Research Method Analysis Type 2 Diabetes

Summary Table of Evidence • PICO Question Dose three months of self-management sessions and community programs help adult patients who have type 2 diabetes to regulate their blood glucose levels within the normal range? Instructions: Use the problem identified in your PICOT statement as the topic for review. The paper MUST be prepared using APA guidelines for references. Citations (author and year) should also be present as the studies are discussed. For this assignment, review the research on the topic, synthesize the findings and, based on the strength of the evidence, evaluate the usefulness of applying the findings into clinical practice. This assignment consists of the following steps: 1. Decide which research problem you would like to address and obtain approval from the professor. Research Method Analysis Type 2 Diabetes

Be sure that the title reflects the research problem. 2. Present the PICOT question 3. Conduct a thorough literature search; these articles must address the specific research problem and include both quantitative and qualitative articles, if possible. 4. Complete the Summary Table of Evidence a) Title the table appropriately (see suggested sample below). b) Fill in the cells of the table appropriately and accurately for each article. c) Prepare a two page summary of your findings, indicating your perception of the appropriateness of applying the evidence-based treatment/ intervention into clinical practice, based on your review of the studies. Include this prior to the table of evidence. d) Add a legend at the bottom of the table that explains any abbreviations used in the table. e) APA (title page that includes your name, the title, the course name, and the date. Summary Table Title of Table Complete citation Research Aims/questions/hypo thesis Study Design Theoretical/ conceptual framework Sample Selection and and Characteristics Setting Variables/Measu res Azami. Golnaz, eta Behavioral interventions to improve selfmanagement in Iranian adults with type 2 diabetes: a systematic review and meta-analysis a systemati c review and metaanalysis None Twenty-three studies met the inclusion criteria for this review. All eligible articles had been published between January 2009 and March 2017. Of the twenty-three included studies, eleven (47.8%) were published in English, and the rests were published in Persian. The search was performed in Pub Med, Web of Science, Science Direct, Ovid Medline, EBSCO, ProQuest, Google Scholar, and the Scientific Information Database (SID), for English and Persian language articles published between 2009 and 2017. Research Method Analysis Type 2 Diabetes

Primary outcome of this review was to assess the effects of behavioral interventions on glycosylated hemoglobin. the blood pressure, Lipid profiles, BMI, Self-efficacy, knowledge, attitude, practice, Selfcare behaviors, social support, anxiety, and depression were the secondary outcomes. Journal of Diabete s& Metabol ic Disorde rs Data Collection Instrument s Used Data collection methods Descript ion of Interven tion Major Findings Citation: List Authors, journal, year of publication and other data pursuant to APA format Research aims/questions/hypotheses: Describe these aspects of the study Study Design: Accurately identify study design and type of study Conceptual/theoretical framework: Describe framework if used and relationship to the research questions/hypothesis Sample: Describe sample design and methods used and size and characteristics for all groups; applicability for the research questions/methods Setting: Describe setting in which the research was conducted Variables/measures: Describe the study variables and their relationship to the research hypotheses/questions Data collection instruments: Describe the instruments, their reliability and validity, relationship to variables, linguistic and cultural appropriateness Data collection methods: describe data collection methods, appropriateness for research questions Intervention: describe the intervention and its relationship to the research aims/questions/hypothesis Protection of human subjects: Describe processes used to protect human subjects Data analysis: describe data analysis used and its appropriateness for study questions, hypotheses, design, variables, and data collection methods Major findings: describe major findings and their relevance for practice Summary Table of Evidence Evaluation Topic:____________________________ Date:_____________ Presenter:___________________________________________________ Reviewer: ___________________________________________________ Topic approval by faculty 5% Summary Table of Evidence 40% Critical Appraisal of Evidence 45% APA Format 10% Total Int J Med. Public Health. 2020; 10(1):24-28. A Multifaceted Peer Reviewed Journal in the field of Medicine and Public Health www.ijmedph.org | www.journalonweb.com/ijmedph Original Article A Study on Assessment of Level of Self-Care Practices among Known Type 2 Diabetes Patients in Rural Field Practice Area of South India Chittooru Chandra Sekhar, Darivemula Surendra Babu, Gorantla Anand Krishna, Chittem Sravana Deepthi, Jawahar Basha Kalluri ABSTRACT Background: Self-care in diabetes has been defined as an evolutionary process of development of knowledge or awareness by learning to survive with the complex nature of the diabetes in a social context. Methodology: A community based cross-sectional study was conducted with the objective to assess the level of self-care among known type-2 diabetes patients in rural field practice area. A total of 727 patients were involved and predesigned, pretested and semi structured questionnaire developed by referring the Summary of diabetes self-care activities measure (SDSCA), Diabetes self-management questionnaire (DSMQ) and patient health questionnaire-2 was used for the study. Data entry was made in Microsoft excel and analysis was done using the SPSS statistics 20.0 version. Results were expressed in proportions and percentages and appropriate statistical tests was applied to see the association. Results: A total of 727 known diabetes patients were participated, out of which 298 (40.9%) were males and 429 (59.1%) were females. With respect to self-care activities variables in diet modification except intake of fried foods, binge eating and skipping of the meals, good physical activity, drug adherence and some variables in problem solving are having good influence over glycemic control with P value <0.05.

