Education Program for End-stage Renal Disease
This week you will be working on an evaluation plan that will be attached to your EBP in Week 9. Submit your Evaluation Plan to the DB –listed as 1-2-3…
Culturally Targeted Self-Management Program for African Americans with Type 2 Diabetes: Program Evaluation
Lifestyle choices play a critical role in influencing the occurrence of lifestyle diseases, including diabetes mellitus (DM). Consequently, inadequate or lack thereof of information on the influence of lifestyle on clinical outcomes of Type 2 Diabetes (T2DM) contributes to difficulties among at-risk population. One such at-risk population is the population of African Americans (AA). A program was designed to improve understanding of the influence of lifestyle on clinical outcomes of Type 2 Diabetes among African Americans, a program which is subject to evaluation in this paper.
Program Goal
The goal of the program is to achieve an effective self-management, Church-Based Culturally Targeted (CBCT) diabetes self-management education program. It is designed to tailor self-management education for middle-aged African Americans. The program included 12 (including 10 women and 2 men) participants in urban churches aged 35 to 68 years (Collins-McNeil et al., 2013). It focuses on seven areas of concern with regards to self-management for diabetics, including healthy eating, being active, blood glucose monitoring, medication, risk reduction, and healthy coping. The program includes education and behavioral strategies, which aim at helping patients, achieve their self-management goals.
Purpose of the Evaluation
The following program evaluation is undertaken with the aim of evaluating the effectiveness of the program to the extent that it met its key objectives set out at the beginning as well as it used evidence-based approaches for diabetes education intervention.
Resources Needed by a Diabetes Education Program to Meet Its Goals
Diabetes education program’s success relies on the availability of science- and audience-based, culturally and linguistically appropriate resources and materials. The National Institute of Health (NIH, n.d) through the National Diabetes Education Program (NDEP) has, over the last two decades, developed diabetes education toolkit to help designers of diabetes education programs to tailor their programs for the best outcomes based on the population for which the intervention is aimed (Siminerio et al., 2018; Spruill, Magwood, Nemeth, & Williams, 2015). NDEP maintains a national repository of these important diabetes education tools and keeps updating them based on evidence from new study findings.
One such resource is the diabetes self-management education and support (DSMES). DSMES remains is considered a cornerstone in diabetic care and education (Siminerio et al., 2018). With a plethora of new therapies from research and the recognition of the fact that living with diabetes is increasingly associated with emotional challenges, DSMES as it is today moves beyond basic provision of knowledge to include behavioral strategies. This is evidenced by the move by the National Diabetes Prevention Program (DPP) to include in its modules the best evidence for T2D intervention through structured lifestyle changes (Siminerio et al., 2018). The evaluation will show how these resources were utilized in the program under evaluation.
Other important resources in diabetes education intervention for prevention or reduction of risk factors associated with type 2 diabetes are the measurement or assessment tools. NDEP recognizes that diabetes diagnosis is the first and foremost step in diabetes education and should be performed at the beginning and end of such education programs. Some of the important tools to measure various variables at the beginning and end of diabetes education programs include Diabetes Self-Care Practices Measurement (DSCPM) questionnaire, Self-Appraisal Diabetes Self-Management Scale (SADSM), Center for Epidemiological Studies Depression Scale (CES-D), and Spielberger State Anxiety Subscale from the Spielberger State–Trait Anxiety Inventory (STAI). The evaluation will assess how well such tools, if any, were utilized in the program to be evaluated.
Program Activities
Conducting Sessions
The program leadership adopts Diabetes Self-Management Education (DSME) modules from Adult Diabetes Education Program (ADEP) used for outpatients at the Duke University (Collins-McNeil et al., 2013). These modules are evidence-based and abide by the standards of diabetes care and education recommended by the American Diabetes Association (ADA). They are a culmination of years of research, which have been integrated into diabetes education toolkit in the NDEP website. Using evidence-based diabetes education modules would help to improve the reliability of the findings regarding the effectiveness of this intervention for diabetic patients among African Americans in Southeaster United States. Using the DSME modules, the program leaders, including a clergy and healthcare providers, conducted sessions lasting 2 hours each week for 6 weeks (Collins-McNeil et al., 2013). During these sessions, culturally written materials, videotapes as well as presentations were used. The educators included culturally written materials in an effort to tailor the materials to the needs of the population of participants. This approach was informed by the fact that cultural barriers are among some of the most difficult barriers to overcome in self-management for diabetes (Caballero, 2018). Therefore, designing an educational intervention that addressed such underlying cultural factors would promise the best outcomes in the intervention. This first phase included diabetes education.
