Efficacy of Self-Management and Education of Diabetes Type II in African Americans

Efficacy of Self-Management and Education of Type II Diabetes (T2D) Among African Americans Student's Name Institutional Affiliation Course Code and Title Professor's Name Submission Date Abstract Preventing complications from diabetes requires routine diabetes care that includes self-management education and support. Consequently, a framework for conceptualizing integration and self-management is presented in this synthesis. A search was conducted through six electronic databases: HMIC, PsycINFO, PubMed, Embase, CINAHL, and Scopus. Twelve articles were eligible for inclusion. Data were combined according to the critical interpretive synthesis principles to create the conceptual framework. The Common-Sense Model of Self-Regulation by Leventhal serves as the conceptual framework for this study, which examines how patients view and manage their illness. The research question inquires whether self-management education in check-up routines will impact adult African American T2DM patients' self-management behavior and knowledge. Methodological aspects include data collection over three months, with exclusions depending on patient desire. The study admits limitations such as socioeconomic status, cultural attitudes, and accessibility. However, it underlines the possibility of favorable results in blood sugar levels, patient behavior, and T2DM comprehension. The ultimate goal is to reduce healthcare disparities, empower individuals, and provide vital insights into diabetes treatment practices for the African American community. Keywords: Type II diabetes, African Americans, self-management education, healthcare disparities TOC \o "1-3" \h \z \u Table of Contents TOC \o "1-3" \h \z \u SECTION I: Introduction PAGEREF _Toc157852438 \h 4Background of the Problem PAGEREF _Toc157852439 \h 5Review and Summary of Relevant Literature PAGEREF _Toc157852440 \h 9Statement of the Problem PAGEREF _Toc157852441 \h 17Purpose of the Project PAGEREF _Toc157852442 \h 18Scope, Limitations, Delimitations, Change, and Change Framework PAGEREF _Toc157852443 \h 19Theoretical Framework PAGEREF _Toc157852444 \h 22Summary PAGEREF _Toc157852445 \h 25References PAGEREF _Toc157852446 \h 26Figures PAGEREF _Toc157852447 \h 32 Introduction Due to rapid economic expansion and urbanization, diabetes is becoming more common in many parts of the world. It affects life expectancy and medical expenses and severely threatens public health. According to Khan et al. (2020), most of the deaths per year are caused by diabetes, making it the tenth most prevalent cause of death. Although the prevalence of T2D is rising worldwide, the rate of increase is comparatively quicker in developed countries like Western Europe. African Americans bear a disproportionate share of the disease's burden among the afflicted communities, which is determined by several intricate factors, including socioeconomic position, genetics, and inadequate access to healthcare services. Minority populations and other marginalized communities experience a disproportionate impact from the inequalities within the American healthcare system. Taylor (2019) argues that these inequities result in discrepancies in health provision for specific populations. The majority of African Americans are affected by these healthcare issues. The need to address the extensive obstacles African Americans with Type II Diabetes Mellitus encounter is critical, as the International Diabetes Federation predicts a significant rise in diabetes cases worldwide. In 2019, non-Hispanic black individuals in the US faced double the likelihood of mortality from diabetes compared to non-Hispanic white individuals. In 2018, African American people had a sixty percent higher probability of being diagnosed with diabetes by a doctor compared to non-Hispanic White individuals (Health and Human Services Department of the United States, 2021). This highlights the significant cost consequences and alarming prevalence of diabetes, particularly among African Americans, who have a higher likelihood of acquiring the condition due to socioeconomic disadvantages and inequitable healthcare access. This study explores the efficacy of self-management and education programs tailored exclusively for individuals of African American descent with T2DM within the target population (African American). The primary purpose of this quality improvement study is to assess if "African American patients" with T2D exhibit enhanced response to "self-management education" and training during direct care visits during a three-month timeframe. When patients and their healthcare providers work together, they can control and oversee their treatment (Vainauskienė & Vaitkienė, 2021). The goal is to close the gaps in healthcare outcomes by integrating a structured program into primary care appointments. This study informs and directs the execution of self-management and education programs by drawing on current knowledge through an extensive literature evaluation. The ITHBC and CSM of Self-Regulation, together with the project question and purpose, set the groundwork for addressing the urgent need to enhance self-management practices and knowledge in this vulnerable population. The following parts will examine the literature, methodology, and analysis to provide insightful information to the continuing discussion over managing diabetes among African Americans. Background of the Problem A condition known as diabetes mellitus results in an unusually high blood sugar level in the patient. The condition is a metabolic disorder because the body does not create sufficient insulin to regulate the blood sugar. Diabetes comes in two forms: early onset and late-onset. The late onset is the one referred to as Type II Diabetes. Since DM can affect the entire body and necessitates regular self-care, complications could drastically lower life expectancy and negatively influence the quality of life. Projections from the International Diabetes Federation (2023) indicate that by 2045, one out of eight adults, or approximately 783 million, will have diabetes, a 46 percent increase. Type 