Using Evidence

Introduction

Research plays a key role in knowledge development and advancement in learning. Through research, it is possible to gather evidence that could be used to solve existing problems or answer critical questions. Different approaches have been used to gather, evaluate, and interpret data to answer research questions. In healthcare, the methods used in research impact the validity and reliability of the findings. Qualitative and quantitative research methods are the two main approaches adopted in the research. The two methods have also been used to study different aspects of type-2 diabetes (McGovern et al., 2016; McGovern et al., 2018; Young et al., 2017). Regardless of the method used, it is important to note that when using evidence from research work, one should assess the quality in terms of validity and reliability of findings in line with the method used. Applying the findings from studies regarding diabetes prevention, treatment, and management has played a key role in clinical improvement (Goldman et al., 2016; Hirst et al., 2013; Inzucchi et al., 2012). This paper provides a critical analysis of two journal articles addressing the issue self-management in diabetes type-2 in United Kingdom to determine the quality of evidence and how it could be used in healthcare.

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Background

The comprehensive data on type-2 diabetes in the United Kingdom could be traced back to 1996 when the number was estimated at 1.4 million people. However, this value has increased to a higher level and currently it is estimated that over 3.5 million people have been diagnosed with the condition (Diabetes UK, 2019). According to Diabetes UK (2019), there is a possibility that a significant number of citizens are living with the condition undiagnosed, which also increases the number of those affected. By 2015, it has been forecasted that the rate of prevalence could see a total of 5 million UK residents suffering from type-2 diabetes. Based on this nature of prevalence, it is important to consider the strategies that could be used to foster prevention, self-management, and coping up with the symptoms (Lewis et al., 2015; Mannucci et al., 2018). It is important to note that the objective of treating type-2 diabetes is to maintain blood sugar and reduce the risk of complications. It is important for patients to focus on how to improve the quality of life by focusing on the recommended lifestyle and prescribed medication.

Studies have published diverse perspectives regarding type-2 diabetes. Evidence gathered in studies provides essential knowledge that could be integrated into clinical practice to improve patient experience and treatment outcomes (American Diabetes Association, 2018a; Inzucchi et al., 2015; Khunti et al., 2017). The use of qualitative research is common in this area. Qualitative research entails the assessment of experiences, perspectives, attitudes, and beliefs regarding an individual, a phenomenon, or an occurrence. On the other hand, quantitative studies have also been adopted when studying self-management among type-2 diabetes patients. In a quantitative study, the focus usually set on the numerical or statistical implications, meaning, and characteristics as defined by variables under investigation. The use of quantitative research is important when seeking to make a prediction, determine statistical relationships, and assessing the existing trends. Each of these methods has been adopted in the study of type-2 diabetes to improve clinical practice and self-management. The next section evaluates two studies conducted using a quantitative and qualitative method respectively to determine the quality of evidence and its applicability in clinical practice.

Journal One

A qualitative study was carried out by Pal et al. (2018) regarding self-management in diabetes. The purpose of the study was to assess the perspective of adult patients regarding digital health interventions for diabetes type-2 self-management. The focus of the study was on patient education and support. The scholars sought to assess how the patients recruited for the study perceived the interventions offered using digital health programs. The study was carried out using a qualitative method (Pal et al., 2018). The scholars recruited participants and assigned them into four focus groups. A total of 20 patients participated in the study. The patients responded to the focus group questions where they narrated their experiences with the management of the condition. The data collected from the focus groups were used to assess the nature of experiences among type-2 patients in the United Kingdom (Pal et al., 2018).

The researchers performed a comprehensive literature review that covered significant aspects of diabetes management. The study addressed the negative impacts associated with self-management among diabetes patients. The scholars went further to examine how work, social life, and physical wellbeing defined the experiences of people diagnosed with the condition. From the literature review, the researchers were able to link the existing literature to the objectives in order to enhance the scholarly evidence regarding diabetes management among patients. The dimensions covered in the literature clearly linked to the objective of the study. Such a scenario could be justified by the way the scholars focused on the challenges and implications of risk factors that impede successful self-management among diabetes adult patients, which was in line with the purpose of the study.

On the other hand, the data was obtained from 20 participants assigned to four different focus groups. The study sample was limited, which impacts the reliability and validity of the findings. It is estimated that over 3 million people are living with diabetes; therefore, the sample size could have been larger than 20 people. The use of focus groups to collect the data was important based on the objective of the study, which was focusing on the needs and wants of the participants regarding self-management education. The data collection approach provided each patient with the opportunity to narrate their experience and anticipations regarding self-management education. The patients were only allowed to participate in the study after accenting the research consent. The study also did not include personal details of the patients, which is an important ethical consideration in clinical research. The scope of the study was maintained throughout the literature review, data collection, and assessment of the findings. There were no limitations identified by the authors; however, it is clear that the sample size was small.

