There is also a type known as gestational diabetes that is discovered during pregnancy and influences the development of a fetus, as well as a general condition of a woman. Common symptoms of all diabetes types in addition to a high level of blood sugar are frequent urination, weight changes, frequent and unexplained fatigue, thirst, and vision impairment. The reasons for such changes are the inability of the immune system to work properly and the destruction of cells that are responsible for insulin production in the pancreas.

At this moment, the investigations of the Centers for Disease Control and Prevention (CDC) (2017) show that more than 30 million people are diagnosed with diabetes (it is 9.4% of the US population) (Centers for Disease Control and Prevention, 2017). There is also a suggestion that about 7 million people who continue living with diabetes without even being aware of the possibility of this diagnosis, and approximately 84 million people are officially defined as pre-diabetic (American Diabetes Association, 2014). Health disparities in diabetes have been globally investigated during the last several centuries. Risk factors include age (older patients may suffer from heart diseases and strokes that promote complications), race/ethnicity (traditions may promote specific interests and lifestyles that lead to obesity or hypertension that turn out to be significant contributors to diabetes), and family history. In this project, special attention will be paid to Hispanic Americans with Puerto Rican, Cuban, Mexican, and South American descents. This group of people takes the third place (approximately 12%) in the list of adults diagnosed with diabetes, giving way to American Indians (15%) and African Americans (12.5%) (Spanakis & Golden, 2013). Diabetic patients may face certain challenges in diagnosing and treating despite their race or age, and perceptions of diabetes may vary but stay important for the US population and Hispanics in particular.

Problem Statement

Justification

Despite the existing diagnostic tools, preventive programs, and treatment plans, diabetes continues killing people around the whole globe. In addition to the fact that millions of people have to live with diabetes, restricting themselves in certain physical activities, interests, and personal demands, the governments of all countries have to spend millions or even billions (in case of the United States) of dollars to investigate all aspects of this disease. The US population is divided into several subgroups with their traditions, opportunities, and demands. Each group has its background, and representatives may be exposed to a specific disease due to family history, genomic structures, and the chosen styles of life.

The reasons why perceptions of diabetes in the Hispanic population vary. In this project, a researcher will be guided by several facts to justify this choice. These factors include:

1. The definition of Hispanics as a high-risk for diabetes group of people cannot be ignored;
2. Statistics play an important role: Hispanics are about 50% likely to die because of diabetes compared to Whites, many Hispanics are pre-diabetic, and more than a half of all Hispanic Americans do not know about having diabetes due to a weak healthcare system or poor communication with nurses or doctors;
3. The level of awareness about diabetes among the Hispanic population remains to be unstable or even unknown in some parts of the United States;
4. Diabetes is a serious global health problem that has to be solved regardless of people’s race, age, or gender, and the Hispanic population should have access to different knowledge, sources, and programs.

Problem Statement

Diabetes is on the list of dangerous diseases that may influence the quality of human life and the necessity to take treatment and promote changes from different perspectives. Its history began during the ancient times when the disease bothered people through extreme thirst and urine changes. Though this disease did not have the name or was known under other names, such symptoms as sweet urine and vision problems could not be ignored (Ramachandran et al., 2017). Different diagnostic methods and treatments have been developed through ages. Today, people know a lot about diabetes, its types, and treatment. Still, they continue dying because of diabetes, spending much money to treat it, or thinking about new interventions.

The main problem of this research is the necessity to prove that Hispanic people are under the threat of having diabetes with small chances to get rid of it with time. Hispanic Americans are poorly aware of this health problem and ask for additional help, care, and support. Despite the governmental involvement in diabetes programs, training and learning are not enough for the Hispanic population to predict and avoid diabetes complications. Therefore, it is expected to enlarge the level of knowledge about diabetes and its threats among the Hispanic population through increased discussions about diabetes’ signs, symptoms, diagnostic tools, interventions, and complications.

Objectives

The main goal of this nursing research project is to discuss the perception of diabetes in the Hispanic population. This purpose is general and requires the creation of several supplementary goals that cannot be neglected. For example, it is expected to investigate the health needs of Hispanic patients and management issues. The identification of every goal is a step in a plan of research that has to be developed. To achieve the main goal, the following objectives should be taken into consideration:

1. To define diabetes and its symptoms among the Hispanic population;
2. To review recent interventions and programs that have been offered to the population in the United States;
3. To investigate the existing self-management problems among diabetic patients and their doctors/nurses;
4. To focus on cultural, behavioral, emotional, and financial factors in diabetic treatment.

