Interventions to Develop Education for Diabetic Patients

Research literature design and implications of young diabetic adults aged 18 to 40 years of patient education is a vital healthcare needs in the contemporary generation. This is a growing concern in many countries. The impact of diabetes is profoundly affected by morbidity, mortality, and healthcare costs in the USA. According to The Centers for Disease Control and Prevention (2017), out of 30.3 million US population that has diabetes, 1.5 million new cases are diagnosed to adults who are 18 years or older while 84.1 millions of Americans have prediabetes that may develop into diabetes within the next five years. The is to reduce this high rates by encouraging and educating young adults, teens and their families and caregivers to follow healthier nutrition, diet and exercises to improve the quality of life practice healthy lifestyle, and prevent complications. This paper will present research-based literature, supporting evidenced-based PICOT questions related to diabetic patient education based on research approaches, design, sample collection of subjects, and proposed implementation strategies and change model implications.

Research Literature Support

Clinical practice protocols are systematic reviews of data that gives a guidance of the quality of the appropriate scientific literature and consists of a validity of the benefits and harms of alternative methods of  consistent practice of physical activities along with dietary restrictions caused the significant adherence to treatment regimen, reduction of HbAIC , self motivation for initiations, and increase in workforce productivity in diabetes patient population (Lari, Noroozi, & Tahmasebi, 2015). The PICOT question is the following: How can patients and families or caregiver of young adults 18 to 41 years engage in evidenced-based patient education and interventions to reduce the risk of diabetes and blood glucose control over the next six months period? The following literature reviews and evidence related to this PICOT question.

The first literature review was to examine the relationship between advanced technology initiated education, and glucose monitoring could help diabetes adolescent and young adults to control blood sugar and promote their general health. The study was a government registered clinical trial that included 182 randomly selected diabetes patients of age varied from 14 to 24 years of age. The method used was a randomized controlled trial. The new trend was a multicenter, open-label, randomized subjects were treated by basal-bolus insulin. The controlled group was allocated with traditional glucometer, and conventional education materials of booklets, and brochures. Ninety-two people were awarded by iBGStar and text messaging reminders for glucose monitoring, and electronic smartphone apps of diabetes education and recording glucose results. Both groups were monitored monthly for their HbAIC reports and follow up visits by a provider. Complaint subjects were shown the more significant reduction in HbAIC levels of 0.61% than that of control group of  0.18% (Di Bartolo et al., 2017) This study Identified that younger diabetes population has capable and improve adherence to treatment regimen and acceptable to promotion of health interventions when they were given new technologies and user friendly electronic tools and strategies.

The secondary literature was to identify the relationship due to the changes in nutritional education, physical activity, and exercises, that relates to the behavioral changes and psychosocial adaptation to the changed practices. The study was focused on 238 adult diabetic patients of age variation from 18 years and 41 years for six months. It was based on patients, caregivers, and families. It was a no randomized controlled study. The program included patient family education about diet, exercise, consistent monitoring of blood glucose levels, home visits, and group education and control group. Constant follow up with providers, usage of electronic education strategies and applications of activity logins, self-empowerment, and ownership of care. Total of 238 individuals and caregivers that are chosen from the local community health center participated in the study. The population included 120 males and 118 females. Inclusion criteria were diagnosed with diabetes, type II diabetes, and their blood glucose levels were higher than average, and hemoglobin AIC is higher than 8.0 consistently(Santos et al., 2017). A well informed ethical consent was obtained from the patients, and caregivers were also informed consent was taken and requested their participation as well for the next six months interventions. The Socio-demographic self-care and empowerment data collected. Statistical analysis performed by education tools and methods that showed p<0.001). Results showed that both strategies presented the same conclusions regarding self-care practices and treatment adherence and patient ownership of care, but education group had better HbAIC level reduction of that of the control group

The third literature review is a quasi-experimental design used to assess Telemedicine Assisted Self-Management Program for Type 2 Diabetes Patients. This study was to determine how telemedicine assist with the self-management of diabetes care in everyday life of patients as needed. The study used to evaluate the effects in terms of HbAIC values and self-management behavior of telemedicine assisted self-management program offered to Type II diabetic patients by a large insurance company. The method used was the experimental design. Sixty young adults were in the intervention group M= 59.4 years, and 55 were in the control group, of age 58.4 years.  The study provided a tablet for the intervention group and motivated for diabetes self-management skills. The control group received usual visits and not offered any additional treatment (Von Storch et al., 2019). The examined subjects after three months. The intervention group had a decline in HbAIC and improvements in self-management as that of the control group. The study gave positive effects on telemedicine and innovative education effects on diabetes care. But the sample was small, and need further studies to verify the feasibility and effectiveness in more extensive scale study.

The fourth literature review was to explore the range of teaching approaches and culturally competent education used in diabetes patients. The purpose of the study was to address patient educational needs, diet modifications, and treatment options that are according to patient culture, and needs. The study was conducted in 3 countries and employed using multiple ethnographic data collection by observation and qualitative personal and telephonic interviews. Data was collected 39 participants observation and 22 interviews across three counties. Collective didactic meetings were a collective conversation allowed each one to derive their management plan. Clinician provided information and used knowledge reinforcement to facilitate behavioral changes (Choi, et al., 2019). Participatory diabetes education from western culture did not translate to the people in the east culture side and varied in each ethnic group perception and adaptation. Personal interests, adaptation, and motivation were significantly variable than traditional education strategies and diet modifications, and exercises.

The fifth study conducted to evaluate the patient adherence to the therapy influence associated with social, psychological, economic, and person-centered approach besides that of other factors. The aim of this study was mental and behavioral impacts on diabetes patient into the educational interventions and compliance of treatments. Compliance was assessed indirectly by the principal outcome of HbAIC results. The method used was a systematic review and meta-analysis of a randomized controlled trial of one thousand seven hundred eighty-two participants from age variation from 18 to 24 years. There were 57 studies conducted, and 191 articles were published, and four groups were divided for interventions for psychological interventions(818 patients), such as psychoeducation(153), telecare(494), traditional education(394). The study was aimed for a period of 2 months to 24 months (Viana et al., 2017). The decrease in HbAIC has noted a significant reduction in psychologically supported population P=.035 the highest level of discount. The conclusive result was psychological approaches. Interventions increase the adherence of diabetic care and modestly reduced HbAIC.

The purpose of the sixth literature review was to analyze the hypoglycemia among patients with diabetes: Epidemiology, risk factors,  and prevention strategies. Hypoglycemia is a common treatment-limiting adverse effect of diabetes therapy. Hypoglycemia is preventable with proper education and precautions.review the epidemiology and risk factors of hypoglycemia to discuss for the prevention strategies. American  Diabetes Association (ADA) classified asymptomatic hypoglycemia is a blood glucose level below 70 mg/dl. It was an observational study revealed that 0.7 to 12 cases per 100 person-years. 0.2 % of patients treated without insulin. 2 per 100 person-years were treated with insulin therapy. 1to 17 % of insulin-dependent patients needed hospitalizations and assistance for the recovery. 1to 4% non -insulin-dependent patients required hospitalization for hypoglycemia. The study was conducted for 12 months. 37to 64 % verbalized need for education hypoglycemic symptoms (Silbert et al., 2018). The study revealed that, and multidisciplinary educational care may reduce hypoglycemia incidences proactively in diabetes patients. Most symptoms of hypoglycemia happen outside healthcare systems, and we lack an effective method to recognize and document such events while blood glucose levels are randomly monitored. Continuous glucose monitoring systems and responsive symptom testing are to be part of treatment plans for severe hypoglycemic events.

The seventh study aimed to identify the indicators of self-management in insulin administration in diabetes patients. The method used was a cross-sectional survey of 72 participants in a metabolic center in Taiwan. The subjects were started to use Lantus, Levemir, Humulin R. Novomix pen injectors, for six months. The study targeted knowledge, photograph demonstrating injection skills, self-efficacy, in self-administration of insulin injections. The study revealed that education level was above high school level education for the subjects to be efficient in insulin injection skills. Diabetes duration was a predictor for usage.  The variance was 41% in self-efficacy. Healthcare professionals need to establish specific teaching strategies to implement insulin administration skills for diabetes patients before discharge from the hospital (Huang et al.,2019).

The purpose of the eights study was done to research about healthy habits that established in the early in life can lead to healthy promotional behaviors, easy adaptation, and health-focused decision making in later stages of life. It shows the importance of training children in a healthy diet, routines, and moral values for psychological health and physical health as they grow to adulthood. Educational strategies to start in community settings to head start program in preschool and elementary school-age of 3 to 5 years of age along with their families. Methods were used as a collaborative community study from Jackson County Civic action Agency and supported by the Mississippi Gulf Coast Youth Health coalition Childhood Obesity Initiatives. The research was a quasi-experimental educational group and controlled group pre and post-test design to evaluate 12 weeks physical activities and nutrition education program in early strat setting. Results showed that in fruit (5.6 )and vegetable (16.1) intake scores and “tried and liked methods.” Subjects in the intervention group were n =303, and control group was n=  86 (Fastring et al., 2018). Conclusion of the study was utilizing headstart early health education strategies for the earlier aged people with family support that assist in obesity control strategies to adopt a positive behavioral change for the healthy lifestyle strategies for the promotion of health and adaptation of healthy food habits.

