Introduction
Diabetes is a serious disorder in which the levels of blood glucose and sugar become very high, which causes serious complications. The underlying reason for diabetes is that the body cannot produce a necessary amount of insulin. Diabetes affects the body’s ability to not only produce but also use insulin. This hormone is necessary to convert food into glucose, which gives energy to the body’s cells. Insulin opens cells so that they can receive glucose. Therefore, if the body does not produce enough insulin, glucose remains in the blood. There are two types of diabetes (American Diabetes Association, 2015a). Type 1 diabetes means that the body cannot produce insulin at all. Type 2 diabetes means that either the body does not produce enough insulin or the cells do not use it properly.
To control the patient’s conditions, they need to carry out the HbA1c test regularly (American Diabetes Association, 2015b). Therefore, it is the major factor that determines the health of a patient with diabetes. Diabetes alone does not lead to any complications. However, if the disease is not adequately controlled, it might cause severe health problems. High blood sugar drastically affects people’s health, but most patients do not feel any significant changes until complications become serious. People with uncontrolled diabetes might lose vision, die from a stroke or heart attack, or develop neuropathy. In the most serious cases, neuropathy might lead even to the amputation of a limb.
Problems related to diabetes are especially relevant for Latin Americans. Statistics show that diabetes death rates among Hispanics are higher than among white people by approximately 20 percent (Schneiderman et al., 2014). However, there are different methods to address such a problem. One of the most effective approaches is educational programs. Such interventions are applied by different care providers. However, the effectiveness of this method is often questioned. The main goal of this paper is to discuss the effects of continuing patient education on Hispanic patients with diabetes type two.
The Spirit of Inquiry Ignited
Many educators acknowledge the fact that the most effective teaching method is to address the personal needs of each patient. Another important fact is that the ability to comprehend and apply information depends on the patient’s background that includes life experience and origin. However, these components mostly depend on the patient’s culture. Therefore, it is very important to improve cultural awareness among educators.
Cultural awareness is one of the most important elements that can enhance diabetes education processes. This aspect encompasses knowledge about cultural traditions, language, values, behaviors, and attitudes. It is also necessary to cultivate cultural tolerance as this factor is crucial for effective cooperation between educators and patients. Positive relationships contribute to a better learning environment. It helps to engage people more deeply in their healthcare, which increases chances for favorable outcomes (Rotberg, Greene, Ferez-Pinzon, Mejia, & Umpierrez, 2016). Therefore, it is necessary to develop cultural sensitivity in diabetes educators as it plays a significant role in delivering adequate education.
Cultural sensitivity is an important skill that allows working with patients who have different religions, nationalities, and traditions. This skill is highly pertinent to problems related to educational programs for diabetes patients. Cultural sensitivity is necessary to accept the unique characteristics of minority cultures without emphasizing the importance of the hegemonic class. One of the most significant problems related to educational programs for Hispanic patients is effective communication. This community requires special methods and cannot be regarded as others.
Another important issue is the diabetes rates. As the number of patients with diabetes is higher in Hispanic communities than in others, it is necessary to pay particular attention to this ethnic group (Schneiderman et al., 2014). However, various cultural barriers negatively affect proper communication between care providers and Hispanic patients, which subsequently leads to unfavorable outcomes. Some of the most important aspects of this issue are the low level of literacy and insufficient English skills among Latin Americans (Baig et al., 2015). Therefore, educational materials should include more visuals that can help to understand the presented information. Also, professional interpreters are essential when it comes to educating people who do not speak English.
Although educational programs might help to solve this problem, Hispanic patients require special treatment due to cultural differences. Many specialists doubt the effectiveness of such programs. Some studies prove this point. For example, in the article by Baig et al. (2015), the authors demonstrate that the church-based educational approach did not result in a significant improvement of A1C levels in Hispanic patients. Therefore, it is important to continue research in this field to find more evidence that either proves or refutes such positions.
The PICOT Question Formulated
To guide this project the following PICOT question has been formulated: How effectively does diabetes education (I) improve health outcomes (O) in Hispanics aged 30 to 60 with diabetes mellitus type 2 (P) in comparison with patients who do not have such knowledge and skills (C) during a 2-year time frame after being diagnosed (T)?
Search Strategy Conducted
The main strategy that was applied to the research was to review relevant literature that covers all aspects of diabetes education for Hispanics and demonstrates its effect on their health. It was necessary to study only credible works that were published in peer-reviewed journals. Several databases have been used in this study: CINAHL, PubMed, Cochrane Library, National Guidelines Clearinghouse, TRIP, and Google Scholar. More than twenty different works, which included peer-reviewed, evidence-based, and meta-analysis studies published within the last 5 years, have been reviewed.
Several elements of the conducted search strategy are worth mentioning. First, the main search terms were determined. Some of them included diabetes mellitus, diabetes type two, Hispanic patients with diabetes, and diabetes education programs. Therefore, the search was conducted using keywords and exact phrases. Second, subject headings also helped to find articles that did not contain the search terms. As subject headings vary between databases, it was necessary to scrutinize each of them separately. Third, Boolean operators allowed trying different combinations of headings and terms. Finally, citation searching helped to find works cited by other authors.