Definition of Key Terms

In this nursing research project, several key terms will frequently be used. Therefore, their definitions have to be given:

• Antibodies – blood proteins in the immune system that are created as a response to antigens (i.e., bacterium or virus).
• Beta cells – the cells that are located in the pancreas and responsible for the production of insulin.
• Blood glucose level – the identification of glucose in the blood at a certain period (if it is high, it means that the blood does not have enough insulin, and if it is low, it means that the level of insulin in the blood is extremely high).
• Diabetes mellitus – a full name of diabetes, a metabolic disease that is characterized by a high blood sugar level that depends on insulin production.
• Glucose – a sugar substance that is used to produce energy in the body.
• Hispanics – people of Puerto Rican, Cuban, Mexican, or South American descent who live in the United States.
• Insulin – a hormone with the help of which glucose is produced in the body.
• Pre-diabetes – also known as glucose intolerance, a condition with a high level of glucose in the blood but not high enough to be diagnosed as diabetes.
• Type I – also known as juvenile or insulin-dependent diabetes, a chronic condition when the pancreas is not able to produce enough insulin for body energy.
• Type II – also known as a non-insulin-dependent life-long disease or adult-onset diabetes that is usually observed in adults when the body can’t metabolize sugar.

Literature Review

Diabetes is a health problem that changes many lives of the Hispanic population in a short period whether it is a person who directly has diabetes or a family member who has to observe these changes (Ramachandran et al., 2017). Spanakis and Golden (2013) underline that health disparities in diabetes cannot be ignored because of multiple contributing biological and clinical factors. Diabetes is known as one of the possible causes of different health complications, including kidney failure, blindness, stroke, and cardiovascular diseases. The reasons that may cause this disease remain to be poorly investigated in the Hispanic population, resulting in the inability to develop effective interventions and treatment plans for patients. The reduction of morbidity is the goal that can be achieved. Still, socioeconomic factors, the necessity of acculturation and acceptance of new traditions, and poor learning or employment prevent an appropriate perception of diabetes in the population, promoting knowledge gaps, language barriers, and ineffective treatment.

Diabetes and Hispanics in the United States

Hispanics, also known as Latinos, are the people with Cuban, Mexican, or Puerto Rican origins who compose 15% of the total US population (about 53 million) (Spanakis & Golden, 2013). There is a suggestion that this number may be increased by up to 45% in 2060 (Ferguson, Swan, & Smaldone, 2015). Therefore, it is required to focus on the health of this population and discover the ways to educate people, provide them with care and support, and gain control over the incidence of diabetes and other diseases that may threaten human life.

The Hispanic population plays an important role in American life, determining the necessity of specialized health care, economics, and learning/employment conditions. Health conditions of Hispanics serve as important markers of public health in the United States (Zhao, 2014). Though the number of Hispanics who live in the United States continues increasing, the representatives of the CDC admit that they do not have enough information about Hispanic health to control the prevalence of the disease (Schneiderman et al., 2014). Self-reported cases of diabetes may be used as a basis for surveys and interventions. Hispanics can learn about diabetes and receive information about its complications from healthcare providers, friends, newspapers, the Internet, and television (Zhao, 2014). However, all these sources can be defined as inconsistent due to increased rates of diabetes and poor health outcomes in the Hispanic population (Ferguson et al., 2015). Yoshida et al. (2016) state Hispanic Americans who have diabetes have poorer access to care and lack health insurance compared to non-Hispanic Whites of the same region. The result of such barriers and challenges can be observed in wrong nutrition, harmful behaviors, and poor diabetes management.

Diabetes prevalence also depends on the geographical and gender factors. Hispanic men (approximately 16%) are under a higher risk of having diabetes in comparison to Hispanic women (approximately 17%) (Spanakis & Golden, 2013). Hispanics with South American roots have the lowest prevalence rates (about 10%). Then, Cuban Hispanics follow in this list of prevalence, composing 13%. The rates of Hispanics with Mexican or Puerto Rican roots are about 18-19%, proving that diabetes may become an epidemic for some groups of people (Spanakis & Golden, 2013). Yoshida et al. (2016) explain the role of acculturation in the life of Hispanics and people’s intentions to follow the values, traditions, and behaviors of the host country. High consumption of sugar and fast food and low intake of fruits, vegetables, and ordinary water is inherent for many Americans. A considerable part of Hispanics tries to take similar steps and change their habits to become a worthwhile part of society. However, their bodies and immune systems are not as prepared for such changes and new diets as their brains can be (Yoshida et al., 2016). Cultural, socioeconomic, and language barriers challenge many Hispanics and promote health complications that result in diabetes (Spanakis & Golden, 2013). Therefore, it is required to understand what Hispanic people know about diabetes, and what improvements can be offered to them regarding diabetes management.