The ninth study was to utilize to assess the impact of community-based food education program to increase nutrition-related knowledge in Type II diabetes patients. The method was a randomized controlled study. The subject population of the educational group was  20. Control group was 16. The review was nine months long. Age limit is from 20 years to 60 years of age.  Subjects were randomly assigned to a community-based exercise program, and nutritional knowledge was assessed by a General Nutritional Knowledge Questionnaire (Vasconcelos et al., 2018). No variation was found in both groups between understanding of dietary recommendations and diet-disease relationships. Dietary improvements were found in the intervention group than the control group. This is a community based easy applicable tasks with short lectures and dual-task problem-solving activities along with exercises.

The tenth study conducted to utilize to assess the impact of community-based food education program to increase nutrition-related knowledge in Type II diabetes patients. The method was a randomized controlled study. The subject population of the educational group was  20. Control group was 16. The review was nine months  of period long. Age included from 20 years to 60 years of age.  Subjects were randomly assigned to a community-based exercise program, and nutritional knowledge was assessed by a General Nutritional Knowledge Questionnaire (Vasconcelos et a., 2016). No variation was found in both groups between understanding of dietary recommendations and diet-disease relationships. Dietary improvements were found in the intervention group than the control group. This is a community based easy applicable tasks with short lectures and dual-task problem-solving activities along with exercises.

The purpose of the eleventh literature was quality of life study. Quality of life study included 50 healthy people and 50 diabetic patients. This study consists of an intellectual concept of positive and negative aspects of an individual’s life experiences and how an individual perceives the health condition and how he or she reacts to it and how that translates into a chronic disease such as diabetes. This study was focusing on diabetes type II patient population. Fifty people were in an educational group, and 50 people were in the control group, aged 30 to 60 years. It was a qualitative study with experimental design model, with interviewing methods and follow up after 12 months of re-evaluating the same questionnaire completion. Results showed that the mean of quality of life points regarding physical functionality, emotional health active participation, vitality, enthusiasm, social involvements, bodily tolerance to pain are were much lower scores in diabetes patients than the control group (Aghakoochak et al., 2014). This verifies that diabetes patients require a psychological, and educational and emotional support as whole-person care and holistic care to achieve their full potential recovery process, and treatment plans.

Research Approach and Design

The research approach applied for the PICOT question will be a quantitative approach, and q quasi-experimental (QE) design used for data collection and sampling. In this quantitative approach, the study is based on scientific methods that generate numerical data. That will develop a relationship with subjects, variables relation to intervention, and no intervention group. The strength of the relationship is studied, and the occurrence of relationship also collected. In the QE design, mostly non-randomized sample collection before the introduction of relationship and steps of pre-assessment and post-assessments and approaches. In both groups of subjects are consented for the relationship and disclosures of the methods and received test variables. The intervention guidelines are collected in the education group, and the control group does not accept any further instructions or interventions. They both educational group and control groups receive post-test at the end of the period of study. This design assists in my PICOT question in the analysis of data, results, and conclusive statements. Advantage of this design is an application of relationship to educational group and control group was varied advancements in intervention relates to valuable information in the results and conclusion of the study (Camille, Nian-Lin, & Ban, 2016). The disadvantage of this model was that bias could be in the control group, relationship, and sample collection because it was a nonrandomized sample collected for six months.

My PICOT question is: What are the roles used as a description of the education, learning process, and the effects of training in diabetic care in young adults diabetic patients?

Specific research approach appropriate for the PICOT question will be a quantitative approach with quasi-experimental (QE) design will be used for data collection, analysis, and outcome and result proposal. It will seek relationship and the strength of the relationship between two variables within the education group and control group (Polit, & Beck, 2017). Test variable will be diabetic education methods of delivery of traditional education methods and using technology assistance and smartphone applications and follow up HgbAIC evaluation after six month period.

Data collection methods will be through the Questionnaire and validation of their HgbAIC values before and after the six-period of study analysis. The program will be incorporated through the providers of the local community health center diabetic clinic. Open-ended Questionnaire will be the electronic version as well as paper format. Quality data of EBP will be beneficial to behavioral and change modifications for the contemporary health care system needs of the younger diabetic patients health promotion and prevention of complications (McCusker, & Gunaydin, 2015).

Variables were that of diabetic education in the traditional way and technology-assisted school. The study will be facing challenges of lack of control, and biased results can not be excluded. It will be a consented study so that the individuals are fully informed, and that may cause behavioral changes due to the personal impacts on research or study interviewer. The self-motivation and enhancement of self-care management and ownership of care facilitate better adherence of treatment plans and positive reinforcement and effects on self-care, and self-discipline (Sweeney, & Moyer. 2015). This could be a strength of the study to motivate and cause behavioral changes in young adults to be part of group study and take ownership of care to prevent complications and promote their general well being (Di Bartolo et al., 2017).  The variable outcome will be a reduction of HbAIC levels and promotion of self-care management efficiency that leads to self-motivation in young adults to lead a healthy lifestyle. This also will promote continuous follow-up care for six months and self-validation for the reprocessing results of HbAIC that indicates their blood glucose control and diet modifications and activity regimen results. This will assist them for their efforts and be paid for their participation

Sampling

Age group will be diabetic patients from 18 to 40 years of age and including male and females. Targeting 30 diabetic patients participated in the study for the duration of the study time. Group was meeting biweekly for six months period. Study sampling was non- probability sampling method. Patients with Hb AIC level more than 7.5 was assigned to an educational group, and less than 7.5 was assigned to the control group. The sample size is a mall in numbers, so validity was questioned. Exclusion criteria were non consented patients, and Hb AIC was less than 6.5. Advantage was sample size small, so intervention was productive and well recognized by the group and developed a personal trust with the researcher and the subjects, and able to provide a holistic approach of mind-body-spirit care to whole family and caregivers., Disadvantage was small size and biased due to self-motivation was a factor in behavioral changes, sampling and time period was not sufficient (Wagner,  & Ramsey, 2015).

Proposed Implementation with a Change Model

Plan, Do, Study, and Act (PDSA) model is a tool for management and learning. It is quality improvement initiative guidelines for the contemporary healthcare initiatives that we face. This is process improvement strategies shows relevant data of success in ever-changing problems in current societal needs (Donnelly, & Kirk,2015). This initiative model makes modern healthcare safety, a change catalyst for the betterment of patients, community to provide evidence-based cost-effective and value based care in consumer focussed and patient centered holistic manner. In PDSA model Interveiwer will establish the purpose, plan the actions and interventions, study the consequences and steps of implementation, then establish them to act on based of use and planning. Researcher continuously observes the progress and impacts and formulates the changes with the effects of the study and efforts(Camille, Nian-Lin, & Ban, 2016).

In this study plan the study process and strategies data collection, sampling methods, plan of actions of group engagements, education, consistent reinforcements, and action plans. Management of education, HbAIC monitoring, exercise programs, the adaptation of education in a traditional manner, electronic resources adaptation, and utilization. The researcher will document every observation for the improvements and study conclusion validation as study progress. The researcher will make a note of the strengths and weaknesses of the quasi-experimental design as it arises. The researcher will continually study and validate available study evidence pertains to the specific topic of diabetes education. The researcher will analyze pre-test and post-test values, weight monitoring, questionnaire evaluations (Wagner,  & Ramsey, 2015). The final step to act upon that observation and data collection to implement the changes needs to be done to improve patient self-management and patient outcome of specific diabetes young adult patients

The proposed actions will be diabetic education electronic resources, traditionally printed materials, dietary modification, and  consistent exercise program, and follow up monitoring of HbAIC before and after the six months of EBP program, intervention and data collection reveal facilitation of self-care and ownership of care (Sweeney, & Moyer. 2015).

A potential barrier of the model of this EBP is data collected is insufficient to make a decision, due to the small sample size and shorter period of observance of the group (Walker, 2015). More health centers are open for research and resources, and volunteer participation of healthcare providers are beneficial to increase research opportunities to enhance and act positively upon the results.

Conclusion

We are encouraging family and caregiver support in the participation of education sections to facilitate lifestyle and behavioral changes. Intervention group encouraged to use smartphone apps for electronic educational assistance and reminders for glucose monitoring. EBP with education and clinical practice gives us continuous process improvements in our practice and patient outcome improvements for the patient safety and reduction of morbidity mortality and cost-effective and efficient care to each patient every time. This model is widely accepted and highly recognized in healthcare, business as well as in the technological world

References

• Aghakoochak, A., Shojaoddiny-Ardekani, A., Vakili, M., & Namiranian, N. (2014). Quality of Life in Diabetic Patients: A Case-Control Study.
  
  Iranian Journal of Diabetes & Obesity (IJDO)
  
  ,
  
  6
  
  (1), 28–33. Retrieved from
  
  https://search-ebscohost-com.chamberlainuniversity.idm.oclc.org/login.aspx?direct=true&db=a9h&AN=100219499&site=eds-live&scope=site
  
• Aloe, A., Becker, B., Duvendack, M. (2017). Quasi-experimental study designs series—paper 9: Collecting data from quasi-experimental studies.
  
