Background and Significance

Background and Significance
Student:
Professor:
Course title:
Date:
Implementation of mobile web app for medication reminder and health education to increase treatment adherence among Hispanic women with type II diabetes
Background and Significance
Type II diabetes mellitus (T2DM) is today an increasing and significant health problem. Hispanic-Americans are amongst the high-risk ethnic groups given that they have a disproportionate burden of obesity along with its related comorbidities (Gazmararian, Ziemer & Barnes, 2009). Drugs do not work in patients who do not take them and adherence to medication is of great importance. Adherence to a medication regimen is basically understood as the degree to which a patient takes medicines as prescribed. The problem of poor adherence to prescribed treatments is considerably complex. Compliance to therapy in patients who have T2DM is dependent on various variables, including variables that are specific to the provider, to the patient, and to the treatment. Non-adherence to therapy is complicated even further when religion and cultural factors are computed with the Hispanic community (Whittemore, 2007).
The risk of weight gain, for some patients, might put forth a substantial influence on their adherence to diabetes therapy, whilst for other patients the cost of drugs or the risk of hypoglycemia might be more significant factors. Physicians have to discuss these issues with their patients and come up with a patient-centric treatment plan in order to attain optimal adherence to treatment (Linn, Vervloet & van Dijk, 2011). It is of note that diabetes that is not controlled in a proper way opens a pathway for several other serious medical complications such as nephropathy, retinopathy, peripheral neuropathy, as well as an increased of developing cardiovascular disease. In the United States, diabetes affects roughly 25.8 million persons. It affects over 10 percent of all Hispanic Americans – 2 million. Hispanic women are seventeen times more likely to die from diabetes compared to non-Hispanic Caucasian women. Although countrywide more men compared to women have been diagnosed with T2DM, Hispanic women have a higher diagnosis rate relative to Hispanic men (Campos, 2007).
Barriers diabetic Hispanic women face to the adherence to diabetes treatment
A lot of ethnic minorities in the United States have restricted access to health care owing to their lower socio-economic status. Cost: Campos (2007) stated that roughly 60 percent of diabetic Hispanic adults have a yearly income under $20,000 relative to about 28 percent of diabetic whites. Cost of medicines is a significant reason as to why some patients with diabetes decrease their frequency or dose of insulin therapy. Treatment cost contributes to the hesitancy of patients to seek treatment of their diabetes, to remain adherent to insulin therapy, and to escalate dosages of insulin as required in order to control hyperglycemia (Campos, 2007). The other barrier is miscommunication. Language barriers could prevent the delivery of sufficient care through preventing or limiting exchange of communications contributing to a loss of vital cultural information, poor shared decision-making, misunderstanding of doctors’ instructions, as well as ethical compromises for instance difficulty in getting informed consent (Fenerty, West & Davis, 2012). Miscommunication contributes significantly to poor adherence to insulin therapy.
The other barrier is low health literacy among Hispanics. According to Vervloet, van Dijk and Santen-Reestman (2011), health literacy is understood as the ability of an individual to read, understand and utilize health care information in order to make effective and sound healthcare decisions and follow treatment instructions. Campos (2007) observed that low health literacy is especially common amongst Hispanic diabetic patients and this could make it hard for patients to understand educational materials or written medication instructions. Low health literacy in patients who have T2DM is correlated with poor outcomes such as a lesser chance of having tight glycemic control as well as higher chance of developing retinopathy. Moreover, female Hispanic patients have the tendency of relying much on family and friends, and this could give rise to misinformation or confusion. Cultural belief is the other barrier. A lot of Hispanic patients believe that diabetes is a punishment from God – fatalismo – and feel that they cannot do much to change their fate (Campos, 2007). Cultural beliefs such as these might impede the ability of a female Hispanic patient with T2DM to successfully manage her diabetes.
Proposed Intervention: the use of mobile web-based app for delivery of medication reminder and health education
Katz (2013) pointed out that the ubiquitous availability of mobile phones as well as new electronic disease management programs has created possible new ways for enhancing self management of chronic illnesses. In this intervention, the diabetic Hispanic women will receive several text messages everyday that provide education on how to manage the disease, as well as reminders to stick to the recommended self-care measures. Some of the messages would ask these diabetic women to send reply text messages that indicate whether or not they were actually heeding those reminders. The patients who repeatedly fail to respond and the patients whose responses suggested a need for help will be called by a nurse who will be working with the patients and their doctors in overcoming barriers to effective self-management.
The reminders and educational messages that would be sent to the patients each day would be tailored to individual circumstances. A patient will typically get 4 or 3 messages daily. The messages would fall into one of the following categories: reminders or prompts related to apt self-management; education about T2DM; evaluations that will entail requests for information from the patient through a reply text message; feedback basing on the evaluations; tips for promoting adherence; as well as encouragement (Nundy, 2012).
The educational messages will be about self-care; they will cover several facets of self-management such as glucose monitoring, exercise, medications, nutrition and foot care. They will also be about living with chronic disease including messages on managing stress. Examples of the educational messages are as follows: (i) Glucose monitoring – “within two hours of eating, a good blood sugar is below 180 mg/dl, and a good fasting blood sugar is 125 to 80 mg/dl.” (ii) Living with chronic disease – “are you aware that stress actually increases your blood sugars? Not only that, high blood sugars may also increase your stress.” A lot of the text messages will contain links to mobile web pages that will give the patient more information on particular topics (Nundy, 2012).
The reminders and prompts will basically remind the patients regarding the need of taking medicines as prescribed, engaging in proper foot care, and monitoring levels of glucose. The patients themselves would determine the frequency of the delivery. Example of prompts include: “Time for your medicine”; and “always check your feet daily. You have to look in between your toes and bottoms of your feet for any cracks, cuts, or anything that is not ordinary.”
Smart phones are internet-ready multi-use gadgets which allow continuous access to information and communication, and they can do several tasks. Making use of a Smartphone app is a new method for improving adherence and patient behavior considering that it educates and involves the patient, it is always available, and it offers a repository for patient-specific and medication-specific information (Dayer et al., 2013). An adherence app could potentially merge all of the patient’s medication-specific information and in so doing provide a more streamlined process for educating the individual – in this case the female Hispanic patient with diabetes – regarding her care or her diabetes (Dayer et al., 2013). This intervention will greatly increase patient understanding, improve quality of life of diabetic Hispanic women, and reduce costs of health care.
Potential benefits and challenges
One can download adherence ap...