Type 2 Diabetes Mellitus

Article Critique Student will be responsible for choosing one scholarly, peer-reviewed research study from appropriate scholarly journals. Students will analyze, summarize and critique the study. The study may have a qualitative, quantitative, or mixed methods study design. It is highly recommended that students choose an article that informs their research proposals. Students will analyze potential threats to reliability and validity and ways to minimize those threats. Students will write a two-page critique of the article. The review should introduce the research problem, research objective, methodology, findings/results addressed in the article, as well as YOUR critique of the research methods. Please include the source of the article (reference) in APA format in the reference section. Additional information will be provided in class. A grading rubric is posted to Blackboard. Project Description and Rubric Your critique should include the following: 1. Briefly summarize the study (give us context, but do not spend a significant amount of time here. We are most interested in learning about the methods). Type 2 Diabetes Mellitus

2. Introduce the research problem and research objective. 3. Describe the theory used to inform the research. 4. Describe the methodology in detail. 5. Briefly describe the findings and results 6. Provide a personal critique of the research methods, specifically identifying potential threats to reliability and validity and ways to minimize those threats. 7. An APA formatted reference of the article on the final page. 8. A pdf of the article must be submitted with the critique. Be concise and thorough of your critique. The document should include two full pages of text in APA format. The APA formatted reference should be on the third page. The reviews can be prepared from published literature. Students should observe the following rules about article selection: 1. The selected journal article should come from a scholarly journal. 2. The selected journal article should be at least 6 pages. 3. The selected journal article should have been published within the past 5 years. 4. The selected journal article should focus on research studies related to human health. Example Public Health Journals: American Journal of Public Health Health Promotion Practice Environmental Health Perspectives International Journal of Public Health Public Health & Prevention Journals – Medscape HLTH 625 Journal Article Critique Scoring Page 1 of 2 Category A Level B Level Analysis/ Critique Provides a comprehensive critique of the research methods of the article. Addresses strengths and weakness of study design, threats to reliability and validity, and provides ways to minimize the threats. Provides a good critique of the research methods of the article. Addresses some strengths and weakness of study design, threats to reliability and validity, and provides ways to minimize the threats. Provides a weak Does not provide critique of the research required analysis and methods. Lacking detail critique. in the strengths and weakness of study design, threats to reliability and validity, and recommendations to minimize the threats. Shows a full understanding of the topic. Comprehensive coverage of topic (research problem, research objective, methodology, and findings/results) Shows a good understanding of the topic, but left out important information. Shows a good understanding of only parts of the topic.Type 2 Diabetes Mellitus

Does not understand topic. Article from a peer-reviewed scholarly journal; 6 or more pages long, published in the last 5 years; Included in Bb submission Article from a peer-reviewed scholarly journal; lacking in either page length or date of publication requirement; included in Bb submission Article from a peerreviewed scholarly journal; lacking in page length AND date of publication requirement; not submitted to Bb. Article not from a peer-reviewed scholarly journal; not submitted to Bb, Zero spelling, grammar, punctuation or other editing errors 1-2 mistake in spelling, grammar, 3-4 mistakes in punctuation or other editing errors spelling, grammar, punctuation or other editing errors 5 or more mistakes in spelling, grammar, punctuation or other editing errors 1-2 mistake in APA formatting or 3-4 mistakes in APA formatting or other other errors errors 5 or more mistakes in APA formatting or other errors 40% Content 30% Article 10% Editing 15% APA Reference/ Reference in APA format; no mistakes in APA formatting or Editing errors on slides 5% C Level Failing Page 2 of 2 Psychology, Health & Medicine, 2017 VOL. 22, NO. 2, 138–144 http://dx.doi.org/10.1080/13548506.2016.1147055 The effect of diabetes knowledge and attitudes on self-management and quality of life among people with type 2 diabetes Yee Cheng Kueha,b, Tony Morrisa and Aziz-Al-Safi Ismailc a Institute of Sport, Exercise and Active Living, College of Sport and Exercise Science, Victoria University, Melbourne, Australia; bUnit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia; cDepartment of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia ABSTRACT We examined the effect of diabetes knowledge and attitudes on selfmanagement and quality of life (QoL) of people with type 2 diabetes mellitus (T2DM). We employed a cross-sectional study design. A total of 137 female and 129 male participants with T2DM completed the diabetes knowledge scale (DKN), Diabetes Integration Scale-19 (ATT19), Summary of Diabetes Self-care Activities (SDSCA) scale, and Diabetes Qual ity of Life (DQoL) scale, measuring diabetes knowledge, attitudes, self-management, and QoL respectively. Type 2 Diabetes Mellitus