  Journal of Clinical Epidemiology,
  
  
  89
  
  , 77-83. doi:10.1016/j.jclinepi.2017.02.013
• Camille, Y., Nian-Lin, R., & Ban, L. (2016). Legal and ethical issues in research.
  
  Indian Journal of Anaesthesia, 60
  
  (9), 684-688. doi:10.4103/0019-5049.190627
• The Centers for Disease Control and Prevention (2017). Retrieved from: http://www.cdc.gov/diabetes/pubs/ statsreport14/national-diabetes-report-web.pdf.
• Donnelly, P., & Kirk, P. (2015). Use the pdsa model for effective change management.
  
  Education for Primary Care, 26
  
  (4), 279-281. Retrieved from https://chamberlain-on-worldcat-org.chamberlainuniversity.idm.oclc.org/oclc/718372298/
• Lari, H., Noroozi, A., & Tahmasebi, R. (n.d.). Comparison of Multimedia and SMS Education on the Physical Activity of Diabetic Patients: An Application of Health Promotion Model.
  
  IRANIAN RED CRESCENT MEDICAL JOURNAL
  
  ,
  
  20
  
  . https://doi-org.chamberlainuniversity.idm.oclc.org/10.5812/ircmj.59800
• Choi, TST., Walker, KZ., Palermo,C., (2017). Culturally Tailored Diabetes Education for Chinese Patients: A Qualitative study. 5(28): 315-323. Retrieved from doi: 10.1177/1043659616677641. Equub. 2016. PMID:27856820.
• Di Bartolo.P., Nicolucci.a., Cherubin, V., Iafusco. D., Scardapane,. M., Rossi. Mc.,(2017) young patients with type I diabetes poorly controlled and poorly compliant with self- monitoring of blood glucose : can technology help? Results of the i-newTrend randomized clinical trial.4/2017 54(4):393-402. Retrieved from http:// doi:10.1007/s00592-017-0964-4.e pub(2017).PMID. 28138788.
• Fastring. D., Keel, K., Colby, D., ConnerJM., Hilbert, A., (2018). Head Start Centers Can Influence Healthy Behaviors: Evaluation of a nutrition and Physical Activity Educational Intervention. American School Health Association 6(18). Retrieved from.  doi: 10.1111/josh.12811. PMID: 31245850.
• Huang, MC., Hung, CH., Huang YW, Yang SC., (2019). Predictors of self-efficacy in Administering insulin Injection:  Retrieved from 6/(2019): 1054773819858484 doi: 10.1177/1054773819858484.
• McCusker, K., & Gunaydin, S. (2015). Research using qualitative, quantitative or mixed methods and choice based on the research.
  
  Perfusion, 30
  
  (7), 537-542. doi: https://doi.org/10.1177%2F0267659114559116
• Santos JCD, Cortez, DN., Macedo, MML., ReisEA., Torres, HC., (2017). Comparison of education group strategies and home visits in type II diabetes mellitus: 12.25 :e 2979 Retrieved: FROM DOI:10.1590/1518-8345.2315.2979.PMID:29267547.
• Silbert, R., Montenegro., A.S., Guiterrez. R.R., Katabi. A., McCoy. R.,( 2018). Hypoglycemia among Patients with Type 2 Diabetes: Epidemiology , Risk factors, and Prevention strategies.6.(21):18 (8):53
  
  Curr Diab Rep
  
  .6.(2018). Retrieved from doi:10.1007/s 11892-018-1018-0 NIHMSID: NIHMS 986020.
• Smith. K., Baker, K., Bardsley, J.,  & McCartney, P., Magee,.M., (2019). Redesigning Hospital Diabetes Education: A Qualitative Evaluation with Nursing Teams.
  
  Journal of Nursing Care Quality
  
  34(2) 4/ 4019 p. 151-157. Retrieved from doi:10.1097/NCQ.0000000000000349-1057-3631.
• Vasconcelos, C., Almeida A., Cabrral, M., Ramos, E., Mendes, M., (2016). The impact of a community Based Food Education Program on  Nutrition Related Knowledge in Young Diabetes patients.16(13) E 2403.  Retrieved from doi: 10.3390/ijerph1632403. PMID 31284568.
• Viana LV., Gomes, MB., Zaljdenverg L., Pavin EJ., Azevedo, MJ. diabetes study I group.( 2017) Interventions to improve patient compliance with therapies aimed at lowering glycated hemoglobin HbAIc in type I diabetes: a systematic review and meta analysis of randomized controlled study of psychological and educational interventions.: Retrieved from 2(17) 17.94: doi. 10.1186/s 13063-016-1207-6 PMC 4758163
• Von Storch, K., Graaf. E., Wunderlich M., Reitz. C., Polidori, MC., Woopen. C(2019), Telemedicine -Assisted Self- Management Program for Type 2 Diabetes Patients. Retrieved from doi:10.1089/dia.2019.0056. PMID 31287736.
• Vasconcelos, C., Almeida A., Cabrral, M., Ramos, E., Mendes, M., (2016). The impact of a community Based Food Education Program on  Nutrition Related Knowledge in Young Diabetes patients.16(13) E 2403.  Retrieved from doi: 10.3390/ijerph1632403. PMID 31284568.
• Wagner, C., & Ramsey, C. (2015). A systematic approach to representative sampling- sampling quality criteria, material properties, theory of sampling.
  
  Journal of AOAC International, 98
  
  (2), 264-264. Rerieved from
  
  https://web-a-ebscohost-com.chamberlainuniversity.idm.oclc.org/ehost/pdfviewer/pdfviewer?vid=1&sid=21f8f0fa-a79b-4d42-962b-f6e55f39443f%40sessionmgr4008
  
• Walker, W. (2015). The strengths and weaknesses of research designs involving quantitative measures.
  
  Journal of Research in Nursing
  
  ,
  
  10
  
  (5), 571-582.
  
  https://doi.org/10.1177%2F136140960501000505
  
• Benjamin, N., Taveras, E., Ostbye, T., & Gillman, M. (2014). Preventing obesity in infants and toddlers in child care: Results from a pilot randomized controlled trial.
  
  Maternal and Child Health Journal, 18
  
  (5), 1246-57. doi:10.1007/s10995-013-1359-x

Research literature design and implications of young diabetic adults aged 18 to 40 years of patient education is a vital healthcare needs in the contemporary generation. This is a growing concern in many countries. The impact of diabetes is profoundly affected by morbidity, mortality, and healthcare costs in the USA. According to The Centers for Disease Control and Prevention (2017), out of 30.3 million US population that has diabetes, 1.5 million new cases are diagnosed to adults who are 18 years or older while 84.1 millions of Americans have prediabetes that may develop into diabetes within the next five years. The is to reduce this high rates by encouraging and educating young adults, teens and their families and caregivers to follow healthier nutrition, diet and exercises to improve the quality of life practice healthy lifestyle, and prevent complications. This paper will present research-based literature, supporting evidenced-based PICOT questions related to diabetic patient education based on research approaches, design, sample collection of subjects, and proposed implementation strategies and change model implications.

Research Literature Support

Clinical practice protocols are systematic reviews of data that gives a guidance of the quality of the appropriate scientific literature and consists of a validity of the benefits and harms of alternative methods of  consistent practice of physical activities along with dietary restrictions caused the significant adherence to treatment regimen, reduction of HbAIC , self motivation for initiations, and increase in workforce productivity in diabetes patient population (Lari, Noroozi, & Tahmasebi, 2015). The PICOT question is the following: How can patients and families or caregiver of young adults 18 to 41 years engage in evidenced-based patient education and interventions to reduce the risk of diabetes and blood glucose control over the next six months period? The following literature reviews and evidence related to this PICOT question.

The first literature review was to examine the relationship between advanced technology initiated education, and glucose monitoring could help diabetes adolescent and young adults to control blood sugar and promote their general health. The study was a government registered clinical trial that included 182 randomly selected diabetes patients of age varied from 14 to 24 years of age. The method used was a randomized controlled trial. The new trend was a multicenter, open-label, randomized subjects were treated by basal-bolus insulin. The controlled group was allocated with traditional glucometer, and conventional education materials of booklets, and brochures. Ninety-two people were awarded by iBGStar and text messaging reminders for glucose monitoring, and electronic smartphone apps of diabetes education and recording glucose results. Both groups were monitored monthly for their HbAIC reports and follow up visits by a provider. Complaint subjects were shown the more significant reduction in HbAIC levels of 0.61% than that of control group of  0.18% (Di Bartolo et al., 2017) This study Identified that younger diabetes population has capable and improve adherence to treatment regimen and acceptable to promotion of health interventions when they were given new technologies and user friendly electronic tools and strategies.