Diabetes definition

Every researcher or writer aims at developing a specific definition of diabetes and covering all its characteristics. As a rule, diabetes is included in a group of metabolic diseases where hyperglycemia is observed because of a low level of insulin. Insulin has to transport glucose to cells where it can be used for energy production (Ramachandran et al., 2017). Hispanic Americans have increased insulin resistance that determines glucose metabolism and reduced insulin sensitivity (Spanakis & Golden, 2013). Diabetes may be of two types. Type I diabetes occurs when no insulin that is necessary for keeping energy in the body is produced in the pancreas (Ramachandran et al., 2017). In most cases, this type of diabetes is observed among children or young patients who have to take insulin day by day to live.

Type 2 diabetes is another form of the disease that differs from the first type by a possible presence of insulin in the body that works in the wrong way. Being one of the most common types of diabetes, this disease may be developed at any age because of family history, obesity, and glycemic complications (Zhao, 2014). In many cases, researchers do not differentiate type 1 diabetes from type 2 diabetes to gather as much information as possible and focus on this disease prevention (Schneiderman et al., 2014; Yoshida et al., 2016). The peculiar difference between these types is their symptoms or, to be more exact, the period and urgency of the first symptoms’ recognition.

Diabetes symptoms

Though the symptoms of both types are similar, they may be recognized at different stages. As a rule, patients with type I diabetes can experience certain health changes, report on them in a short period, and perform self-care as a part of diabetes management (Ferguson et al., 2015). Still, millions of people continue living with type II diabetes without even knowing about it because of no evident symptoms being observed. Such unawareness may be explained by poor knowledge and education offered to the Hispanic population, on the one hand, or the inability to identify true causes of diabetes, on the other hand (Zhao, 2014). Frequent urination, excessive thirst, and fatigue without any reasons, blurred vision without any traumas, and weight changes are the common symptoms that may be developed slowly or fast, depending on the type and the condition of patients (Zhao, 2014). The excess of sugar promotes new changes in the body, and a patient feels uncomfortable while doing regular activities.

Diabetes diagnosis and treatment

The risk of having diabetes groups include people who are 45-year old (or older) and obese or have a similar family history. In such cases, it is recommended for them to take regular tests to identify if they have diabetes or not. Today, several tests can be used to test the level of glucose in the blood depending on the urgency of diagnosis and the necessity to take as close results as possible. The most frequent tests are A1C (glycated hemoglobin test) that may be used to indicate the level of glucose during the last three months and OGTT (oral glucose tolerance test) that shows the level of sugar in the blood annually (Schneiderman et al., 2014). Random and fasting plasma glucose tests (RPG and FPG) are offered at some hospitals in case fasting is possible to control. However, the investigations developed by Zhao (2014) and Ferguson et al. (2015) show that not all Hispanic Americans are aware of available tests and their possibility to be checked for this disease at free or specialized clinics.

Diabetes and its treatment have to be properly discussed in the Hispanic population because of the necessity to reduce the cases of death and complications caused by diabetes. Though it is a hard task for ordinary people to live with diabetes, several simple and effective steps that can be taken to facilitate this condition. Preventive medicine is available to all people and includes regular physical activities, no smoking, and healthy nutrition (Spanakis & Golden, 2013; Yoshida et al., 2016). People with diabetes have to monitor the level of blood sugar regularly and know where they can address for urgent help. Management of diabetes mellitus may be developed in several stages. Spanakis and Golden (2013) admit that physically active patients with no smoking habits report on diabetes complications rarely. Community education and support are effective for diabetic patients.

For example, Ferguson et al. (2015) introduce diabetes self-management education for the Hispanic population with special attention to cultural varieties, eating behaviors, and personal beliefs that may determine the quality and frequency of treatment. Finally, research by Yoshida et al. (2016) examines the effectiveness of nutrition among diabetic Hispanics. The work by Zhao (2014) can be used as a strong supportive tool in terms of which different sources of health information and diabetes knowledge in the Hispanic population are discussed to prove that people are free to learn a lot in case they are properly motivated.