Frequency of glucose monitoring, variables in risk reduction except stopping smoking and alcohol and healthy coping were not influencing the glucose levels and it was not significant statistically. Conclusion: Self-care activities such as eating green leafy vegetables and fruits frequently, occasional consumption of meat, strict restriction of sweets and consuming salt restricted diet will have positive influence over glycemic control. Key words: Self-care, Diabetes mellitus, Knowledge, Practices, Rural. Chittooru Chandra Sekhar, Darivemula Surendra Babu, Gorantla Anand Krishna, Chittem Sravana INTRODUCTION Deepthi, Jawahar Basha Self-care of diabetes is essential for control of disKalluri Department of Community Medicine, Apollo Institute of Medical Sciences and Research, Murukambattu, Chittoor, Andhra Pradesh, INDIA. Correspondence Dr. D. Surendra Babu, MBBS.,MD. (AIIMS, New Delhi), MIPHA Assistant Professor, Department of Community Medicine, ESIC Medical College and Hospital, Sanath Nagar-500018, Hyderabad, INDIA. Mobile no: +91 9989967110 Email: surya.doc.2@gmail.com History • Submission Date: 28-08-2019; • Revised Date: 11-11-2019; • Accepted Date: 06-02-2020; DOI : 10.5530/ijmedph.2020.1.5 Article Available online http://www.ijmedph.org/v10/i1 Copyright © 2020 Phcog.Net. This is an openaccess article distributed under the terms of the Creative Commons Attribution 4.0 International license. ease and improvement of quality of patients’ life. Earlier patient education was generally prescriptive (e.g., “Do as I say.”) and therapeutic goals were set by health professionals.1 Self-care in diabetes has been defined as an evolutionary process of development of knowledge or awareness by learning to survive with the complex nature of the diabetes in a social context.2 According to International diabetes federation, South-East Asia is home to one fifth (19 %) of the total number of people with diabetes in the world. The prevalence of diabetes in India by 2017 is 8.8% and expected to be 11.4% by 2045 in 20–79 years of age.3 Diabetes is a lifelong disease with a variety of complications, an adequate control over blood sugars would delay the onset of diabetes complications and help to lead a better quality of life.4 It is believed that appropriate patient knowledge of self-care is the key to achieving therapeutic goals in ambulatory care, because the vast majority of day-to-day care in dia- betes is handled by patients and/or families.5 Health education can be given to improve the self-care practices among diabetes patients. But education can be effective only if we first understand the knowledge and practices of the patient with regard to the disease, complications and its management.