The secondary literature was to identify the relationship due to the changes in nutritional education, physical activity, and exercises, that relates to the behavioral changes and psychosocial adaptation to the changed practices. The study was focused on 238 adult diabetic patients of age variation from 18 years and 41 years for six months. It was based on patients, caregivers, and families. It was a no randomized controlled study. The program included patient family education about diet, exercise, consistent monitoring of blood glucose levels, home visits, and group education and control group. Constant follow up with providers, usage of electronic education strategies and applications of activity logins, self-empowerment, and ownership of care. Total of 238 individuals and caregivers that are chosen from the local community health center participated in the study. The population included 120 males and 118 females. Inclusion criteria were diagnosed with diabetes, type II diabetes, and their blood glucose levels were higher than average, and hemoglobin AIC is higher than 8.0 consistently(Santos et al., 2017). A well informed ethical consent was obtained from the patients, and caregivers were also informed consent was taken and requested their participation as well for the next six months interventions. The Socio-demographic self-care and empowerment data collected. Statistical analysis performed by education tools and methods that showed p<0.001). Results showed that both strategies presented the same conclusions regarding self-care practices and treatment adherence and patient ownership of care, but education group had better HbAIC level reduction of that of the control group

The third literature review is a quasi-experimental design used to assess Telemedicine Assisted Self-Management Program for Type 2 Diabetes Patients. This study was to determine how telemedicine assist with the self-management of diabetes care in everyday life of patients as needed. The study used to evaluate the effects in terms of HbAIC values and self-management behavior of telemedicine assisted self-management program offered to Type II diabetic patients by a large insurance company. The method used was the experimental design. Sixty young adults were in the intervention group M= 59.4 years, and 55 were in the control group, of age 58.4 years.  The study provided a tablet for the intervention group and motivated for diabetes self-management skills. The control group received usual visits and not offered any additional treatment (Von Storch et al., 2019). The examined subjects after three months. The intervention group had a decline in HbAIC and improvements in self-management as that of the control group. The study gave positive effects on telemedicine and innovative education effects on diabetes care. But the sample was small, and need further studies to verify the feasibility and effectiveness in more extensive scale study.

The fourth literature review was to explore the range of teaching approaches and culturally competent education used in diabetes patients. The purpose of the study was to address patient educational needs, diet modifications, and treatment options that are according to patient culture, and needs. The study was conducted in 3 countries and employed using multiple ethnographic data collection by observation and qualitative personal and telephonic interviews. Data was collected 39 participants observation and 22 interviews across three counties. Collective didactic meetings were a collective conversation allowed each one to derive their management plan. Clinician provided information and used knowledge reinforcement to facilitate behavioral changes (Choi, et al., 2019). Participatory diabetes education from western culture did not translate to the people in the east culture side and varied in each ethnic group perception and adaptation. Personal interests, adaptation, and motivation were significantly variable than traditional education strategies and diet modifications, and exercises.

The fifth study conducted to evaluate the patient adherence to the therapy influence associated with social, psychological, economic, and person-centered approach besides that of other factors. The aim of this study was mental and behavioral impacts on diabetes patient into the educational interventions and compliance of treatments. Compliance was assessed indirectly by the principal outcome of HbAIC results. The method used was a systematic review and meta-analysis of a randomized controlled trial of one thousand seven hundred eighty-two participants from age variation from 18 to 24 years. There were 57 studies conducted, and 191 articles were published, and four groups were divided for interventions for psychological interventions(818 patients), such as psychoeducation(153), telecare(494), traditional education(394). The study was aimed for a period of 2 months to 24 months (Viana et al., 2017). The decrease in HbAIC has noted a significant reduction in psychologically supported population P=.035 the highest level of discount. The conclusive result was psychological approaches. Interventions increase the adherence of diabetic care and modestly reduced HbAIC.

The purpose of the sixth literature review was to analyze the hypoglycemia among patients with diabetes: Epidemiology, risk factors,  and prevention strategies. Hypoglycemia is a common treatment-limiting adverse effect of diabetes therapy. Hypoglycemia is preventable with proper education and precautions.review the epidemiology and risk factors of hypoglycemia to discuss for the prevention strategies. American  Diabetes Association (ADA) classified asymptomatic hypoglycemia is a blood glucose level below 70 mg/dl. It was an observational study revealed that 0.7 to 12 cases per 100 person-years. 0.2 % of patients treated without insulin. 2 per 100 person-years were treated with insulin therapy. 1to 17 % of insulin-dependent patients needed hospitalizations and assistance for the recovery. 1to 4% non -insulin-dependent patients required hospitalization for hypoglycemia. The study was conducted for 12 months. 37to 64 % verbalized need for education hypoglycemic symptoms (Silbert et al., 2018). The study revealed that, and multidisciplinary educational care may reduce hypoglycemia incidences proactively in diabetes patients. Most symptoms of hypoglycemia happen outside healthcare systems, and we lack an effective method to recognize and document such events while blood glucose levels are randomly monitored. Continuous glucose monitoring systems and responsive symptom testing are to be part of treatment plans for severe hypoglycemic events.

The seventh study aimed to identify the indicators of self-management in insulin administration in diabetes patients. The method used was a cross-sectional survey of 72 participants in a metabolic center in Taiwan. The subjects were started to use Lantus, Levemir, Humulin R. Novomix pen injectors, for six months. The study targeted knowledge, photograph demonstrating injection skills, self-efficacy, in self-administration of insulin injections. The study revealed that education level was above high school level education for the subjects to be efficient in insulin injection skills. Diabetes duration was a predictor for usage.  The variance was 41% in self-efficacy. Healthcare professionals need to establish specific teaching strategies to implement insulin administration skills for diabetes patients before discharge from the hospital (Huang et al.,2019).

The purpose of the eights study was done to research about healthy habits that established in the early in life can lead to healthy promotional behaviors, easy adaptation, and health-focused decision making in later stages of life. It shows the importance of training children in a healthy diet, routines, and moral values for psychological health and physical health as they grow to adulthood. Educational strategies to start in community settings to head start program in preschool and elementary school-age of 3 to 5 years of age along with their families. Methods were used as a collaborative community study from Jackson County Civic action Agency and supported by the Mississippi Gulf Coast Youth Health coalition Childhood Obesity Initiatives. The research was a quasi-experimental educational group and controlled group pre and post-test design to evaluate 12 weeks physical activities and nutrition education program in early strat setting. Results showed that in fruit (5.6 )and vegetable (16.1) intake scores and “tried and liked methods.” Subjects in the intervention group were n =303, and control group was n=  86 (Fastring et al., 2018). Conclusion of the study was utilizing headstart early health education strategies for the earlier aged people with family support that assist in obesity control strategies to adopt a positive behavioral change for the healthy lifestyle strategies for the promotion of health and adaptation of healthy food habits.

The ninth study was to utilize to assess the impact of community-based food education program to increase nutrition-related knowledge in Type II diabetes patients. The method was a randomized controlled study. The subject population of the educational group was  20. Control group was 16. The review was nine months long. Age limit is from 20 years to 60 years of age.  Subjects were randomly assigned to a community-based exercise program, and nutritional knowledge was assessed by a General Nutritional Knowledge Questionnaire (Vasconcelos et al., 2018). No variation was found in both groups between understanding of dietary recommendations and diet-disease relationships. Dietary improvements were found in the intervention group than the control group. This is a community based easy applicable tasks with short lectures and dual-task problem-solving activities along with exercises.

The tenth study conducted to utilize to assess the impact of community-based food education program to increase nutrition-related knowledge in Type II diabetes patients. The method was a randomized controlled study. The subject population of the educational group was  20. Control group was 16. The review was nine months  of period long. Age included from 20 years to 60 years of age.  Subjects were randomly assigned to a community-based exercise program, and nutritional knowledge was assessed by a General Nutritional Knowledge Questionnaire (Vasconcelos et a., 2016). No variation was found in both groups between understanding of dietary recommendations and diet-disease relationships. Dietary improvements were found in the intervention group than the control group. This is a community based easy applicable tasks with short lectures and dual-task problem-solving activities along with exercises.

The purpose of the eleventh literature was quality of life study. Quality of life study included 50 healthy people and 50 diabetic patients. This study consists of an intellectual concept of positive and negative aspects of an individual’s life experiences and how an individual perceives the health condition and how he or she reacts to it and how that translates into a chronic disease such as diabetes. This study was focusing on diabetes type II patient population. Fifty people were in an educational group, and 50 people were in the control group, aged 30 to 60 years. It was a qualitative study with experimental design model, with interviewing methods and follow up after 12 months of re-evaluating the same questionnaire completion. Results showed that the mean of quality of life points regarding physical functionality, emotional health active participation, vitality, enthusiasm, social involvements, bodily tolerance to pain are were much lower scores in diabetes patients than the control group (Aghakoochak et al., 2014). This verifies that diabetes patients require a psychological, and educational and emotional support as whole-person care and holistic care to achieve their full potential recovery process, and treatment plans.

Research Approach and Design

The research approach applied for the PICOT question will be a quantitative approach, and q quasi-experimental (QE) design used for data collection and sampling. In this quantitative approach, the study is based on scientific methods that generate numerical data. That will develop a relationship with subjects, variables relation to intervention, and no intervention group. The strength of the relationship is studied, and the occurrence of relationship also collected. In the QE design, mostly non-randomized sample collection before the introduction of relationship and steps of pre-assessment and post-assessments and approaches. In both groups of subjects are consented for the relationship and disclosures of the methods and received test variables. The intervention guidelines are collected in the education group, and the control group does not accept any further instructions or interventions. They both educational group and control groups receive post-test at the end of the period of study. This design assists in my PICOT question in the analysis of data, results, and conclusive statements. Advantage of this design is an application of relationship to educational group and control group was varied advancements in intervention relates to valuable information in the results and conclusion of the study (Camille, Nian-Lin, & Ban, 2016). The disadvantage of this model was that bias could be in the control group, relationship, and sample collection because it was a nonrandomized sample collected for six months.

