The Evaluation of a Diabetes Self-Management Program Delivered in a Community Health Clinic
AuthorSumler, Tamara Neshae
Type 2 Diabetes
MetadataShow full item record
PublisherThe University of Arizona.
RightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction, presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
AbstractBackground: The prevalence and incidence of type 2 diabetes are steadily increasing in the United States. Diabetes self-management education (DSME) programs seek to improve delivery of diabetes care and education. The end result of diabetes self-management education is behavior change towards successful self-management of diabetes and improved outcomes. Aims: Aims of project are to assess whether project site’s existing DSME program meets evidence based standards for diabetes self-management education, to explore potential variables that reflect existing diabetes self-management program, and to obtain perceptions about existing program, barriers and facilitators to class attendance, and ideas for program improvement from self-management class participants and class facilitators. Methods: The project was implemented in a large Federally Qualified Health Care (FQHC) clinic using a descriptive study design. A sample of 20 adult diabetic patients who attended at least one diabetes self-management class between months of July, August, and September, 2018 was obtained. Additionally, I attended two diabetes self-management classes to distribute surveys to both self-management class participants and class facilitators. Results: Among the sample of adult diabetic patients, 75% were women. Mean age was 60.7 years old. Mean number of classes attended among sample was 7.35, the mean A1C was 8.7%. The project site’s diabetes self-management education program met six out of 10 of National Standards for Diabetes Self-Management Education and Services (evidenced-based tools for health care providers and health care organizations who provide diabetes education). Eleven class participant surveys were returned and demonstrated that the majority of class participants were satisfied with existing self-management program, including current method of education (face-to-face group education). Barriers for self-management classes were transportation, distance between home and clinic where classes are held, time that classes are held, and conflicting appointments during time classes are held. Facilitators to attending class were vouchers for fresh fruits and vegetables given as incentive for attending classes, being provided with transportation to classes, and social interaction that occurs from attending classes. Class facilitators most enjoyed opportunities class participants had to ask more questions pertaining to diabetes self- management. Limited class offerings in English language and time restraints were identified among class participants as least enjoyed aspect of existing self-management program. Both class participants and facilitators suggested addition of an exercise segment and cooking demonstration to existing diabetes self-management program. Conclusion: Project findings suggest while the sample utilized diabetes self-management education classes conducted at the clinic, they demonstrated poor glycemic control and thus poor self-management of diabetes. Continuous quality improvement measures should be initiated to ensure the existing program is meeting evidence-based standards, while delivering diabetes self-management education and services that are patient centered, effective in meeting and sustaining glycemic control, and improve outcomes subsequently. A significant project limitation was low class attendance among diabetes self-management class participants during time of data collection. Lack of medical provider stakeholder input regarding project site’s existing diabetes self-management program was an additional limitation in this project. These conclusions must be reviewed cautiously in light of identified project limitations.
Degree ProgramGraduate College
Degree GrantorUniversity of Arizona
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After receiving language concordant, individual health education interventions, do Spanish speaking, diabetic inpatients at a safety net hospital demonstrate acquired diabetes self-management competency as measured by pre-training and post training evaluation of key, diabetes self-management knowledge?Cagle, Jonathan; The University of Arizona College of Medicine - Phoenix; Abdollahi, Shagyegh (The University of Arizona., 2018-03-28)The purpose of this research was to assess the quality of the inpatient, health education diabetes program as it relates to primary Spanish speaking patients. Complications from diabetes account for huge personal and financial costs. There is substantial evidence supporting the use of targeted diabetes education to reduce complications but we need to know if our education interventions are valid. In order to accomplish this by auditing the knowledge of a sample of inpatient diabetics before and after receiving the standard MMC Spanish language diabetes education interventions via Spanish language pre and post surveys (standardized by the previously validated SKILLD survey). Demographic and clinical data were analyzed and all significant data (p value <0.05) were considered for their importance. The data demonstrated that in all 10 items on the survey, overall patients were able to demonstrate significant improvement in survey scores. Additionally, comparisons of demographic data demonstrated that being less than 50 years old was associated with improved survey scores. This indicates overall benefit of the training program as well as possible insight into need for more aggressive training for patients greater than 50 years in age.