The importance of motivation is a crucial factor in diabetes management. The rates of diabetes among Hispanic patients may be explained by poor motivation or the lack of attention to ethnic subgroups in hospitals. Motivation has already been proved as an important part of diabetes management in such countries as Saudi Arabia (Al-Mutairi, Bawazir, Ahmed, & Jradi, 2015). It is high time to discuss the possible impact of the motivation of the Hispanic population in their needs to prevent or treat diabetes or reduce the number of death because of this disease.

Conceptual Model

In this research, a conceptual model will be used as a plan with the help of which an understanding of diabetes mellitus in the Hispanic population can be promoted. It is not enough to have a plan for discussion of diabetes. It is required to understand what each task can bring to research and what contributions may be expected. As it is shown in Figure 1, this model may be a solid mechanism for identifying and explaining diabetes:

According to this model, the analysis of diabetes should be organized in several stages. First, diabetes has to be properly identified as discussed through its two types, I and II. Then, the main symptoms of diabetes have to be described to understand what problems and changes matter for diabetic patients. The next step in the analysis of perceptions of diabetes is the evaluation of diagnostic tools. As long as people recognize what type of diabetes they have, nurses and other medical staff should discuss the peculiarities of management and treatment. It is necessary to admit that treatment may be pharmacological and non-pharmacological. Both types have to be described with clear examples given. Finally, risk factors for diabetes may vary, and patients should be aware of these factors to take precautionary measures. Researchers identify such factors as age, gender, education, lifestyle, and traditions (Zeng, Sun, Gary, Li, & Liu, 2014). As a result, diabetes of both types has to be investigated from the Hispanic population perspective, including available diagnostic tools, management, and treatment. These steps are necessary for the researcher’s intentions to understand what kind of work and support has already been offered to the population. Also, new interventions and improvements may be identified regarding the existing diabetes basis in the United States.

Theoretical Model

To support the conceptual model for understanding diabetes in the Hispanic population, a theoretical framework is also offered. It is based on the health belief model (HBM). This psychological model was introduced by Hocbaum, Rosenstock, and Kegels in the 1950s (“Health belief model,” 2017). It aims at explaining the health behaviors of different populations regarding disease and health impairments observed. According to this model, people may improve their everyday activities in case they know that avoidance of negative health conditions is possible, positive outcomes may be expected from recommendations, and the success of a recommended health action can be achieved.

This model focuses on benefits that may be achieved by patients in their intentions to learn more about diabetes and make a correct decision as it is shown in Figure 2. It includes several important variables like barriers that exist in the health system, severity and susceptibility the assessment of which show risks and consequences of the problem, self-efficacy that demonstrates people’s perception of their competence to successful behavior, social support, and self-care behaviors that promote an understanding of diabetes in one particular population. These variables are effective to measure the psychological, emotional, and behavioral impact of diabetes on the population (Al-Mutairi et al., 2015). People have to be properly motivated to comprehend what they can or cannot do to avoid diabetes complications, what the government can offer to the healthcare system and its population, and why diabetes knowledge is important. At the end of the project, a researcher should use this model to clarify if awareness of diabetes and its preventive treatment and cautions are effective for the Hispanic population who live in the United States.

Research Methods

This research project will be a descriptive study the goal of which is to describe the information available on the chosen topic and create a general picture of diabetes as a health problem that bothers the Hispanic population. The main research instrument will be a systematic review of the literature that is associated with diabetes and its incidence among the Hispanic population. The systematic review is a process in terms of which several studies will be selected by specific inclusion criteria. This research method will help to identify the gaps in current research, understand the chosen topic, clarify new perspectives on diabetes treatment, and learn how to combine theory and practice in one empirical study.

Population

The choice of a population plays an important role in this research. The task is not only to clarify the symptoms and outcomes of diabetes. The goal is to investigate this disease from one particular perspective – the Hispanic population. At this moment, about 52 million Hispanic people live in the United States, and 16% of them have diabetes (Spanakis & Golden, 2013). The main threat is that the majority of Hispanics remain unaware if they have diabetes or not. General statistical data about the Hispanic population of the US will be taken into consideration in the project. No particular cases will be discussed. This review will be based on the necessity to gather what the level of general knowledge of diabetes among the Hispanic population is, and if the population is aware of the basic preventive steps to avoid diabetes complications.