My PICOT question is: What are the roles used as a description of the education, learning process, and the effects of training in diabetic care in young adults diabetic patients?

Specific research approach appropriate for the PICOT question will be a quantitative approach with quasi-experimental (QE) design will be used for data collection, analysis, and outcome and result proposal. It will seek relationship and the strength of the relationship between two variables within the education group and control group (Polit, & Beck, 2017). Test variable will be diabetic education methods of delivery of traditional education methods and using technology assistance and smartphone applications and follow up HgbAIC evaluation after six month period.

Data collection methods will be through the Questionnaire and validation of their HgbAIC values before and after the six-period of study analysis. The program will be incorporated through the providers of the local community health center diabetic clinic. Open-ended Questionnaire will be the electronic version as well as paper format. Quality data of EBP will be beneficial to behavioral and change modifications for the contemporary health care system needs of the younger diabetic patients health promotion and prevention of complications (McCusker, & Gunaydin, 2015).

Variables were that of diabetic education in the traditional way and technology-assisted school. The study will be facing challenges of lack of control, and biased results can not be excluded. It will be a consented study so that the individuals are fully informed, and that may cause behavioral changes due to the personal impacts on research or study interviewer. The self-motivation and enhancement of self-care management and ownership of care facilitate better adherence of treatment plans and positive reinforcement and effects on self-care, and self-discipline (Sweeney, & Moyer. 2015). This could be a strength of the study to motivate and cause behavioral changes in young adults to be part of group study and take ownership of care to prevent complications and promote their general well being (Di Bartolo et al., 2017).  The variable outcome will be a reduction of HbAIC levels and promotion of self-care management efficiency that leads to self-motivation in young adults to lead a healthy lifestyle. This also will promote continuous follow-up care for six months and self-validation for the reprocessing results of HbAIC that indicates their blood glucose control and diet modifications and activity regimen results. This will assist them for their efforts and be paid for their participation

Sampling

Age group will be diabetic patients from 18 to 40 years of age and including male and females. Targeting 30 diabetic patients participated in the study for the duration of the study time. Group was meeting biweekly for six months period. Study sampling was non- probability sampling method. Patients with Hb AIC level more than 7.5 was assigned to an educational group, and less than 7.5 was assigned to the control group. The sample size is a mall in numbers, so validity was questioned. Exclusion criteria were non consented patients, and Hb AIC was less than 6.5. Advantage was sample size small, so intervention was productive and well recognized by the group and developed a personal trust with the researcher and the subjects, and able to provide a holistic approach of mind-body-spirit care to whole family and caregivers., Disadvantage was small size and biased due to self-motivation was a factor in behavioral changes, sampling and time period was not sufficient (Wagner,  & Ramsey, 2015).

Proposed Implementation with a Change Model

Plan, Do, Study, and Act (PDSA) model is a tool for management and learning. It is quality improvement initiative guidelines for the contemporary healthcare initiatives that we face. This is process improvement strategies shows relevant data of success in ever-changing problems in current societal needs (Donnelly, & Kirk,2015). This initiative model makes modern healthcare safety, a change catalyst for the betterment of patients, community to provide evidence-based cost-effective and value based care in consumer focussed and patient centered holistic manner. In PDSA model Interveiwer will establish the purpose, plan the actions and interventions, study the consequences and steps of implementation, then establish them to act on based of use and planning. Researcher continuously observes the progress and impacts and formulates the changes with the effects of the study and efforts(Camille, Nian-Lin, & Ban, 2016).

In this study plan the study process and strategies data collection, sampling methods, plan of actions of group engagements, education, consistent reinforcements, and action plans. Management of education, HbAIC monitoring, exercise programs, the adaptation of education in a traditional manner, electronic resources adaptation, and utilization. The researcher will document every observation for the improvements and study conclusion validation as study progress. The researcher will make a note of the strengths and weaknesses of the quasi-experimental design as it arises. The researcher will continually study and validate available study evidence pertains to the specific topic of diabetes education. The researcher will analyze pre-test and post-test values, weight monitoring, questionnaire evaluations (Wagner,  & Ramsey, 2015). The final step to act upon that observation and data collection to implement the changes needs to be done to improve patient self-management and patient outcome of specific diabetes young adult patients

The proposed actions will be diabetic education electronic resources, traditionally printed materials, dietary modification, and  consistent exercise program, and follow up monitoring of HbAIC before and after the six months of EBP program, intervention and data collection reveal facilitation of self-care and ownership of care (Sweeney, & Moyer. 2015).

A potential barrier of the model of this EBP is data collected is insufficient to make a decision, due to the small sample size and shorter period of observance of the group (Walker, 2015). More health centers are open for research and resources, and volunteer participation of healthcare providers are beneficial to increase research opportunities to enhance and act positively upon the results.

Conclusion

We are encouraging family and caregiver support in the participation of education sections to facilitate lifestyle and behavioral changes. Intervention group encouraged to use smartphone apps for electronic educational assistance and reminders for glucose monitoring. EBP with education and clinical practice gives us continuous process improvements in our practice and patient outcome improvements for the patient safety and reduction of morbidity mortality and cost-effective and efficient care to each patient every time. This model is widely accepted and highly recognized in healthcare, business as well as in the technological world

References

• Aghakoochak, A., Shojaoddiny-Ardekani, A., Vakili, M., & Namiranian, N. (2014). Quality of Life in Diabetic Patients: A Case-Control Study.
  
  Iranian Journal of Diabetes & Obesity (IJDO)
  
  ,
  
  6
  
  (1), 28–33. Retrieved from
  
  https://search-ebscohost-com.chamberlainuniversity.idm.oclc.org/login.aspx?direct=true&db=a9h&AN=100219499&site=eds-live&scope=site
  
• Aloe, A., Becker, B., Duvendack, M. (2017). Quasi-experimental study designs series—paper 9: Collecting data from quasi-experimental studies.
  
  Journal of Clinical Epidemiology,
  
  
  89
  
  , 77-83. doi:10.1016/j.jclinepi.2017.02.013
• Camille, Y., Nian-Lin, R., & Ban, L. (2016). Legal and ethical issues in research.
  
  Indian Journal of Anaesthesia, 60
  
  (9), 684-688. doi:10.4103/0019-5049.190627
• The Centers for Disease Control and Prevention (2017). Retrieved from: http://www.cdc.gov/diabetes/pubs/ statsreport14/national-diabetes-report-web.pdf.
• Donnelly, P., & Kirk, P. (2015). Use the pdsa model for effective change management.
  
  Education for Primary Care, 26
  
  (4), 279-281. Retrieved from https://chamberlain-on-worldcat-org.chamberlainuniversity.idm.oclc.org/oclc/718372298/
• Lari, H., Noroozi, A., & Tahmasebi, R. (n.d.). Comparison of Multimedia and SMS Education on the Physical Activity of Diabetic Patients: An Application of Health Promotion Model.
  
  IRANIAN RED CRESCENT MEDICAL JOURNAL
  
  ,
  
  20
  
  . https://doi-org.chamberlainuniversity.idm.oclc.org/10.5812/ircmj.59800
• Choi, TST., Walker, KZ., Palermo,C., (2017). Culturally Tailored Diabetes Education for Chinese Patients: A Qualitative study. 5(28): 315-323. Retrieved from doi: 10.1177/1043659616677641. Equub. 2016. PMID:27856820.
• Di Bartolo.P., Nicolucci.a., Cherubin, V., Iafusco. D., Scardapane,. M., Rossi. Mc.,(2017) young patients with type I diabetes poorly controlled and poorly compliant with self- monitoring of blood glucose : can technology help? Results of the i-newTrend randomized clinical trial.4/2017 54(4):393-402. Retrieved from http:// doi:10.1007/s00592-017-0964-4.e pub(2017).PMID. 28138788.
• Fastring. D., Keel, K., Colby, D., ConnerJM., Hilbert, A., (2018). Head Start Centers Can Influence Healthy Behaviors: Evaluation of a nutrition and Physical Activity Educational Intervention. American School Health Association 6(18). Retrieved from.  doi: 10.1111/josh.12811. PMID: 31245850.
• Huang, MC., Hung, CH., Huang YW, Yang SC., (2019). Predictors of self-efficacy in Administering insulin Injection:  Retrieved from 6/(2019): 1054773819858484 doi: 10.1177/1054773819858484.
• McCusker, K., & Gunaydin, S. (2015). Research using qualitative, quantitative or mixed methods and choice based on the research.
  