Critical Appraisal of the Evidence Performed
Much evidence pertinent to the research has been identified during the literature review. All the examined works revealed the effects of different educational methods on health outcomes in Hispanic adults with type 2 diabetes mellitus. Most interventions included diabetes self-management education and support programs aimed at improving the knowledge and skills required for blood sugar level control. The article by Murayama, Spencer, Sinco, Palmisano, and Kieffer (2017) revealed the outcomes of community health worker interventions. The improvement in A1C levels and diabetes self-efficacy proved the importance of the ethnic identity of patients for the development of such interventions. Another study by Pérez-Escamilla et al. (2015) evaluated the effectiveness of “the Diabetes Among Latinos Best Practices Trial (DIALBEST), a community health worker (CHW)-led structured intervention for improving glycemic control among Latinos with T2D” (p. 197). The intervention included several individual sessions that were conducted for one year. The data were collected over 18 months. The results showed that the A1C levels in patients from the intervention group decreased by 0.55 percent (Pérez-Escamilla et al., 2015).
Therefore, it was proved that the DIALBEST method successfully improved blood sugar control among Hispanics diagnosed with type 2 diabetes. In the next study by Rotberg et al. (2016), the authors examined the Emory Latino Diabetes Education Program (ELDEP). This intervention included 2.5-hour education classes in Spanish. The classes addressed such issues as a healthy diet, physical activities, monitoring and control, medications, and problem-solving. The results of the study revealed that A1C levels in patients who attended the classes decreased from 9.1 percent to 7.8 percent and home blood sugar monitoring increased by 22 percent (Rotberg et al., 2016). Hence, these data proved the effectiveness of the ELDEP. Also, the study highlighted the importance of exploring community-based interventions as it enhanced engagement in follow-up care. Another reviewed work by Ferguson, Swan, and Smaldone (2015) had the main goal to assess the impact of different diabetes self-management education interventions that were implemented in combination with primary care on health outcomes among Latinos diagnosed with diabetes mellitus type two.
This systematic review identified more than 600 studies and 13 randomized controlled trials that were retrieved from such databases as PubMed and Cochrane Library. All the trials analyzed the data collected before and after the interventions, which allowed conducting meta-analysis. They tracked the change in A1C levels. The authors examined various interventions that included individual, group, and telephone sessions. Also, the duration of interventions varied from several weeks to several years. The results showed that the mean reduction in A1C levels was approximately 0.25 percent in patients from the intervention groups (Ferguson et al., 2015). Therefore, these findings prove the effectiveness of diabetes self-management education programs. They also improved glycemic control in Latino patients with diabetes type two. However, the authors emphasized the necessity to continue research in this field to optimize the existing education delivery methods. The next study revealed different results. In the article by Baig et al. (2015), the authors examined another diabetes educational approach that was based on church engagement.
Several churches provided space for chronic disease self-management education intervention for Hispanics with diabetes type two. The authors analyzed the impact of such an intervention on diabetes outcomes in the target population. This community-based, randomized controlled study included one-hundred participants most of who were Hispanics with self-reported diabetes. The intervention included weekly educational classes for eight weeks. The classes were led by certified educators. However, the enhanced usual care group was offered one lecture. The measured outcomes included the change in glycosylated hemoglobin, low-density lipoproteins, blood pressure, weight, and diabetes self-management activities (Baig et al., 2015). The results showed that there were no essential differences in A1C levels between participants from intervention and control groups. However, the intervention group patients consumed less high-fat products and engaged in exercising for more days than the patients from the control group. Therefore, the study proved that church-based diabetes self-management program did not have a significant impact on A1C levels. However, the data revealed that certain improvements still took place.
Therefore, these studies provide necessary data for both the existing practices and future research. The evidence presented in these works is abundant enough to be used for the assessment of reviewed interventions. The findings demonstrate positive changes in A1C levels in most cases. Also, educational interventions improved other important biomedical markers such as blood pressure and weight. Also, some authors based their implications on the evidence provided by previous works in the field. Therefore, these studies have a particular value for the present research.
Evidence Integrated with Clinical Expertise and Patient Preferences to Inform a Decision and Practice Change Implemented
The findings presented in the reviewed works have significant importance for the practices implemented in this area. Diabetes self-management education might be integrated into the existing treatment plans. This clinical expertise combined with patient preferences should be used by decision-makers to promote changes in the healthcare system. Diabetes patients need educational support as the chronic nature of the disease requires self-management decisions every day. Diabetes self-management education and support are necessary to help patients with diabetes, navigating their decisions and activities. Abundant evidence proves that such approaches improve health outcomes. Educational interventions cultivate the knowledge and skills that are crucial for diabetes patients. Self-care is an important element in all treatment plans aimed at reducing such biomedical indicators as A1C levels, blood pressure, and weight. To cope with the disease, diabetes patients need to develop specific attitudes and behaviors. Many care providers and other members of a community support such methods. However, it is necessary to allocate additional resources to this sector. The shortage of funds is one of the crucial factors that hinder the development of new diabetes educational programs. Governments should maintain initiatives aimed at promoting this type of care. Also, it is important to engage in different community-based resources.