It is important to note that the study found out that patients diagnosed with diabetes type-2 face significant challenges in line with the desire to achieve effective self-management. The scholars ascertained how the participants had critical emotional, social, and physical challenges that affected their ability to meet the education requirements about the management of the condition. Although the study did not recommend a new change in practice, it emphasized on the need to adhere to interventions stipulated on the diabetes management guidelines to assist patients to achieve maximum self-management. Therefore, the study concluded that there is a need to improve how practitioners address the issue of educating patients on self-management by focusing on emotional, behavioral, and physical dimensions. The researchers did not focus on the need for further research on this area but recommended on how to improve professional practice.

Journal Two

Other scholars have adopted the use of the quantitative methodology to investigate the issue of diabetes self-management among patients. Carnesciali, Wallace and Odlum (2018) conducted research to determine the effectiveness of the education intervention tailored for patients with diabetes to foster self-management. The study was limited to those programs delivered using avatar-based technology. The scholars focused on the rating and perceptions of educators. Certified diabetes educators have played a significant role in improving the process and effectiveness of self-management among patients. The scholars were motivated by increasing e-health interventions that have enhanced access to different diabetes-related care management for patients seeking to enhance their skills in symptom control and wellbeing improvement.

The study adopted a quantitative approach to investigate how the educators perceived and rated the technologies based on their clinical experiences as professionals. Carnesciali, Wallace and Odlum (2018), therefore, recruited a total of 198 certified diabetes educators who participated in the study. A logical model was developed in line with the general and complex factors that characterized the objective of the study. The framework allowed the researchers to establish the interrelation between the perception of educators and the need to improve self-management skills and adherence among patients. The data was collected through the survey monkey platform using surveys (Carnesciali, Wallace and Odlum, 2018). The cross-sectional study included different scales that were adopted to improve data analysis and interpretation. Statistical analysis involved Pearson correlations, T-tests, backward regression, and thematic assessments. The researchers, therefore, conducted a multidimensional analysis of the perception and rating of the educators regarding the technology-based interventions for self-management education to enhance diabetes control.

It is important to note that the study was characterized by a high level of validity and reliability. The researchers included a larger sample size of 198 compared to 20 individuals who participated in the qualitative study. The data was collected using surveys, which allowed the study to include multiple factors that define perception and ratings of a clinical education program for patients. The study included four different statistical tests that are used to determine the magnitude and dimension of the relationship between variables (Carnesciali, Wallace and Odlum, 2018). The study also took into account ethical consideration such as the privacy of the participants and the privacy of their personal details. However, the problem with this study was the limited level of dependability associated with online survey especially regarding the reliability of the participants in terms of eligibility to participate in the research.

Furthermore, the findings of the study were clearly outlined and systematically presented because it was a quantitative study. The findings reflected the objectives of the study and were in line with the comprehensive literature review that was carried out to determine the exploited gaps. The results showed that the ethnicity and age of the educators determined how they perceived the technology interventions. However, thematic and content analysis showed that the educators had a generally positive perception regarding the technology-based self-management education interventions for diabetes patients (Carnesciali, Wallace and Odlum, 2018). Based on the findings, the scholars recommended that e-health interventions meant for diabetes patients should be grounded in evidence and theories to meet the needs of targeted patients.

Improving Practice

Research regarding diabetes management has been used to improve treatment and patient experiences and outcomes (Anjana et al., 2017; Gregg, Sattar and Ali, 2016). The qualitative study provided a comprehensive account of the experiences encountered among patients in line with the effectiveness of self-management in type-2 diabetes. Understanding the experience of patients provides clinical insights that could be used to develop patient-centered guidelines on how to achieve effective self-management outcomes. At the same time, through the outcomes of qualitative analysis, it was possible to account for the attitudes and perceptions of both the patients and clinicians with the objective of improving care management. On the other hand, the quantitative study focused on understanding the relationships regarding the topic. The findings of this study could be used to create predictive models that could be adopted in preventive and treatment care delivery across at-risk populations. Home-based care, as well as in-hospital care, is the main approach adopted in type-2 diabetes management (American Diabetes Association, 2018b; American Diabetes Association, 2018c). Data depicting the trends in recovery, coping up, and treatment outcomes could improve how practitioners work collaboratively with patients to improve their experiences.

Conclusion

In conclusion, researchers could use qualitative or quantitative study when evaluating health-related issues and problems. However, scholars need to understand how the selected method affects the validity and reliability of the study. On the other hand, when using evidence published in scholarly research, it is important the reliability and appropriateness of the data used and the interpretation techniques adopted during analysis. At the same time, the appraisal of the research content should also consider the implication of the findings on clinical and professional practice. Based on the above analysis of how the evidence in each study could be used, the qualitative study provided a comprehensive perspective regarding self-management among type-2 diabetes patients. The study focused on the experience of patients and how the outcomes could be improved in the short-term and long-term.