MATERIALS AND METHODS A Community based Cross-Sectional Study was conducted in rural field practice area of Parla under Department of Community Medicine from November 2017 to April 2018. The objective of the study was to know the level of self-care among known diabetes patients in rural field practice area. A total of 11 villages were present under Parla Primary Health Centre and based on the records from Primary Health Centre a total of 786 diabetic individuals were present in the study area. An attempt was made to trace all the 786 diabetic individuals. Figure 1 showing the flow of participants involved. Amongst them 15 individuals Cite this article : Sekhar CC, babu DS, Krishna GA, Deepthi CS, Kalluri JB. A Study on Assessment of Level of SelfCare Practices among Known Type 2 Diabetes Patients in Rural Field Practice Area of South India. Int J Med Public Health. 2020;10(1):24-8. Research Method Analysis Type 2 Diabetes

International Journal of Medicine and Public Health, Vol 10, Issue 1, Jan-Mar, 2020 24 Sekhar, et al.: Assessment of Self-care Practices among T2DM Patients in Rural Area Table 1: Distribution of participants according to their socio-demographic variables. HbA1C Variable <7% (n=419) ≥7% (n=308) Age (Completed Years) <50 years 50-59 years 60-69 years ≥70 years 146 (65.2) 136 (59.9) 104 (50.0) 33 (48.5) 78 (34.8) 91 (40.1) 104 (50.0) 35 (51.5) Gender Male Female 166 (55.7) 253 (59.0) 132 (44.3) 176 (41.0) Religion Hindu Muslim Christian 281 (59.7) 66 (66.7) 72 (45.9) 190 (40.3) 33 (33.3) 85 (54.1) Family type Nuclear Joint 410(58.2) 9(40.9) 295(41.8) 13(59.1) Socio-economic status Upper class Upper middle class Middle class Lower middle class Lower class 18(81.8) 65(53.3) 120(59.1) 206(57.1) 10(52.6) 4(18.2) 57(46.7) 83(40.9) 155(42.9) 9(47.4) Marital status Married Widow/Separated 306 (58.3) 113 (55.9) 219 (41.7) 89 (44.1) Family history of DM Yes No 288(54.8) 131(65.2) 238(45.2) 70(34.8) History of Hypertension Yes No 178(46.2) 241(70.5) 207(53.8) 101(29.5) Duration of Diabetes ≤5 Years >5 Years 248(58.4) 171(56.6) 177(41.6) 131(43.4) Facility sought for medical care Government Private 339(58.7) 80(53.7) 239(41.3%) 69(46.3%) Figure 1: Flow of participants. were found to be dead during the time of the study, 26 were non traceable, 10 moved away from present location and 10 were not willing to participate. So, the final sample size of the study was 727. Participation information sheet was given and Informed consent was taken from the study participants. All the cases of diabetes were included irrespective of the complications. Research Method Analysis Type 2 Diabetes

Newly diagnosed cases of diabetes mellitus after the survey period were excluded. Study subjects were identified with the help of Health assistants and local people and interviewed at their houses with a Predesigned and Pre-tested semi structured questionnaire. Patients with HbA1C less than 7%, were considered to meet the criteria of glycemic control.6 Predesigned and pretested semi-structured questionnaire consisting of demographic and socioeconomic parameters, behavioral aspects like alcohol, tobacco use and knowledge and practice of self-care activities. The self-care practices among the participants were studied in the seven domains namely Diet modification, Physical activity, Glucose monitoring, Drug adherence, Problem solving, Risk reduction and Healthy coping recommended by the American Association of Diabetes Educators (AADE) known as the “AADE 7 measures of outcome measurement”.7 Questions related to knowledge and practice of self-care activities were derived by referring the various scales like “Summary of diabetes selfcare activities measure8 (SDSCA),” “Diabetes self-management questionnaire9 (DSMQ),” and patient health questionnaire-2.10 We translated the questionnaire in to Telugu for easy interview in the local language of the people and for analyzing the English version was used. We conducted a pilot survey on the questionnaire for the validation of the instrument. Institutional ethical committee clearance was obtained before the start of the study. Data entry was made in Microsoft excel and analysis was done with SPSS statistics 21.0 version.