2 diabetes, which is primarily caused by socioeconomic, demographic, environmental, and genetic factors, affects more than ninety percent of those with the disease. According to recent data on the prevalence of diabetes in 2021 released by the American Diabetes Association, 1.2 million Americans receive a diabetes diagnosis every year, accounting for 38.4 million Americans or approximately eleven percent of the population (American Diabetes Association, 2023). The world economy has expanded over the last 30 years, particularly in developing nations, and notable shifts have followed this growth in lifestyle, employment, and dietary habits. Highly processed foods high in calories, sugar, salt, and saturated fats have replaced less processed ones. Rapid industrialization and urbanization have brought significant environmental contamination, particularly in the air. Furthermore, there is less activity because of the increasingly sedentary work routine. These elements are crucial in developing type 2 diabetes (Ye et al., 2023). The urgency of addressing diabetes promptly is essential in mitigating its impact on individuals and the healthcare system, given that it rates as the eighth leading cause of mortality in the USA. There are apparent differences in diabetes, especially among African Americans. When it comes to health results and status, Black Americans and White Americans differ significantly. Compared to the entire U.S. population, young adult African Americans have a much higher burden, morbidity, and death from chronic diseases (ASPE, 2022). The U.S. Census Bureau reports that in 2020, non-Latino White Americans had a 3.6-year longer life expectancy than Black Americans. According to the CDC, recognizing and resolving the different SDOHs helps reduce health risks and inequities. Examples of factors that may contribute to healthcare disparities are shown in Figure 1. Figure 1: Factors Contributing to Health Disparities According to data from the American Diabetes Association, around 38.4 million Americans had diabetes in 2021, and an estimated 1.2 million Americans receive a diagnosis each year (American Diabetes Association, 2023). Individuals' lives are influenced by the socially constructed classifications of race and ethnicity, which are determined by self-perception and external perception. One example of the differences in health outcomes is the fact that African Americans have a far greater prevalence of diabetes than White people do. The economic expenses of diabetes care, which account for sixty-one percent of healthcare spending, also show these discrepancies beyond prevalence numbers. African Americans' skepticism or lack of trust in the healthcare system is a result of these discrepancies. African Americans' use of healthcare is impacted as a result. Taylor (2019) asserts that individuals belonging to racial and ethnic minority groups, as well as other marginalized populations, experience a higher degree of negative impact from the inequalities present in the American healthcare system. These inequities result in discrepancies in the provision of health insurance, inequitable access to treatments, and inferior health outcomes for specific communities. The majority of African Americans are affected by these healthcare issues. Poorer health outcomes are a result of inequities and African Americans' mistrust of the healthcare system. A chronic illness, obesity poses a serious threat to public health since several interrelated genetic, psychological, and environmental factors influence it. Obesity is one of the most severe adverse effects of Type II Diabetes Mellitus. According to research, Black Americans experience disparities that could explain their more excellent obesity rates, including a lower socioeconomic level and less availability of nutrient-dense foods (Washington et al., 2023). The other main element influencing diabetes mellitus is socioeconomic status. Diabetes screening is recommended for all obese people. The first step in avoiding and treating type 2 diabetes is treating obesity (Yashi & Daley, 2023). Disparities in obesity treatment disproportionately affect racial and ethnic minorities, with African Americans being significantly impacted. Numerous assessments have been conducted to determine whether variables other than race are responsible for the diabetes discrepancy between Whites and African Americans. Given the elevated prevalence of diabetes within the African American community, Zarkasi et al. (2022) hypothesize that African Americans may have a genetic predisposition to the disease or that there may be negative gene-environment interactions that make them more vulnerable than White people. For at least half of the 20th century, Whites had a higher diabetes rate than African Americans, suggesting that current lifestyle variables may affect African Americans more. In addition to being more prone to chronic disease, morbidity, and mortality than the general population, African Americans also face health disparities that go beyond diabetes (ASPE, 2022). Diabetes mellitus can have insidious side effects. Diabetes that is not under control or managed can result in kidney damage, high blood pressure, eyesight loss, limb loss, strokes, heart failure, nerve damage, and even death. The disease of diabetes is deadly (World Health Organisation, 2023). The most costly chronic illness in the USA, according to the CDC (2022), is diabetes. The care of diabetics accounts for one dollar of approximately every four dollars spent on US healthcare. The need to manage Type II Diabetes Mellitus within this more significant epidemic disproportionately impacts African Americans. Review and Summary of Relevant Literature PICO(T) Process In the healthcare sector, where it is crucial to develop precise and focused research questions, the PICO framework is an indispensable research tool. PICO(T), which indicates Population, Intervention, Comparison, and Outcome, provides a structured approach to developing research questions (Pacher, 2022). To establish the study's goals and guide the subsequent systematic evaluation, a thorough analysis of the PICO(T) features is required in the