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References

American Diabetes Association, 2018a. Glycemic targets: standards of medical care in diabetes—2018. Diabetes Care, 41, pp. S55– S64.

American Diabetes Association, 2018b. Pharmacologic approaches to glycemic treatment: standards of medical care in diabetes—2018. Diabetes Care, 41, pp. S73–S85.

American Diabetes Association, 2018c. Classification and diagnosis of diabetes: standards of medical care in diabetes—2018. Diabetes Care, 41, pp. S13–S27.

Anjana R. M., Kesavadev, J., Neeta, D., Tiwaskar, M., Pradeepa, R., Jebarani, S., Thangamani, S., Sastry, N. G., Brijendra, K. S., Ramu, M., and Gupta, P. P. K., 2017. A multicenter real-life study on the effect of flash glucose monitoring on glycemic control in patients with type 1 and type 2 diabetes. Diabetes Technol Ther, 19, pp. 533–540.

Carnesciali, J. D., Wallace, B. C., and Odlum, M., 2018. An Evaluation of a Diabetes Self-Management Education (DSME) Intervention Delivered Using Avatar-Based Technology: Certified Diabetes Educators’ Ratings and Perceptions. Diabetes Educ., 44(3), pp. 216 – 224.

Diabetes UK, 2019. The prevalence of diabetes in the United Kingdom. [online] Available at: https://www.diabetes.co.uk/diabetes-prevalence.html [Accessed on 1 December 2019].

Gregg, E. W., Sattar, N., and Ali, M. K., 2016. The changing face of diabetes complications. Lancet Diabetes Endocrinol, 4, pp. 537–547.

Goldman, J., Kapitz,a C., Pettus, J., and Heise, T., 2017. Understanding how pharmacokinetic and pharmacodynamic differences of basal analog insulin’s influence clinical practice. Curr Med Res Opin, 33, pp. 1821–1831.

Hirst, J. A., Farmer, A. J., Dyar, A., Lung, T. W., and Stevens, R. J., 2013. Estimating the effect of sulfonylurea on HbA1c in diabetes: a systematic review and meta-analysis. Diabetologia, 56, pp. 973–984.

Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diament, M., Ferrrannini, E., Nauck, M., Peters, A. L., Tsapas, A., Wender, R., and Mathews, D. R., 2012. Management of hyperglycemia in type 2 diabetes: a patient-centered approach. Diabetologia, 55, pp. 1577–1596.

Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diament, M., Ferrrannini, E., Nauck, M., Peters, A. L., Tsapas, A., Wender, R., and Mathews, D. R., 2015. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach. Diabetologia, 58, pp. 429–442.

Khunti, K., Seidu, S., Kunutsor, S., and Davies, M., 2017. Association between adherence to pharmacotherapy and outcomes in type 2 diabetes: a meta-analysis. Diabetes Care, 40, pp. 1588–1596.

Lewis, J. D., Habel, L. A., Quesenberry, C. P., Strom, B. L., Peng, T., Hedderson, M. M., and Ehrlich, S. F., 2015. Pioglitazone use and risk of bladder cancer and other common cancers in persons with diabetes. JAMA, 314, pp. 265–277.

Mannucci, E., Antenore, A., Giorgino, F., and Scavini, M., 2018. Effects of structured versus unstructured self-monitoring of blood glucose on glucose control in patients with non-insulin-treated type 2 diabetes: a meta-analysis of randomized controlled trials. J Diabetes Sci Technol, 12, pp. 183–189.

McGovern, A., Tippu, Z., Hinton, W., Munro, N., Whyte, M., and Lusighan, S., 2016. A systematic review of adherence rates by medication class in type 2 diabetes: a study protocol. BMJ Open, 6, pp. e010469.

McGovern, A., Tippu, Z., Hinton, W., Munro, N., Whyte, M., and Lusignan, S., 2018. Comparison of medication adherence and persistence in type 2 diabetes: a systematic review and meta-analysis. Diabetes Obes Metab,vol. 20, pp. 1040– 1043.

Pal, K., Dack, C., Ross, J., Michie, S., May, C., Stevenson, F., Farmer, A., Yardley, L., Barnard, M., and Murray, E., 2018. Digital Health Interventions for Adults with Type 2 Diabetes: Qualitative Study of Patient Perspectives on Diabetes Self-Management Education and Support. J Med Internet Res, 20(2), pp. e40

Young, L. A., Buse, J. B., Weaver, M. A., Vu, M. B., Blakeney, T., Grimm, K., Rees, J., Niblock, F., Donahue, K. E., and Monitor Trial Group, 2017. Glucose self-monitoring in non-insulin-treated patients with type 2 diabetes in primary care settings: a randomized trial. JAMA Intern Med, 177, pp. 920–929.

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