Sample/Materials

A search of such databases as Cochrane, PubMed, and the local library will be developed. It is expected to find at least 20 studies about diabetes in the Hispanic population and make sure that five of them meets the inclusion criteria, which are the year of publication (within the last five years, from 2013 till now), the geographical location (the United States), the population (Hispanics), and the disease (diabetes at any of its stages). Also, the review will be improved with the help of available statistical data and scholarly material that describes diabetes from different perspectives.

All studies have to be published in peer-reviewed journals. The research methods chosen by other authors should not play a role in the study. Still, it is better to identify the approaches chosen to understand how the information was gathered, and if the material could be defined as credible. The methodology of a future nursing research project is based on a descriptive study with the literature review as the main research instrument in terms of which it can be possible to identify the approaches of other authors and use them as a solid background for understanding the perceptions of diabetes in the US Hispanic population.

Findings

The analysis of data that is relevant to the US Hispanic population with diabetes provides significant insights into the gaps in diabetes knowledge, management, and treatment. The investigation should show if Hispanic Americans, as well as other representatives of the US population, have extensive access to health information about diabetes and other diseases and their treatment options or not. However, even without any clear conclusions and real steps, it is wrong to neglect the presence of certain problems and inconveniences for diabetic patients in their intentions to improve their knowledge and gain control over rates and diabetes incidence. In this chapter, the evaluation of expected findings will be given to clarify if this research project has a rationale and what results and outcomes may be observed.

Findings of the Study

A systematic review of the literature is chosen as the main research method for this nursing project. The goal is to identify what knowledge and practices are available to diabetic patients in case there are members of the Hispanic community in the United States. Many Americans have their health insurance and medical plans with the help of which they can be diagnosed at any time and received required care and support. Hispanic Americans are usually challenged in their opportunities. Some of them do not have health insurance, and some of them lack knowledge about how dangerous diabetes can be. At the end of the work on this project, it is expected to explore additional options for diabetic patients in the following directions:

1. General facts about diabetes, statistics, and personal experiences of different ethnic/race groups have to be shared in different ways (TV, online forums, special meetings, and learning courses).
2. Intentions of patients to learn more about their diseases and options (past studies prove that many Hispanic Americans understand the threats of diabetes and want to improve their health, avoid complications, and prevent extension).
3. Studies of several authors are directed to cover different aspects of diabetes treatment and clarify the outcomes that may and may not effective for Hispanic patients (the results of the literature review will be introduced in a separate table below):

In addition to the necessity to introduce the findings of the study in a table format, it is expected to use the already discussed health belief model and explain what benefits, barriers, and other factors may influence the perception of diabetes. The Hispanic population may or may not be motivated in a proper way to solve their health problems. The role of the government should be identified so that the socio-economic challenges of the Hispanic population may be solved. Finally, the findings of the study should touch upon the interventions that can help the Hispanic population to improve their diabetic knowledge, predict diabetic complications, and investigate all sources to exchange information about the disease.

Discussion

The implications of the findings that can be achieved at the end of this nursing research project may vary, depending on the objectives and main research questions. First, it is necessary to give a clear definition of diabetes and discuss all its types, signs, and symptoms to make sure that Hispanic Americans have access to credible and helpful information. The perception of diabetes depends on how many facts can be used to support a discussion and how much information a person can evaluate at once. Therefore, the more Hispanic patients know about diabetes before the diagnosis, the better. At the moment of receiving a diagnosis, a person can evaluate a situation and avoid confusion or misunderstanding of what has happened or why such a diagnosis is given.

The second aspect of the discussion will include the existing interventions, programs, and helpful centers where Hispanics can ask for additional explanations and support. In the chosen studies, the authors gave several strong ideas on how the Hispanic population can treat diabetes and what programs can be used. Self-management and education play an important role in the perception of diabetes. All people despite their race, age, and gender have to be willing to learn the basics of diabetes and the steps they can easily be taken to avoid diabetic complications.

Finally, the analysis of different factors that may differentiate patients with the same diagnosis is required. Within the frames of diabetic research in the Hispanic population, the attention to such factors as cultural, behavioral, socioeconomic, and financial ones should be paid. Some Hispanics may earn money and buy health insurance, but many of them are challenged by the conditions under which millions of immigrants live in the United States. The studies should help to clarify what challenges promote the development of pre-diabetic and diabetic conditions in case they are not genetic and biological ones.