The SDSCA scale measures diet, exercise, blood glucose monitoring, and foot care. The DQoL scale measures satisfaction and impact of QoL. An initial path model that tested the inter-relationships of the study variables was first identified based on previous research. Then, the path model was tested using Mplus 7.3. In the final model, diabetes knowledge was a significant predictor of attitudes and self-management in terms of blood glucose monitoring and foot care. Attitudes was a significant predictor of impact of QoL. Self-management in terms of blood glucose monitoring was a significant predictor of impact of QoL and diet was a significant predictor of satisfaction and impact of QoL. Exercise and foot care aspects of Self-management were significant predictors of satisfaction and impact of QoL respectively. The final model showed a good fit to the data: RMSEA = .045 (90% CI: .009, .071; Clfit = .601), CFI = .950, SRMR = .058. The findings suggest a theoretical basis to direct the development of appropriate health programs and interventions for improving QoL in people with T2DM and warrant replication in diverse samples. ARTICLE HISTORY Received 18 August 2015 Accepted 22 January 2016 KEYWORDS Diabetes knowledge; attitudes; self-management; quality of life; type 2 diabetes Introduction Diabetes is a chronic disease for which there is currently no cure. However, diabetes can be managed with various treatments that are available in most developed countries (Ambler, Ambler, Barron, Cameron, & May, 2008). In the health system of many countries, there are CONTACT Yee Cheng Kueh yckueh@usm.my © 2016 Informa UK Limited, trading as Taylor & Francis Group Psychology, Health & Medicine  139 Knowledge Basic physiology Hypoglycaemia Food/ food substitutions Sick day management General diabetes care Duration of diabetes since diagnosis Self-management Diet Exercise Blood glucose monitoring Foot care Age Quality of life Satisfaction of treatment Impact of diabetes Attitudes/ Psychological Adjustment Attitudes toward diabetes Diabetes integration Emotional adjustment Figure 1. Proposed conceptual framework. Notes. — Hypothesized direct relationship; —– hypothesized indirect relationship. multidisciplinary diabetes teams that assist people to make changes to a healthier lifestyle and other aspects of diabetes management. Diabetes self-management plays an important part in diabetes because it can impact the quality of life (QoL) of people with type 2 diabetes mellitus (T2DM; Khanna, Bush, Swint, Peskin, & Naik, 2012). Research on major aspects of diabetes suggests that the variables, such as knowledge, attitudes, and self-management could contribute to predicting diabetes QoL. For example, Ménard et al. (2007) illustrated that a change in QoL was associated with more positive attitudes. Some researchers have reported that self-care behaviour of people with T2DM was associated with QoL (Misra & Lager, 2008), adherence to self-management has been shown to improve QoL (American Diabetes Association, 2003), and it has been reported that success in diabetes control through self-care can influence the QoL of people with T2DM (Gilden, Casia, Hendryx, & Singh, 1990; Luker & Caress, 1989). QoL in people with T2DM can be considered to be associated, in many ways, with the presence of satisfaction with diabetes treatment, which is the positive aspect of living with diabetes, and the impact of diabetes, which is the negative aspect of living with diabetes. There could be a possible link between diabetes self-management, individual satisfaction and the impact of T2DM on QoL. How diabetes knowledge and attitudes might link to satisfaction and impact remains open to question. The present study examined relationships between key variables (i.e. knowledge, attitudes, self-management, QoL) and background variables, including age and duration of diagnosis with T2DM in a path model. We then examined the direct and indirect effects of diabetes knowledge and attitudes on QoL. These relationships are depicted in Figure 1. 140 Y. C. Kueh et al. Method Participants A total of 266 people with T2DM completed the questionnaires (129, 48.5% Male, 137, 51.5% female). Type 2 Diabetes Mellitus