  Perfusion, 30
  
  (7), 537-542. doi: https://doi.org/10.1177%2F0267659114559116
• Santos JCD, Cortez, DN., Macedo, MML., ReisEA., Torres, HC., (2017). Comparison of education group strategies and home visits in type II diabetes mellitus: 12.25 :e 2979 Retrieved: FROM DOI:10.1590/1518-8345.2315.2979.PMID:29267547.
• Silbert, R., Montenegro., A.S., Guiterrez. R.R., Katabi. A., McCoy. R.,( 2018). Hypoglycemia among Patients with Type 2 Diabetes: Epidemiology , Risk factors, and Prevention strategies.6.(21):18 (8):53
  
  Curr Diab Rep
  
  .6.(2018). Retrieved from doi:10.1007/s 11892-018-1018-0 NIHMSID: NIHMS 986020.
• Smith. K., Baker, K., Bardsley, J.,  & McCartney, P., Magee,.M., (2019). Redesigning Hospital Diabetes Education: A Qualitative Evaluation with Nursing Teams.
  
  Journal of Nursing Care Quality
  
  34(2) 4/ 4019 p. 151-157. Retrieved from doi:10.1097/NCQ.0000000000000349-1057-3631.
• Vasconcelos, C., Almeida A., Cabrral, M., Ramos, E., Mendes, M., (2016). The impact of a community Based Food Education Program on  Nutrition Related Knowledge in Young Diabetes patients.16(13) E 2403.  Retrieved from doi: 10.3390/ijerph1632403. PMID 31284568.
• Viana LV., Gomes, MB., Zaljdenverg L., Pavin EJ., Azevedo, MJ. diabetes study I group.( 2017) Interventions to improve patient compliance with therapies aimed at lowering glycated hemoglobin HbAIc in type I diabetes: a systematic review and meta analysis of randomized controlled study of psychological and educational interventions.: Retrieved from 2(17) 17.94: doi. 10.1186/s 13063-016-1207-6 PMC 4758163
• Von Storch, K., Graaf. E., Wunderlich M., Reitz. C., Polidori, MC., Woopen. C(2019), Telemedicine -Assisted Self- Management Program for Type 2 Diabetes Patients. Retrieved from doi:10.1089/dia.2019.0056. PMID 31287736.
• Vasconcelos, C., Almeida A., Cabrral, M., Ramos, E., Mendes, M., (2016). The impact of a community Based Food Education Program on  Nutrition Related Knowledge in Young Diabetes patients.16(13) E 2403.  Retrieved from doi: 10.3390/ijerph1632403. PMID 31284568.
• Wagner, C., & Ramsey, C. (2015). A systematic approach to representative sampling- sampling quality criteria, material properties, theory of sampling.
  
  Journal of AOAC International, 98
  
  (2), 264-264. Rerieved from
  
  https://web-a-ebscohost-com.chamberlainuniversity.idm.oclc.org/ehost/pdfviewer/pdfviewer?vid=1&sid=21f8f0fa-a79b-4d42-962b-f6e55f39443f%40sessionmgr4008
  
• Walker, W. (2015). The strengths and weaknesses of research designs involving quantitative measures.
  
  Journal of Research in Nursing
  
  ,
  
  10
  
  (5), 571-582.
  
  https://doi.org/10.1177%2F136140960501000505
  
• Benjamin, N., Taveras, E., Ostbye, T., & Gillman, M. (2014). Preventing obesity in infants and toddlers in child care: Results from a pilot randomized controlled trial.
  
  Maternal and Child Health Journal, 18
  
  (5), 1246-57. doi:10.1007/s10995-013-1359-x

Research literature design and implications of young diabetic adults aged 18 to 40 years of patient education is a vital healthcare needs in the contemporary generation. This is a growing concern in many countries. The impact of diabetes is profoundly affected by morbidity, mortality, and healthcare costs in the USA. According to The Centers for Disease Control and Prevention (2017), out of 30.3 million US population that has diabetes, 1.5 million new cases are diagnosed to adults who are 18 years or older while 84.1 millions of Americans have prediabetes that may develop into diabetes within the next five years. The is to reduce this high rates by encouraging and educating young adults, teens and their families and caregivers to follow healthier nutrition, diet and exercises to improve the quality of life practice healthy lifestyle, and prevent complications. This paper will present research-based literature, supporting evidenced-based PICOT questions related to diabetic patient education based on research approaches, design, sample collection of subjects, and proposed implementation strategies and change model implications.

Research Literature Support

Clinical practice protocols are systematic reviews of data that gives a guidance of the quality of the appropriate scientific literature and consists of a validity of the benefits and harms of alternative methods of  consistent practice of physical activities along with dietary restrictions caused the significant adherence to treatment regimen, reduction of HbAIC , self motivation for initiations, and increase in workforce productivity in diabetes patient population (Lari, Noroozi, & Tahmasebi, 2015). The PICOT question is the following: How can patients and families or caregiver of young adults 18 to 41 years engage in evidenced-based patient education and interventions to reduce the risk of diabetes and blood glucose control over the next six months period? The following literature reviews and evidence related to this PICOT question.

The first literature review was to examine the relationship between advanced technology initiated education, and glucose monitoring could help diabetes adolescent and young adults to control blood sugar and promote their general health. The study was a government registered clinical trial that included 182 randomly selected diabetes patients of age varied from 14 to 24 years of age. The method used was a randomized controlled trial. The new trend was a multicenter, open-label, randomized subjects were treated by basal-bolus insulin. The controlled group was allocated with traditional glucometer, and conventional education materials of booklets, and brochures. Ninety-two people were awarded by iBGStar and text messaging reminders for glucose monitoring, and electronic smartphone apps of diabetes education and recording glucose results. Both groups were monitored monthly for their HbAIC reports and follow up visits by a provider. Complaint subjects were shown the more significant reduction in HbAIC levels of 0.61% than that of control group of  0.18% (Di Bartolo et al., 2017) This study Identified that younger diabetes population has capable and improve adherence to treatment regimen and acceptable to promotion of health interventions when they were given new technologies and user friendly electronic tools and strategies.

The secondary literature was to identify the relationship due to the changes in nutritional education, physical activity, and exercises, that relates to the behavioral changes and psychosocial adaptation to the changed practices. The study was focused on 238 adult diabetic patients of age variation from 18 years and 41 years for six months. It was based on patients, caregivers, and families. It was a no randomized controlled study. The program included patient family education about diet, exercise, consistent monitoring of blood glucose levels, home visits, and group education and control group. Constant follow up with providers, usage of electronic education strategies and applications of activity logins, self-empowerment, and ownership of care. Total of 238 individuals and caregivers that are chosen from the local community health center participated in the study. The population included 120 males and 118 females. Inclusion criteria were diagnosed with diabetes, type II diabetes, and their blood glucose levels were higher than average, and hemoglobin AIC is higher than 8.0 consistently(Santos et al., 2017). A well informed ethical consent was obtained from the patients, and caregivers were also informed consent was taken and requested their participation as well for the next six months interventions. The Socio-demographic self-care and empowerment data collected. Statistical analysis performed by education tools and methods that showed p<0.001). Results showed that both strategies presented the same conclusions regarding self-care practices and treatment adherence and patient ownership of care, but education group had better HbAIC level reduction of that of the control group

The third literature review is a quasi-experimental design used to assess Telemedicine Assisted Self-Management Program for Type 2 Diabetes Patients. This study was to determine how telemedicine assist with the self-management of diabetes care in everyday life of patients as needed. The study used to evaluate the effects in terms of HbAIC values and self-management behavior of telemedicine assisted self-management program offered to Type II diabetic patients by a large insurance company. The method used was the experimental design. Sixty young adults were in the intervention group M= 59.4 years, and 55 were in the control group, of age 58.4 years.  The study provided a tablet for the intervention group and motivated for diabetes self-management skills. The control group received usual visits and not offered any additional treatment (Von Storch et al., 2019). The examined subjects after three months. The intervention group had a decline in HbAIC and improvements in self-management as that of the control group. The study gave positive effects on telemedicine and innovative education effects on diabetes care. But the sample was small, and need further studies to verify the feasibility and effectiveness in more extensive scale study.

The fourth literature review was to explore the range of teaching approaches and culturally competent education used in diabetes patients. The purpose of the study was to address patient educational needs, diet modifications, and treatment options that are according to patient culture, and needs. The study was conducted in 3 countries and employed using multiple ethnographic data collection by observation and qualitative personal and telephonic interviews. Data was collected 39 participants observation and 22 interviews across three counties. Collective didactic meetings were a collective conversation allowed each one to derive their management plan. Clinician provided information and used knowledge reinforcement to facilitate behavioral changes (Choi, et al., 2019). Participatory diabetes education from western culture did not translate to the people in the east culture side and varied in each ethnic group perception and adaptation. Personal interests, adaptation, and motivation were significantly variable than traditional education strategies and diet modifications, and exercises.

The fifth study conducted to evaluate the patient adherence to the therapy influence associated with social, psychological, economic, and person-centered approach besides that of other factors. The aim of this study was mental and behavioral impacts on diabetes patient into the educational interventions and compliance of treatments. Compliance was assessed indirectly by the principal outcome of HbAIC results. The method used was a systematic review and meta-analysis of a randomized controlled trial of one thousand seven hundred eighty-two participants from age variation from 18 to 24 years. There were 57 studies conducted, and 191 articles were published, and four groups were divided for interventions for psychological interventions(818 patients), such as psychoeducation(153), telecare(494), traditional education(394). The study was aimed for a period of 2 months to 24 months (Viana et al., 2017). The decrease in HbAIC has noted a significant reduction in psychologically supported population P=.035 the highest level of discount. The conclusive result was psychological approaches. Interventions increase the adherence of diabetic care and modestly reduced HbAIC.