At the end of the first 6 weeks, participants will be asked to take part in another 6 weeks of behavioral strategies on self-management. Here, the participants will act independently, implementing what they learned during the first six weeks of intervention (Collins-McNeil et al., 2013). During the 6-weeks period, the healthcare providers will evaluate participants on the seven items identified at the beginning of the program, including healthy eating, being active, self-monitoring of blood glucose, medication adherence, risk reduction, problem solving, and healthy coping. The sessions also include emotion-focused coping modules for participants experiencing emotional stress resulting various stressors or events (Collins-McNeil et al., 2013). Equally important was spiritual coping led by the clergy and integrated into every session as this intervention as basically church-based.
Measuring Variables
The program also includes measurement of various variables among participants. At the beginning of the program implementation, healthcare providers will measure such variables at baseline. Quantitative data collection at baseline is important in assessing the effectiveness of a program by comparing such baseline data with that at collected at the end of sessions. Apart from data on racial background, medical diagnosis for T2DM, and written and verbal communication proficiency, the program also measures data on variables associated with diabetes, including socio-economic dynamics, patient perception of diabetes self-management, psychological and emotional status, and anthropometric measures.
Targeted Outputs
In this particular intervention, the educators targeted specific program outcomes, including the following:
- Improved healthy eating habits;
- Improved understanding of the underlying cultural factors in diabetes care;
- Improved emotional outcomes associated with stress, depression, and anxiety associated with diabetic conditions; and
- Generally improved perception of the effectiveness of self-management behavioral strategies;
Short-Term Patient Outcomes
From the above list of targeted outcomes, short-term patient outcomes would be associated with improved lifestyle choices, which would be assessed in various metrics. For example, by collecting data on blood glucose levels at baseline and comparing with that at the end of the program, the educators would evaluate the effectiveness of glycemic control among participants in the short-term. Furthermore, the educators also wanted to evaluate the impact of the program in medication adherence. Finally, the educators also targeted improvements in foot care adherence among patients included as participants in the program. Based on the findings reported for the program at the end of the 13-weeks period of its implementation, there were significant increases in healthy eating among participants. Such significant increases in healthy eating point to better glycemic control efforts by participants and constitute part of the short-term outcomes targeted by the program.
Long-Term On Patients
At the end of the entire program, the educators will help to leave a mark in the lives of the patients who they expected to be better equipped with information on targeted, culturally relevant diabetes self-management strategies. This is expressed in the key objective of the CBCT program stated in the introduction to this evaluation. The achievement of long-term measures could not be measured in the 12-weeks period, but perhaps through a longitudinal follow-up with the 12 participants.
Conclusion
From the preceding program evaluation, it is clear that the CBCT program was effective to the extent in which it included an evidence-based approach to diabetes patient education. The program utilized science- and audience-based strategies enshrined in the National Diabetes Education Program toolkit. It included two sections, with section one focusing in impating patients with the knowledge and section two focusing on strengthening behavioral strategies to reduce risk factors associated with type 2 diabetes. Furthermore, the program utilized culturally and linguistically relevant materials, which improve outcomes in a culturally relevant intervention.
References
Caballero, A. (2018). The “A to Z” of Managing Type 2 diabetes in culturally diverse populations. Frontiers In Endocrinology, 9(479), 1-15. doi: 10.3389/fendo.2018.00479
Collins-McNeil, J., Edwards, C. L., Batch, B. C., Benbow, D., MacDougal, C. S., et al. (2018). A Culturally Targeted Self-Management Program for African Americans with Type 2 Diabetes Mellitus. Canadian Journal of Nuesing Research, 44(4), 126-141.
National Institute of Health. Game Plan for Preventing Type 2 Diabetes. Nih.gov. Retrieved from https://www.niddk.nih.gov/health-information/communication-programs/ndep/health-professionals/game-plan-preventing-type-2-diabetes
Siminerio, L., Albright, A., Fradkin, J., Gallivan, J., McDivitt, J., & Rodríguez, B. et al. (2018). The National Diabetes Education Program at 20 years: Lessons learned and plans for the future. Diabetes Care, 41(2), 209-218. doi: 10.2337/dc17-0976
Spruill, I., Magwood, G., Nemeth, L., & Williams, T. (2015). African Americans’ culturally specific approaches to the management of diabetes. Global Qualitative Nursing Research, 2, 1-9. doi: 10.1177/2333393614565183