Results were expressed in proportions and percentages and statistical tests like chi-square was applied to see the association of different variables on the influence of glycemic control. RESULTS A total of 727 known diabetes patients were participated in the study, out of them 298 (40.9%) were males and 429 (59.1%) were females respectively. In Table 1 more than half 435 (59.8%) of the participants were belongs to more than 50 to 69 years, followed by 224 (30.8%) were belongs to less than 50 years and only 68 (9.3%) were belongs to more than 70 years. Majority 471 (64.7%) of them were belongs to Hindu religion followed by 157 (21.5%) and remaining 99 (13.6%) were Muslims. Research Method Analysis Type 2 Diabetes

Nearly half 354 (48.6%) of the participants were illiterates and the remaining 373 (51.4%) had completed at least their primary education. Almost all 705 (96.9%) were living in the nuclear family and only 22 (3.1%) were living in the joint family. More than half 474 (65.2%) were belongs to below middle class and only 144 (19.8%) were belongs to upper and upper middle socio-economic class. More than three fourth 526 (72.3%) of the participants were had the family history of diabetes and 425 (58.4%) were had more than five years duration of diabetes. Majority 578 (79.5%) of them were taking treatment at the government hospitals for the diabetes and rest 149 (21.5%) were going to private clinics/hospitals for the treatment. Table 2a showing the influence of self-care activities on glycemic control. On assessing the diet pattern of the patients, it was showing that frequency of intake of green leafy vegetables and fruits have positive influence over the glycemic control among the patients (p<0.05; significant). Intake of meat occasionally, restriction of sweets completely and controlled use of salt in the food making them better glycemic control.

International Journal of Medicine and Public Health, Vol 10, Issue 1, Jan-Mar, 2020 25 Sekhar, et al.: Assessment of Self-care Practices among T2DM Patients in Rural Area Yes No Table 2a: Influence of self-care activities on Glycemic control. a. Diet modification and physical activity Variable HbA1c <7% (n=419) ≥7% (n=308) Chi-square value P value 130(34.2) 178(51.3) 21.68 <0.001; S 2.2 Duration of physical activity per day ≥ 30 mins < 30 mins None 1. Diet modification 250(65.8) 169(48.7) 152(69.7) 98(60.5) 169(48.7) 66(30.3) 64(39.5) 178(51.3) 3.519 0.06; NS 1.1 Frequency of intake of green leafy vegetables Occasionally 1 – 3 days per week ≥3 days per week 15 (34.9) 158 (57.5) 246 (60.1) 28 (65.1) 117 (42.5) 163 (39.9) Table 2b: Glucose monitoring, Drug adherence and problem solving. 10.18 0.006; S 25(39.1) 196(58) 167(59.2) 31(72.1) 39(60.9) 142(42) 115(40.8) 12(27.9) 13.03 0.005; S 84(51.5) 158(68.7) 150(55.4) 27(42.9) 79(48.5) 72(31.3) 121(44.6) 36(57.1) 20.223 <0.001; S 172 (62.1) 196 (59) 51 (43.2) 171(42.6) 73(42.4) 64(41.6) 0.054 0.973: NS 97 (70.3) 322(54.7) 41 (29.7) 267(45.3) 11.17 0.01; S 153(34.1) 155(55.8) 33.05 <0.001; S 174(47) 134(37.5) 6.70 0.01; S 134(37.5) 164(46.6) 10 (55.6) 7.27 0.03; S 122(44.5) 39(33.6) 147(43.6) 4.37 0.112; NS 4.1 Adhered to the drugs prescribed Yes No 296(65.9) 123(44.2) 5.1 Experienced any episode of fainting attacks 105 (37.9) 136 (41) 67 (56.8) 15.25 0.002; S 159 (62.6) 227 (55.4) 33 (52.4) 95 (37.4) 183 (44.6) 30 (47.6) 201 (59.5) 216 (56.3) 2 (40) 137 (40.5) 168 (43.7) 3 (60) 166(57.2) 126(55.3) 85(65.9) 42(52.5) 124(42.8) 102(44.7) 44(34.1) 38(47.5) 4.14 0.126; NS 2. Physical activity 2.1 Doing regular physical activity 166(39.3) 142(46.6) Not at all Occasionally Frequently (≥1 episode per week) 196(53) 223(62.5) 1.403 0.496; NS 6.085 0.193; NS 3.78 0.049; S 223(62.5) 188(53.4) 8(44.4) 5.3 Tackling hyperglycemia state Consult doctor Adjust own Nothing done 1.8 Taking salt restricted diet 256(60.7) 163(53.4) Yes No 5.2 Frequency of fainting attacks 1.7 Frequency of skipping the meal 26 230(57.4) 99(57.6) 90(58.4) 5. Problem solving Not at all Occasionally Frequently (≥1 time per week) Yes No P value 4. Drug adherence 1.6 Frequency of binge eating Not at all Occasionally Once a week Frequently (≥ 2 times per week) Once a month Every three months Very rare Yes No 1.5 Frequency of intake of fried foods Not at all Occasionally Frequently (≥1 time per week) Chi-square value 3.2 Monitoring of blood glucose in illness 1. Research Method Analysis Type 2 Diabetes