The purpose of the sixth literature review was to analyze the hypoglycemia among patients with diabetes: Epidemiology, risk factors,  and prevention strategies. Hypoglycemia is a common treatment-limiting adverse effect of diabetes therapy. Hypoglycemia is preventable with proper education and precautions.review the epidemiology and risk factors of hypoglycemia to discuss for the prevention strategies. American  Diabetes Association (ADA) classified asymptomatic hypoglycemia is a blood glucose level below 70 mg/dl. It was an observational study revealed that 0.7 to 12 cases per 100 person-years. 0.2 % of patients treated without insulin. 2 per 100 person-years were treated with insulin therapy. 1to 17 % of insulin-dependent patients needed hospitalizations and assistance for the recovery. 1to 4% non -insulin-dependent patients required hospitalization for hypoglycemia. The study was conducted for 12 months. 37to 64 % verbalized need for education hypoglycemic symptoms (Silbert et al., 2018). The study revealed that, and multidisciplinary educational care may reduce hypoglycemia incidences proactively in diabetes patients. Most symptoms of hypoglycemia happen outside healthcare systems, and we lack an effective method to recognize and document such events while blood glucose levels are randomly monitored. Continuous glucose monitoring systems and responsive symptom testing are to be part of treatment plans for severe hypoglycemic events.

The seventh study aimed to identify the indicators of self-management in insulin administration in diabetes patients. The method used was a cross-sectional survey of 72 participants in a metabolic center in Taiwan. The subjects were started to use Lantus, Levemir, Humulin R. Novomix pen injectors, for six months. The study targeted knowledge, photograph demonstrating injection skills, self-efficacy, in self-administration of insulin injections. The study revealed that education level was above high school level education for the subjects to be efficient in insulin injection skills. Diabetes duration was a predictor for usage.  The variance was 41% in self-efficacy. Healthcare professionals need to establish specific teaching strategies to implement insulin administration skills for diabetes patients before discharge from the hospital (Huang et al.,2019).

The purpose of the eights study was done to research about healthy habits that established in the early in life can lead to healthy promotional behaviors, easy adaptation, and health-focused decision making in later stages of life. It shows the importance of training children in a healthy diet, routines, and moral values for psychological health and physical health as they grow to adulthood. Educational strategies to start in community settings to head start program in preschool and elementary school-age of 3 to 5 years of age along with their families. Methods were used as a collaborative community study from Jackson County Civic action Agency and supported by the Mississippi Gulf Coast Youth Health coalition Childhood Obesity Initiatives. The research was a quasi-experimental educational group and controlled group pre and post-test design to evaluate 12 weeks physical activities and nutrition education program in early strat setting. Results showed that in fruit (5.6 )and vegetable (16.1) intake scores and “tried and liked methods.” Subjects in the intervention group were n =303, and control group was n=  86 (Fastring et al., 2018). Conclusion of the study was utilizing headstart early health education strategies for the earlier aged people with family support that assist in obesity control strategies to adopt a positive behavioral change for the healthy lifestyle strategies for the promotion of health and adaptation of healthy food habits.

The ninth study was to utilize to assess the impact of community-based food education program to increase nutrition-related knowledge in Type II diabetes patients. The method was a randomized controlled study. The subject population of the educational group was  20. Control group was 16. The review was nine months long. Age limit is from 20 years to 60 years of age.  Subjects were randomly assigned to a community-based exercise program, and nutritional knowledge was assessed by a General Nutritional Knowledge Questionnaire (Vasconcelos et al., 2018). No variation was found in both groups between understanding of dietary recommendations and diet-disease relationships. Dietary improvements were found in the intervention group than the control group. This is a community based easy applicable tasks with short lectures and dual-task problem-solving activities along with exercises.

The tenth study conducted to utilize to assess the impact of community-based food education program to increase nutrition-related knowledge in Type II diabetes patients. The method was a randomized controlled study. The subject population of the educational group was  20. Control group was 16. The review was nine months  of period long. Age included from 20 years to 60 years of age.  Subjects were randomly assigned to a community-based exercise program, and nutritional knowledge was assessed by a General Nutritional Knowledge Questionnaire (Vasconcelos et a., 2016). No variation was found in both groups between understanding of dietary recommendations and diet-disease relationships. Dietary improvements were found in the intervention group than the control group. This is a community based easy applicable tasks with short lectures and dual-task problem-solving activities along with exercises.

The purpose of the eleventh literature was quality of life study. Quality of life study included 50 healthy people and 50 diabetic patients. This study consists of an intellectual concept of positive and negative aspects of an individual’s life experiences and how an individual perceives the health condition and how he or she reacts to it and how that translates into a chronic disease such as diabetes. This study was focusing on diabetes type II patient population. Fifty people were in an educational group, and 50 people were in the control group, aged 30 to 60 years. It was a qualitative study with experimental design model, with interviewing methods and follow up after 12 months of re-evaluating the same questionnaire completion. Results showed that the mean of quality of life points regarding physical functionality, emotional health active participation, vitality, enthusiasm, social involvements, bodily tolerance to pain are were much lower scores in diabetes patients than the control group (Aghakoochak et al., 2014). This verifies that diabetes patients require a psychological, and educational and emotional support as whole-person care and holistic care to achieve their full potential recovery process, and treatment plans.

Research Approach and Design

The research approach applied for the PICOT question will be a quantitative approach, and q quasi-experimental (QE) design used for data collection and sampling. In this quantitative approach, the study is based on scientific methods that generate numerical data. That will develop a relationship with subjects, variables relation to intervention, and no intervention group. The strength of the relationship is studied, and the occurrence of relationship also collected. In the QE design, mostly non-randomized sample collection before the introduction of relationship and steps of pre-assessment and post-assessments and approaches. In both groups of subjects are consented for the relationship and disclosures of the methods and received test variables. The intervention guidelines are collected in the education group, and the control group does not accept any further instructions or interventions. They both educational group and control groups receive post-test at the end of the period of study. This design assists in my PICOT question in the analysis of data, results, and conclusive statements. Advantage of this design is an application of relationship to educational group and control group was varied advancements in intervention relates to valuable information in the results and conclusion of the study (Camille, Nian-Lin, & Ban, 2016). The disadvantage of this model was that bias could be in the control group, relationship, and sample collection because it was a nonrandomized sample collected for six months.

My PICOT question is: What are the roles used as a description of the education, learning process, and the effects of training in diabetic care in young adults diabetic patients?

Specific research approach appropriate for the PICOT question will be a quantitative approach with quasi-experimental (QE) design will be used for data collection, analysis, and outcome and result proposal. It will seek relationship and the strength of the relationship between two variables within the education group and control group (Polit, & Beck, 2017). Test variable will be diabetic education methods of delivery of traditional education methods and using technology assistance and smartphone applications and follow up HgbAIC evaluation after six month period.

Data collection methods will be through the Questionnaire and validation of their HgbAIC values before and after the six-period of study analysis. The program will be incorporated through the providers of the local community health center diabetic clinic. Open-ended Questionnaire will be the electronic version as well as paper format. Quality data of EBP will be beneficial to behavioral and change modifications for the contemporary health care system needs of the younger diabetic patients health promotion and prevention of complications (McCusker, & Gunaydin, 2015).

Variables were that of diabetic education in the traditional way and technology-assisted school. The study will be facing challenges of lack of control, and biased results can not be excluded. It will be a consented study so that the individuals are fully informed, and that may cause behavioral changes due to the personal impacts on research or study interviewer. The self-motivation and enhancement of self-care management and ownership of care facilitate better adherence of treatment plans and positive reinforcement and effects on self-care, and self-discipline (Sweeney, & Moyer. 2015). This could be a strength of the study to motivate and cause behavioral changes in young adults to be part of group study and take ownership of care to prevent complications and promote their general well being (Di Bartolo et al., 2017).  The variable outcome will be a reduction of HbAIC levels and promotion of self-care management efficiency that leads to self-motivation in young adults to lead a healthy lifestyle. This also will promote continuous follow-up care for six months and self-validation for the reprocessing results of HbAIC that indicates their blood glucose control and diet modifications and activity regimen results. This will assist them for their efforts and be paid for their participation

Sampling

Age group will be diabetic patients from 18 to 40 years of age and including male and females. Targeting 30 diabetic patients participated in the study for the duration of the study time. Group was meeting biweekly for six months period. Study sampling was non- probability sampling method. Patients with Hb AIC level more than 7.5 was assigned to an educational group, and less than 7.5 was assigned to the control group. The sample size is a mall in numbers, so validity was questioned. Exclusion criteria were non consented patients, and Hb AIC was less than 6.5. Advantage was sample size small, so intervention was productive and well recognized by the group and developed a personal trust with the researcher and the subjects, and able to provide a holistic approach of mind-body-spirit care to whole family and caregivers., Disadvantage was small size and biased due to self-motivation was a factor in behavioral changes, sampling and time period was not sufficient (Wagner,  & Ramsey, 2015).