Racial and ethnic disparities in the control of cardiovascular disease risk factors in Southwest American veterans with type 2 diabetes: the Diabetes Outcomes in Veterans StudyWendel, Christopher; Shah, Jayendra; Duckworth, William; Hoffman, Richard; Mohler, M. J.; Murata, Glen; Southern Arizona VA Health Care System, Tucson, AZ, 85723, USA; University of Arizona College of Medicine, Tucson, AZ, 85724, USA; Carl T. Hayden VA Medical Center, Phoenix, AZ, 85012, USA; New Mexico VA Health Care System, Albuquerque, NM, 87108, USA; et al. (BioMed Central, 2006)BACKGROUND:Racial/ethnic disparities in cardiovascular disease complications have been observed in diabetic patients. We examined the association between race/ethnicity and cardiovascular disease risk factor control in a large cohort of insulin-treated veterans with type 2 diabetes.METHODS:We conducted a cross-sectional observational study at 3 Veterans Affairs Medical Centers in the American Southwest. Using electronic pharmacy databases, we randomly selected 338 veterans with insulin-treated type 2 diabetes. We collected medical record and patient survey data on diabetes control and management, cardiovascular disease risk factors, comorbidity, demographics, socioeconomic factors, psychological status, and health behaviors. We used analysis of variance and multivariate linear regression to determine the effect of race/ethnicity on glycemic control, insulin treatment intensity, lipid levels, and blood pressure control.RESULTS:The study cohort was comprised of 72 (21.3%) Hispanic subjects (H), 35 (10.4%) African Americans (AA), and 226 (67%) non-Hispanic whites (NHW). The mean (SD) hemoglobin A1c differed significantly by race/ethnicity: NHW 7.86 (1.4)%, H 8.16 (1.6)%, AA 8.84 (2.9)%, p = 0.05. The multivariate-adjusted A1c was significantly higher for AA (+0.93%, p = 0.002) compared to NHW. Insulin doses (unit/day) also differed significantly: NHW 70.6 (48.8), H 58.4 (32.6), and AA 53.1 (36.2), p < 0.01. Multivariate-adjusted insulin doses were significantly lower for AA (-17.8 units/day, p = 0.01) and H (-10.5 units/day, p = 0.04) compared to NHW. Decrements in insulin doses were even greater among minority patients with poorly controlled diabetes (A1c greater than or equal to] 8%). The disparities in glycemic control and insulin treatment intensity could not be explained by differences in age, body mass index, oral hypoglycemic medications, socioeconomic barriers, attitudes about diabetes care, diabetes knowledge, depression, cognitive dysfunction, or social support. We found no significant racial/ethnic differences in lipid or blood pressure control.CONCLUSION:In our cohort, insulin-treated minority veterans, particularly AA, had poorer glycemic control and received lower doses of insulin than NHW. However, we found no differences for control of other cardiovascular disease risk factors. The diabetes treatment disparity could be due to provider behaviors and/or patient behaviors or preferences. Further research with larger sample sizes and more geographically diverse populations are needed to confirm our findings.
Health beliefs of insulin dependent diabetics and non-insulin dependent diabeticsWoodtli, Anne; Wortell, Linda Harbaugh (The University of Arizona., 1987)The descriptive study which explored the insulin dependent diabetics' and non-insulin dependent diabetics' perceptions of susceptibility to diabetic complications, severity of diabetes, and benefits of and barriers to preventive measures. The Wortell Diabetic Perception Scale was developed by the researcher for this study, and administered to a convenience sample of 71 subjects. The Subjects' age ranged from 22 to 80 years. There were 33 females and 38 males in the sample. Forty three percent of the diabetics were classified as insulin dependent diabetics and 57% as non-insulin dependent diabetics. Findings indicated that insulin dependent diabetics perceived diabetes to be significantly more severe than did non-insulin dependent diabetics. No significant difference was found to exist between the insulin dependent diabetics and non-insulin dependent diabetics with regards to perceived susceptibility to diabetic complications, and benefits of and barriers to preventive measures.