context of this research on abuse and neglect in couples and families. Patient/Population The first phase in the PICOT process is to identify the patient group or target population (Pacher, 2022). The study's patient sample consists of African American adults aged 21 to 68 who are patients of a Georgia primary care practice and have uncontrolled diabetes mellitus type II. This broad group includes people from various demographics, socioeconomic backgrounds, and family structures. This population definition makes it possible to analyze the issue in great detail. Intervention The second step of the PICO(T) process includes information regarding the intervention under consideration. A structured self-management education and training program would be conducted during primary care appointments as part of the proposed intervention. This method acknowledges how crucial it is to incorporate diabetes education into regular medical encounters to improve patient knowledge and abilities. This cost-effective approach improves glycaemic control and patient-related outcome indicators, particularly when paired with psychological therapies. Comparison The comparison group is made up of White adult patients with Type II Diabetes Mellitus who did not get the self-management education and training intervention during their primary care visits, as opposed to African American adult patients with the same illness who did. This study investigates possible racial differences in the intervention's three-month effects on self-management behavior and knowledge. This aids in identifying the precise impact of the education and training program on self-management. Outcome This step of the PICOT method describes the intervention's targeted outcome. The main goal is to increase self-management knowledge and behavior significantly. This result consistently improves patients' capacity to control their diabetes and health outcomes adequately. Time The three-month period set aside for evaluation offers a precise and practical time frame. It makes it possible to evaluate the intervention's immediate effects and understand its effectiveness immediately. Methods The PRISMA checklist's quality standards were followed in the execution and reporting of this research project. The selection, assessment, and extraction of data from the studies were done separately. The researcher searched several databases, including HMIC, PsycINFO, PubMed, Embase, CINAHL, and Scopus. The researchers utilized terms such as "African American diabetes Mellitus," "self-management of diabetes," "African American diabetes disparities," "self-management skills in chronic disease management," "diabetes self-management skills," and "African American diabetes culture and traditions" from 2019 to 2024 meet the inclusion requirements. This extensive screening approach aimed to gather relevant research articles about diabetes in African Americans, including its effects, self-management, and educational resources. Inclusion and Exclusion Criteria This criterion captured empirical research that represented elements of integration with DSMES into routine care. A description of how DSMES is integrated into ordinary care and research evidence to support this integration were the primary inclusion criteria. The articles had to describe two or more integrations, provide a precise definition or description of DSMES based on empirical research, define the relationships to an interdisciplinary team, show continuous DSMES in various care delivery settings with clear connections to the community, primary secondary, and tertiary care, or a virtual support network for constant assistance, and discuss DSMES to adult participants with type 2 diabetes diagnoses and identify the medical professionals who provided DSMES to these individuals. Some articles could be read in their entirety. Articles written in languages other than English or released before 2019 were not included. Results In the first phase, the researcher examined databases and read literature reviews to find 3480 publications. The researcher later evaluated abstracts in the initial screening phase to decide whether or not to approve them for review. The article was added to the second screening round if there were a chance it would fit the requirements. Since it was evident that eight hundred did not match the criteria, they were eliminated. Automation methods were used to eliminate 120 research studies in total. The researchers found 380 articles in the database search; all were quickly eliminated as duplicates. A second screening of the 2,180 included was conducted. Examining full-text reports was one step in the second screening process. A total of 2000 articles were eliminated because of the conflicting results, 100 because reports were missing, 48 because the articles were not in the proper context, and ten because the quantitative data in the articles was insufficient. Figure 2 shows specifics. 56705574295Identification of studies via databases and registers00Identification of studies via databases and registers-11607803146425Screening00Screening559435410845Records identified from*:Databases (n = 3480)00Records identified from*:Databases (n = 3480)3039745410845Records removed before screening:Duplicate records removed (n = 380)Records marked as ineligible by automation tools (n = 120)Records removed for other reasons (n = 800)00Records removed before screening:Duplicate records removed (n = 380)Records marked as ineligible by automation tools (n = 120)Records removed for other reasons (n = 800)5594351911985Records screened(n = 2180)00Records screened(n = 2180)30480001911985Records excluded**(n = 2000)00Records excluded**(n = 2000)5607052719705Reports sought for retrieval(n = 180)00Reports sought for retrieval(n = 180)30492702738755Reports not retrieved(n = 100)00Reports not retrieved(n = 100)5619753520440Reports assessed for eligibility(n = 80)00Reports assessed for eligibility(n = 80)30575253517900Reports excluded:Out of Scope (n = 48)Insufficient Detail (n = 10)Limited rigor (n = 10)00Reports excluded:Out of Scope (n = 48)Insufficient Detail (n = 10)Limited rigor (n = 10)5403854786630Studies included in review(...