Participants had a mean age of 57.0 (SD = 8.51) years and duration of diabetes of 10.4 (SD = 7.49) years. Materials Demographic and Health Measures Form included participants’ personal attributes, duration of diabetes since diagnosis and how it was being treated (e.g. diet, tablets, insulin). The Diabetes Knowledge Scale (DKN; Dunn et al., 1984) consists of 15 multiple-choice items. The total correct responses was obtained and converted to a percentage. The original English version of the DKN questionnaire was translated into Malay version prior to the study. The Diabetes Integration Scale-19 (ATT19; Welch, Beeney, Dunn, & Smith, 1996) contains 19 self-report attitudinal items that are scored on a 5-point Likert scale. The Malay version of ATT19 which was tested in a previous study was found to be reliable with Cronbach’s α of .78 (Kueh, Morris, & Ismail, 2014). The Summary of Diabetes Self-Care Activities measure (SDSCA; Toobert, Hampson, & Glasgow, 2000) evaluates the frequency of completing self-management task (i.e. diet, exercise, blood glucose monitoring, and foot care) in the past seven days (Toobert et al., 2000). The Malay version of the SDSCA was found to be reliable with high correlation between items ranging from .53 to .93 within each subscale (Kueh et al., 2014). The Diabetes QoL Measure (DQoL; Jacobson, Groot, & Samson, 1994) consists 15 items on the satisfaction subscale, and 20 items on the impact subscale. Each item is measured on a five-point Likert scale. The Cronbach’s α for the Malay version of the DQoL were .78 for the satisfaction subscale and .81 for the impact subscale, which indicates good reliability (Kueh et al., 2014). Procedure The research was approved by the Universiti Sains Malaysia Human Research Ethics Committee. The participants were recruited through the Diabetes Clinic of the Hospital Universiti Sains Malaysia (HUSM) in Kelantan, Malaysia. Participants were referred to the researcher by staff nurses during their visits to the Diabetes Clinic for medical check-up. Participants were diagnosed with T2DM for at least a year. Malay language is the only language spoken by most of the participants, thus all questionnaires were in Malay language. Participants took approximately 20–30 min to complete the self-administered questionnaires. Their written consent was obtained when they volunteered. Participants were informed about their right to withdraw from the study at any stage without penalty and their involvement in the study would not affect their treatment at the clinic. Type 2 Diabetes Mellitus

Psychology, Health & Medicine  141 Table 1. Participant characteristics. Mean (SD) Age (years) Duration of Diabetes since diagnosis (in years) Education background  Less than high school  High school  College University Working  Yes  No Treatment  Diet  Diet and tablet  Diet and insulin  Diet, tablet and insulin General health  Excellent  Good Fair Poor Diabetes knowledge Attitudes Self-management  Diet  Exercise Blood glucose testing Foot care QoL  Satisfaction  Impact Potential range (midpoint) Number of participants (%) 57.0 (8.51) 10.4 (7.49) 65 (24.4%) 136 (51.1%) 32 (12.1%) 33 (12.4%) 156 (58.6%) 110 (41.4%) 6 (2.3%) 155 (58.3%) 22 (8.2%) 83 (31.2%) 52.5 (17.01) 60.5 (9.49) 0–100 (50) 19–95 (57) 5.2 (2.15) 2.5 (2.34) 1.2 (1.81) 3.0 (2.65) 0–7 (3.5) 0–7 (3.5) 0–7 (3.5) 0–7 (3.5) 70.8 (14.37) 20.9 (13.85) 0–100 (50) 0–100 (50) 20 (7.5%) 109 (41.0%) 133 (50.0%) 4 (1.5%) Statistical analysis The path analysis was conducted using Mplus 7.3 (Muthen & Muthen, 1998–2012) to assess the inter-relationship between the study variables. The assumption of multivariate normality was not met based on multivariate skew test of fit (p < .001). Therefore, alternative estimator robust to maximum likelihood, MLR (Muthen & Muthen, 1998–2012) was used to examine the path models. Several fit indices were taken into consideration in assessing the model, there were the root mean square error of approximation (RMSEA), standardized root mean square (SRMR), the comparative fit index (CFI) and Tucker and Lewis index (TLI) (Kline, 2011). Sample size Kline (2011) suggested that an acceptable sample size for studies using structural equation modeling (SEM) is about 200 cases. Path analysis used in this study is one of the components of SEM. Therefore, the sample for the present study of 266 people with T2DM is considered adequate. 142 Y. C. Kueh et al. Table 2. Summary of the models’ fit indices. Path model Model 1 Model 2 Model 3 RMSEA (90% CI) .144 (.115, .176) .093 (.072, .115) .045 (.009, .071) CIfit* <.001 .001 .601 CFI .756 .772 .950 TLI .105 .645 .919 SRMR .069 .077 .058 *Close fit for RMSEA; RMSEA with desired value of less than .08; Close fit more than .05; SRMR with desired value of less than .08; CFI and TLI both with desired value of more than .95 (Hair, Black, Babin, & Anderson, 2010; Kline, 2011). Diabetes knowledge Attitudes 0.14* Quality of life 0.28* Duration of Diabetes 0.15* -0.19* R2 = 11% -0.31* Satisfaction 0.19* 0.29 0.17* -0.49 Age 0.14* 0.13* 0.21* Impact 0.15* -0.17* 0.22* R2 = 17% 0.11* 0.17* Diet Exercise Foot care Blood glucose testing 0.25 0.26 Self-management Figure 2. Final path model (model 3) with standardized regression weights. Notes. *p < .05, two-tailed; R2 = total variance explained. Results Descriptive statistics of the demographic variables and the study variables are presented in Table 1. The initial path model consisted of 29 hypothesised path relationships. Path analysis revealed that some path relationships were not significant and all of the fit indices for Model 1 were not within the range of recommended values for acceptable fit (see Table 2). The model estimates were re-examined and path relationships were reduced to 14. Although fit indices were improved, they were still not within the range of recommended values for acceptable fit (see Table 2, Model 2). Adequate theoretical support was identified to investigate the new path relationships suggested by the modification indices. Thus a path was added to Model 2 depicted in Figure 2, which was the pathway from age to satisfaction. Then correlations were added between the self-management components. Table 2 reveals that for Model 3, all the fit indices were within the range of desired values for acceptable fit except for TLI, which was close to the recommended fit value. Although there was no significant direct path relationship between diabetes knowledge and QoL, the indirect relationship between diabetes knowledge and QoL via other paths was examined. The path analysis result indicates that there was no significant indirect effect of Psychology, Health & Medicine  143 diabetes knowledge on satisfaction of QoL. However, there was a significant indirect effect of diabetes knowledge on impact of QoL via attitudes (β = −.044, p = .031).The negative slope coefficients (β) based on standardized solution can be interpreted to indicate that as the level of diabetes knowledge increased, the negative impact of QoL was reduced through the mediating factor of attitudes. Discussion The findings from this research contribute to knowledge concerning the relationship between diabetes knowledge, attitudes, self-management, and QoL among people with T2DM living in Malaysia. The present study indicated that there was an association between diet and satisfaction, and also between diet and impact in QoL among people with T2DM in Kelantan. Those who practised more regular management of their diet had higher levels of satisfaction compared to those who practised less diet management and they had lower levels of impact of T2DM on QoL compared to those who practised less diet management. Self-management of T2DM in exercise was significantly associated with satisfaction in QoL of T2DM.