4 Frequency of intake of Sweets Not at all Occasionally Frequently (≥1 time per week) ≥7% (n=308) 3.1 Frequency of glucose monitoring 1.3 Frequency of intake of meat Not at all Occasionally Less frequently (1 to 2 times per week) Frequently (≥ 3 times per week) <7% (n=419) 3. Glucose Monitoring 1.2 Frequency of intake of fruits Not at all Occasionally Less frequently (1 to 2 times per week) Frequently (≥ 3 times per week) HbA1c Variable 152(55.5) 77(66.4) 190(56.4) S = Significant (p<0.05); NS = Not Significant (p>0.05) (p<0.05; significant) Consuming fried foods, binge eating and skipping the meal has no influence over the glycemic control among the patients. (p>0.05; Not significant). On assessing the physical activity pattern of the patients, it is showing that doing regular physical activity will make them better control over blood glucose level. (p<0.05; significant) But the duration of physical activity has no influence over the glycemic control. (p>0.05; Not significant). The glucose monitoring activity (Table 2b) among the patients, it was shown that frequency of glucose monitoring and monitoring in illness episodes had no influence over glycemic control. (p>0.05; Not significant). On assessing the drug adherence among the patients, it was showing that glycemic control was better in patients who consume prescribed drugs regularly (p<0.05; significant). Out of 278 (38.2%) patients who are skipping the drugs, 145 (52.2%) patients were skips the doses because of busy work, 108 (38.8%) misses because to carry during travel, 16 (5.8%) International Journal of Medicine and Public Health, Vol 10, Issue 1, Jan-Mar, 2020 Sekhar, et al.: Assessment of Self-care Practices among T2DM Patients in Rural Area Table 2c: Risk reduction and Healthy coping. Variable HbA1c <7% (n=419) ≥7% (n=308) P value 6. Risk reduction 6.1 Will check feet regularly for the injuries Yes No 287(58.2) 132(56.4) 206(41.8) 102(43.6) 0.212 0.65; NS 192(43.1) 116(41.3) 0.221 0.64; NS 58(33.7) 38(58.5) 12.3 0.002; S 6.2 Will they consult doctor for injuries over the foot Yes No 254(56.9) 165(58.7) … Research Method Analysis Type 2 Diabetes