Conclusions

In general, diabetes is one of the frequently discussed topics around the whole world. People want to know as much as possible about this disease to understand what they can do when they or their family members receive this diagnosis. This nursing research project has several clear and effective goals with the help of which it is possible to understand the relationship between diabetes and the Hispanic population. Many people think that they know a lot about diabetes in case they can give a definition, define symptoms, and enumerate diagnostic tools. However, this knowledge is far from being a full package of the material that has to be discovered about diabetes. This disease has pharmacological and non-pharmacological treatment approaches. Diabetic patients should change their lives and concentrate on the activities they found insignificant several years ago. Control of sugar level in the blood is a regular activity that cannot be neglected. This type of control may be maintained by specialized medical workers in hospitals or by patients using special tools at home. The only requirement that this test, as well as insulin intake, has to be taken all the time when a threat or change is observed.

A systematic literature review is a choice made by the researcher for this nursing project. This process of data gathering is effective due to the possibility to identify what achievements have already been made in the field, what statistical data is known, and why this topic is worth attention. Diabetes is a serious and dangerous disease that has already killed thousands of people and continues changing the quality of human life. The Hispanic population is defined as a high-risk for diabetes groups because of human genetics and acculturation. The lack of knowledge or poor treatment should not be a problem for these people, and this project will introduce a solid basis for helpful and necessary interventions to improve the perception of diabetes in the Hispanic population.

Recommendations

Taking into consideration the expected findings and the discussion that may be developed on the results, several recommendations may be given to improve research. First, the inability or unwillingness to distinguish between type I and type II diabetes in past studies deprives the researcher of an opportunity to identify the peculiarities of the disease, its causes, and symptoms. Therefore, one of the recommendations should aim at specifying diabetes from biological, genetic, and behavioral items.

Second, it is recommended to choose another research method and focus on new aspects of the discussion. For example, direct communication with the population or real-life interventions based on people’s needs and expectations can be offered. Interviews with 20-30 Hispanics of different origin may contribute to this research through credible qualitative information about what services can be offered to the population, what challenges may be observed in information exchange, and why diabetic knowledge is important for the US population. Questionnaires or online surveys help to gather quantitative information and use numbers to prove the importance of the chosen topic. Action research is another recommendation with the help of which perception of diabetes in the Hispanic population may be improved.

Finally, this research should have certain time frames. Diabetes is a disease with a long history, and multiple changes were observed at different epochs. Therefore, credible and up-to-date results can be achieved when diabetic Hispanics treatment is discussed within the last several years. However, every new step may have its limitations, and additional recommendations can be identified to improve the already done work.

References

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American Diabetes Association. (2014). Diabetes among Hispanics: All are not equal. Web.

Centers for Disease Control and Prevention. (2017). National diabetes statistics report. Web.

Ferguson, S., Swan, M., & Smaldone, A. (2015). Does diabetes self-management education in conjunction with primary care improve glycemic control in Hispanic patients? A systematic review and meta-analysis. The Diabetes Educator, 41(4), 472-484.

Health belief model. (2017). Web.

Ramachandran, A., Snehalatha, C., & Nanditha, A. (2017). Classification and diagnosis of diabetes. In R.G. Holt, C. Cockran, A. Flyvbjerg, & B.J. Goldstein (Eds.), Textbook of diabetes (pp. 23-28). Hoboken, NJ: John Wiley & Sons.

Schneiderman, N., Llabre, M., Cowie, C. C., Barnhart, J., Carnethon, M., Gallo, L. C.,… Teng, Y. (2014). Prevalence of diabetes among Hispanics/Latinos from diverse backgrounds: The Hispanic community health study/study of Latinos (HCHS/SOL). Diabetes Care, 37(8), 2233-2239.

Spanakis, E. K., & Golden, S. H. (2013). Race/ethnic difference in diabetes and diabetic complications. Current Diabetes Reports, 13(6), 814-823.

World Health Organization. (2017).The top 10 causes of death. Web.

Yoshida, Y. X., Simonsen, N., Chen, L., Zhang, L., Scribner, R., & Tseng, T. S. (2016). Sociodemographic factors, acculturation, and nutrition management among Hispanic American adults with self-reported diabetes. Journal of Health Care for the Poor and Underserved, 27(3), 1592-1607.

Zeng, B., Sun, W., Gary, R.A., Li, C., & Liu, T. (2014). Towards a conceptual model of diabetes self-management among Chinese immigrants in the United States. International Journal of Environmental Research and Public Health, 11(7), 6727-6742.

Zhao, X. (2014). Relationships between sources of health information and diabetes knowledge in the U.S. Hispanic population. Health Communication, 29(6), 574-585.