Participants who practised more regular self-management of T2DM through exercise had higher levels of satisfaction in QoL of T2DM compared to those who practised less management of exercise. This result supported research conducted by Smith and McFall (2005) who reported that exercise to control weight is associated with significant QoL changes and this may be due to the large reduction in impaired days for people with diabetes who undertake exercise. In the final model, diabetes knowledge was not a significant predictor for either satisfaction or impact related to QoL of T2DM. Ménard et al. (2007) also found that improvement in QoL among participants with T2DM was not related to knowledge about diabetes. However, based on the indirect relationship examined in the present study, we concluded that diabetes knowledge can be an important indicator in reducing the impact of QoL of T2DM. Although it does not directly influence QoL of T2DM, diabetes knowledge can influence other variables such as attitudes that do have a direct influence on QoL. There are several limitations that need to be considered. The study comprised of Malay sample that limits generalizability of the findings to other ethnic groups. Therefore, the results may not reflect the larger diabetes population in Malaysia. However, Malay is the majority ethnic in Malaysia, thus the present findings can provide indication for future research in other ethnic groups. Disclosure statement No potential conflict of interest was reported by the authors. References Ambler, G., Ambler, E., Barron, V., Cameron, F., & May, C. (2008). Diabetes manual. Retrieved from http://www.rch.org.au/diabetesmanual/manual.cfm?doc_id=2745 American Diabetes Association. (2003). Physical activity/exercise and diabetes mellitus. Diabetes Care, 26(Suppl. 1), S73–S77. 144 Y. C. Kueh et al. Dunn, S. M., Bryson, J. M., Hoskins, P. L., Alford, J. B., Handelsman, D. J., & Turtle, J. R. (1984). Development of the diabetes knowledge (DKN) scales: Forms DKNA, DKNB, and DKNC. Diabetes Care, 7, 36–41. Gilden, J. L., Casia, C., Hendryx, M., & Singh, S. P …Type 2 Diabetes Mellitus