Another important aspect of diabetes education is the involvement of family members. The findings of a study by Hu, Wallace, McCoy, and Amirehsani (2014) revealed that family-based diabetes interventions for Hispanic adults were highly effective for both patients and their family members. Such examples emphasize the importance of culturally tailored educational courses. Therefore, it is necessary to promote such a shift towards patient-centered and family care. Alliances among patients, their families, and care providers are an emerging trend. Families have to be included in diabetes education programs to help patients handle emotional isolation. Also, such approaches reduce the risk of the development of diabetes in family members of patients.
Economic benefits are also highly pertinent to the issue. Various studies prove a positive economic effect on different educational patient programs. For example, a study by Nolte and Pitchforth (2014) demonstrated the evidence of a high probability of “cost savings associated with structured home-based, nurse-led health promotion for older people at risk of hospital o care home admission” (p. 33). A similar issue was discussed in another study. The authors concluded that “patient education interventions were beneficial in terms of decreased hospitalization, visits to Emergency Departments or General Practitioners, provide benefits in terms of quality-adjusted life years, and reduce the loss of production” (Stenberg et al., 2018, p. 177). Such studies allow suggesting that diabetes self-management education and support programs might be an effective method to increase savings in the healthcare industry. Although this aspect still requires additional research, these studies provide reasoning for practice implications. Healthcare providers might use the presented data in decision-making processes regarding developing “cost-effective patient education interventions (Stenberg et al., 2018, p. 177). All the above-described findings are pertinent to the subject, this might be used to inform decisions related to practice change.
Outcome Evaluated
Several studies related to the subject were evaluated and revealed similar outcomes of diabetes education interventions. The main strength of a study by Baig et al., (2015) is the qualitative information that demonstrated an increase in the perceived competence in self-care among the participants of church-based diabetes intervention. However, the program could not help to reduce A1C levels. Another study by Ferguson et al. (2015) provides a profound analysis of data obtained from such databases as PubMed, Cochrane Library. The evidence proves the positive effect of diabetes self-management education programs. Similar results were demonstrated in the next work. A study by Rotberg et al. (2016) identified changes in clinical indicators and risk reduction examinations among Hispanic patients with diabetes. However, the authors highlighted that further research is required. A quantitative study by PĂ©rez-Escamilla et al. (2016) addresses such issues as diabetes complications, healthy lifestyles, and nutrition. The intervention described in this work helped to improve blood glucose control. Finally, a study by Murayama et al. (2017) demonstrated the direct correlation between the level of cultural identity and changes in A1C levels and diabetes self-efficacy. All these works proved the effectiveness of diabetes education interventions. It can be seen in the improvement in different biomedical indicators, though the main one is still AC1 level. Therefore, the analyzed interventions might be successfully applied to wider populations.
Project Dissemination
The examined works were published in the leading peer-reviewed medical journals. Therefore, their outcomes were successfully disseminated among the professionals working in this field. The described interventions are used by various care providers. There is also a wide range of other types of educational programs that apply similar principles. For example, different online courses help diabetes patients manage this disease. Other programs aimed at children and young adults. They established a comfortable environment that facilitates learning processes. Also, people can easily share their experiences. Also, there are peer support options that involve online communities. Various local support programs include consultations by phone. Therefore, such interventions increase awareness about the importance of self-management education among diabetes patients.
Conclusion
In conclusion, this project presented abundant evidence that supports different types of diabetes education interventions. Several works were thoroughly scrutinized to appraise their findings. These studies were published in credible peer-reviewed medical journals. Such databases as CINAHL, PubMed, Cochrane Library, National Guidelines Clearinghouse, TRIP, and Google Scholar were used to find relevant materials. Most studies revealed the positive effect of different educational programs that were aimed at increasing medical literacy among Hispanic patients with diabetes type two. The main indicator, A1C, was improved in the majority of participants. Changes in other important characteristics such as blood pressure or weight were also positive. Therefore, this project might serve as an additional source supporting diabetes educational programs for Hispanic patients.
References
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Hu, J., Wallace, D. C., McCoy, T. P., & Amirehsani, K. A. (2014). A family-based diabetes intervention for Hispanic adults and their family members. The Diabetes Educator, 40(1), 48-59.
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Rotberg, B., Greene, R., Ferez-Pinzon, A. M., Mejia, R., & Umpierrez, G. (2016). Improving diabetes care in the Latino population: The Emory Latino diabetes education program. American Journal of Health Education, 47(1), 1-7.
Schneiderman, N., Llabre, M., Cowie, C. C., Barnhart, J., Carnethon, M., Gallo, L. C.,… Teng, Y. (2014). Prevalence of diabetes among Hispanics/Latinos from diverse backgrounds: The Hispanic community health study/study of Latinos (HCHS/SOL). Diabetes Care, 37(8), 2233-2239.
Stenberg, U., VĂĄgan, A., Flink, M., Lynggaard, V., Fredriksen, K., Westermann, K. F., & Gallefoss, F. (2018). Health economic evaluations of patient education interventions a scoping review of the literature. Patient Education and Counseling. 101(2), 177-184.