Proposed Implementation with a Change Model

Plan, Do, Study, and Act (PDSA) model is a tool for management and learning. It is quality improvement initiative guidelines for the contemporary healthcare initiatives that we face. This is process improvement strategies shows relevant data of success in ever-changing problems in current societal needs (Donnelly, & Kirk,2015). This initiative model makes modern healthcare safety, a change catalyst for the betterment of patients, community to provide evidence-based cost-effective and value based care in consumer focussed and patient centered holistic manner. In PDSA model Interveiwer will establish the purpose, plan the actions and interventions, study the consequences and steps of implementation, then establish them to act on based of use and planning. Researcher continuously observes the progress and impacts and formulates the changes with the effects of the study and efforts(Camille, Nian-Lin, & Ban, 2016).

In this study plan the study process and strategies data collection, sampling methods, plan of actions of group engagements, education, consistent reinforcements, and action plans. Management of education, HbAIC monitoring, exercise programs, the adaptation of education in a traditional manner, electronic resources adaptation, and utilization. The researcher will document every observation for the improvements and study conclusion validation as study progress. The researcher will make a note of the strengths and weaknesses of the quasi-experimental design as it arises. The researcher will continually study and validate available study evidence pertains to the specific topic of diabetes education. The researcher will analyze pre-test and post-test values, weight monitoring, questionnaire evaluations (Wagner,  & Ramsey, 2015). The final step to act upon that observation and data collection to implement the changes needs to be done to improve patient self-management and patient outcome of specific diabetes young adult patients

The proposed actions will be diabetic education electronic resources, traditionally printed materials, dietary modification, and  consistent exercise program, and follow up monitoring of HbAIC before and after the six months of EBP program, intervention and data collection reveal facilitation of self-care and ownership of care (Sweeney, & Moyer. 2015).

A potential barrier of the model of this EBP is data collected is insufficient to make a decision, due to the small sample size and shorter period of observance of the group (Walker, 2015). More health centers are open for research and resources, and volunteer participation of healthcare providers are beneficial to increase research opportunities to enhance and act positively upon the results.

Conclusion

We are encouraging family and caregiver support in the participation of education sections to facilitate lifestyle and behavioral changes. Intervention group encouraged to use smartphone apps for electronic educational assistance and reminders for glucose monitoring. EBP with education and clinical practice gives us continuous process improvements in our practice and patient outcome improvements for the patient safety and reduction of morbidity mortality and cost-effective and efficient care to each patient every time. This model is widely accepted and highly recognized in healthcare, business as well as in the technological world

References

• Aghakoochak, A., Shojaoddiny-Ardekani, A., Vakili, M., & Namiranian, N. (2014). Quality of Life in Diabetic Patients: A Case-Control Study.
  
  Iranian Journal of Diabetes & Obesity (IJDO)
  
  ,
  
  6
  
  (1), 28–33. Retrieved from
  
  https://search-ebscohost-com.chamberlainuniversity.idm.oclc.org/login.aspx?direct=true&db=a9h&AN=100219499&site=eds-live&scope=site
  
• Aloe, A., Becker, B., Duvendack, M. (2017). Quasi-experimental study designs series—paper 9: Collecting data from quasi-experimental studies.
  
  Journal of Clinical Epidemiology,
  
  
  89
  
  , 77-83. doi:10.1016/j.jclinepi.2017.02.013
• Camille, Y., Nian-Lin, R., & Ban, L. (2016). Legal and ethical issues in research.
  
  Indian Journal of Anaesthesia, 60
  
  (9), 684-688. doi:10.4103/0019-5049.190627
• The Centers for Disease Control and Prevention (2017). Retrieved from: http://www.cdc.gov/diabetes/pubs/ statsreport14/national-diabetes-report-web.pdf.
• Donnelly, P., & Kirk, P. (2015). Use the pdsa model for effective change management.
  
  Education for Primary Care, 26
  
  (4), 279-281. Retrieved from https://chamberlain-on-worldcat-org.chamberlainuniversity.idm.oclc.org/oclc/718372298/
• Lari, H., Noroozi, A., & Tahmasebi, R. (n.d.). Comparison of Multimedia and SMS Education on the Physical Activity of Diabetic Patients: An Application of Health Promotion Model.
  
  IRANIAN RED CRESCENT MEDICAL JOURNAL
  
  ,
  
  20
  
  . https://doi-org.chamberlainuniversity.idm.oclc.org/10.5812/ircmj.59800
• Choi, TST., Walker, KZ., Palermo,C., (2017). Culturally Tailored Diabetes Education for Chinese Patients: A Qualitative study. 5(28): 315-323. Retrieved from doi: 10.1177/1043659616677641. Equub. 2016. PMID:27856820.
• Di Bartolo.P., Nicolucci.a., Cherubin, V., Iafusco. D., Scardapane,. M., Rossi. Mc.,(2017) young patients with type I diabetes poorly controlled and poorly compliant with self- monitoring of blood glucose : can technology help? Results of the i-newTrend randomized clinical trial.4/2017 54(4):393-402. Retrieved from http:// doi:10.1007/s00592-017-0964-4.e pub(2017).PMID. 28138788.
• Fastring. D., Keel, K., Colby, D., ConnerJM., Hilbert, A., (2018). Head Start Centers Can Influence Healthy Behaviors: Evaluation of a nutrition and Physical Activity Educational Intervention. American School Health Association 6(18). Retrieved from.  doi: 10.1111/josh.12811. PMID: 31245850.
• Huang, MC., Hung, CH., Huang YW, Yang SC., (2019). Predictors of self-efficacy in Administering insulin Injection:  Retrieved from 6/(2019): 1054773819858484 doi: 10.1177/1054773819858484.
• McCusker, K., & Gunaydin, S. (2015). Research using qualitative, quantitative or mixed methods and choice based on the research.
  
  Perfusion, 30
  
  (7), 537-542. doi: https://doi.org/10.1177%2F0267659114559116
• Santos JCD, Cortez, DN., Macedo, MML., ReisEA., Torres, HC., (2017). Comparison of education group strategies and home visits in type II diabetes mellitus: 12.25 :e 2979 Retrieved: FROM DOI:10.1590/1518-8345.2315.2979.PMID:29267547.
• Silbert, R., Montenegro., A.S., Guiterrez. R.R., Katabi. A., McCoy. R.,( 2018). Hypoglycemia among Patients with Type 2 Diabetes: Epidemiology , Risk factors, and Prevention strategies.6.(21):18 (8):53
  
  Curr Diab Rep
  
  .6.(2018). Retrieved from doi:10.1007/s 11892-018-1018-0 NIHMSID: NIHMS 986020.
• Smith. K., Baker, K., Bardsley, J.,  & McCartney, P., Magee,.M., (2019). Redesigning Hospital Diabetes Education: A Qualitative Evaluation with Nursing Teams.
  
  Journal of Nursing Care Quality
  
  34(2) 4/ 4019 p. 151-157. Retrieved from doi:10.1097/NCQ.0000000000000349-1057-3631.
• Vasconcelos, C., Almeida A., Cabrral, M., Ramos, E., Mendes, M., (2016). The impact of a community Based Food Education Program on  Nutrition Related Knowledge in Young Diabetes patients.16(13) E 2403.  Retrieved from doi: 10.3390/ijerph1632403. PMID 31284568.
• Viana LV., Gomes, MB., Zaljdenverg L., Pavin EJ., Azevedo, MJ. diabetes study I group.( 2017) Interventions to improve patient compliance with therapies aimed at lowering glycated hemoglobin HbAIc in type I diabetes: a systematic review and meta analysis of randomized controlled study of psychological and educational interventions.: Retrieved from 2(17) 17.94: doi. 10.1186/s 13063-016-1207-6 PMC 4758163
• Von Storch, K., Graaf. E., Wunderlich M., Reitz. C., Polidori, MC., Woopen. C(2019), Telemedicine -Assisted Self- Management Program for Type 2 Diabetes Patients. Retrieved from doi:10.1089/dia.2019.0056. PMID 31287736.
• Vasconcelos, C., Almeida A., Cabrral, M., Ramos, E., Mendes, M., (2016). The impact of a community Based Food Education Program on  Nutrition Related Knowledge in Young Diabetes patients.16(13) E 2403.  Retrieved from doi: 10.3390/ijerph1632403. PMID 31284568.
• Wagner, C., & Ramsey, C. (2015). A systematic approach to representative sampling- sampling quality criteria, material properties, theory of sampling.
  
  Journal of AOAC International, 98
  
  (2), 264-264. Rerieved from
  
  https://web-a-ebscohost-com.chamberlainuniversity.idm.oclc.org/ehost/pdfviewer/pdfviewer?vid=1&sid=21f8f0fa-a79b-4d42-962b-f6e55f39443f%40sessionmgr4008
  
• Walker, W. (2015). The strengths and weaknesses of research designs involving quantitative measures.
  
  Journal of Research in Nursing
  
  ,
  
  10
  
  (5), 571-582.
  
  https://doi.org/10.1177%2F136140960501000505
  
• Benjamin, N., Taveras, E., Ostbye, T., & Gillman, M. (2014). Preventing obesity in infants and toddlers in child care: Results from a pilot randomized controlled trial.
  
  Maternal and Child Health Journal, 18
  
  (5), 1246-57. doi:10.1007/s10995-013-1359-x