Lesson
Plan for:
Control Risks, Control Health: The Importance of Diabetes
Self-Management Intervention
Submitted
by: Kristy Jamerson
Texas
Woman’s University
HS
6453.50 – Strategies in Health Education Delivery
Fall
2012
Overview
and Rationale
Type 2 diabetes is the most common
form of diabetes; 90-95% of all diagnosed cases of diabetes are type 2. The disease is currently ranked as the
seventh leading cause of death in the U.S. (Centers for Disease Control &
Prevention [CDC], 2011). Type 2 diabetes
is a chronic condition that affects the way the body metabolizes sugar
(glucose), which is the body’s main source of fuel. This metabolic disorder causes the body to
either resist the effects of insulin or causes insufficient production of
insulin to maintain a normal blood glucose level (Mayo Clinic, 2012).
Type 2 diabetes is most prevalent in the
elderly and in minority populations.
African Americans are a minority population that experiences
disproportionate rates of type 2 diabetes.
According to the CDC (2011), 4.9 million or 18.7% of all African
Americans age 20 years or older have diabetes.
Compared to non-Hispanic whites, the risk of diagnosed diabetes was 77%
higher in non-Hispanic blacks (CDC, 2011).
Additionally, African Americans experience higher rates of
diabetes-related complications, as illustrated by the following:
- African
Americans are nearly 50% more likely to develop diabetic retinopathy and diabetes-related
blindness as non-Hispanic whites.
- African
Americans are 2.6 to 5.6 times as likely to suffer from kidney disease;
with more than 4,000 new cases of End Stage Renal Disease (ESRD) each
year.
- African
Americans are 2.7 times as likely to require lower-limb amputations.
(American
Diabetes Association, 2012)
·
African Americans are 2.2 times as
likely as non-Hispanic whites to die from diabetes.
(U.S. Department of Health and
Human Services, Office of Minority Health, 2012)
Upon examining the impact of type 2
diabetes in my home state of Arkansas, a similar impact to what is occurring
nationwide was revealed. The prevalence
of diabetes in Arkansas has been at or above the national average for over 15
years. Diabetes is the 6th
leading cause of death among all Arkansans and the 4th leading cause
of death among African Americans in the state.
In 2008, approximately 248,000 Arkansans were diagnosed with diabetes
and an additional 124,000 were believed to be undiagnosed and untreated. The prevalence of diabetes is four times
greater among persons over the age of 45 compared to younger persons (Arkansas
Department of Health, 2011). Furthermore,
approximately 22% of the population in Arkansas lives in areas designated as
Health Professional Shortage Areas (HPSAs) by the federal government, and more
than half of the population in Arkansas lives in areas designated as Medically
Underserved Areas (MUAs) (Arkansas Department of Health, 2011). Many of these Arkansas counties are located
in the rural Delta region where financial, structural, and personal barriers
prevent proper diabetes self-management behaviors. Financial barriers include lack of health
insurance. Structural barriers involve
inadequate and insufficient numbers of health care facilities and lack of
personal physicians and diabetic specialists in medically underserved
regions. Personal barriers in these
rural areas include lack of education/knowledge involving diabetes, low health
literacy, lack of transportation, and distrust for the medical establishment (Arkansas
Department of Health, 2011).
The need for increased type 2 diabetes
self-management interventions in African Americans residing in rural settings
has been documented in multiple studies (Strom, Lynch, & Egede, 2011; Leeman,
Skelly, Burns, Carlson, & Soward, 2008; Utz, Williams, Jones, Hinton,
Alexander, Yan,…Oliver, 2008). The
aforementioned combination of factors that have led to the enormous negative
impact of type 2 diabetes on the African American population in Arkansas
indicates the need for a targeted diabetes self-management intervention in one
of the rural counties most highly plagued by this condition; Lake Village, AR
in Chicot County.
Program
Description
The Control Risks, Control Health Diabetes Self-Management Intervention
was designed based on the fact that diabetic complications can be prevented
through proper self-management behaviors, such as consistent blood glucose
monitoring, regular physical activity, appropriate diet, weight management, and
routine eye and foot exams (National Diabetes Education Program, 2011). The purpose of the program is to educate African
Americans on the risks associated with uncontrolled type 2 diabetes and improve
self-efficacy regarding consistent implementation of self-management behaviors.
Intended Audience
African Americans, age 45-64, formally
diagnosed with type 2 diabetes. This age
range was selected because in 2010, approximately 1.9 million new cases of
diabetes were diagnosed in those 20 years or older, of which 1,052,000 were in
the 45-64 age range (CDC, 2011). Program
flyers in highly frequented areas, local newspaper ads, and advertisement on
local secular and gospel radio stations will be utilized in advance to recruit
program participants.
The Setting
The setting for the program is the Central
Community Center in Lake Village, AR. This
is a centrally located facility within the community. The maximum capacity of the community center
is 75 people. Numerous six foot tables
are available for use. A close-knit
setting will be facilitated by arranging six of the 6-ft. tables, with four
chairs at each table (on the same side of the table so no one’s back is to the
presenter). The tables will be set up on
each side of a center aisle so the program facilitator can easily navigate the
room and provide assistance as needed. Additional
seats can be added should the need arise (in anticipation of 50 possible
participants).
Program Dates
The Control
Risks, Control Health program will take place on two Saturdays in the month
of November (the 10th and 17th) in order to reach a
significant number of community residents.
November was selected to coincide with American Diabetes Month, which is
observed by one of the main churches in Lake Village; Chicot Baptist Church. Additionally, this will serve as an
opportunity to reinforce the importance of healthy food choices as residents
enter the holiday season. The program
will take place on each date from 11:00 a.m. until noon.
Program Timeline
Introduction
– 2 minutes
Pre-test
questionnaire (7 questions – see Appendix A) – 3 minutes
Distribution
of Type 2 Diabetes Brochures & Topic presentation – 20 minutes
-
What
is type 2 diabetes? What potential
complications result from uncontrolled or poorly controlled diabetes? What self-management behaviors prevent
diabetic complications? Where can one
obtain additional information?
Hands-on
activity – 15 minutes
-
Selecting
healthy foods: Participants at each table will work together to prepare a plate
with servings of food they believe constitute healthy food choices for one meal. The food options will be typed & cut out
on colorful card stock paper, and caloric, fat, and sugar content will be
contained on the back of each food item so participants can see how well they
did with their food selections for each meal.
Q
& A session – 5 minutes
Evaluation Measures: Post-test
questionnaire (7 questions), completion of self-efficacy scale (8 questions),
and evaluation of program effectiveness (5 questions) – 15 minutes
Required Materials –
each session
12
– 6 ft. tables
48-50
chairs
50-60
pencils (in case pencil lead breaks)
50
pre-test questionnaires
50
post-test questionnaires
50
self-efficacy rating scale questionnaires
50
Diabetes Facts brochures
180
note cards with food choices (15 per table)
50
program evaluations
Flash
drive with power point presentation
Computer
& projector
50
copies of power point (if equipment fails)
Guiding
Health Education Model
The
Health Belief Model was used as the guiding health education model for this
program. The key constructs of the HBM
include perceived susceptibility, perceived severity, perceived benefits,
perceived barriers, cues to action, and self-efficacy (Champion & Skinner,
2008). Since the research participants
will have already been diagnosed with type 2 diabetes, the primary constructs
considered in the proposed research are perceived severity, perceived benefits,
perceived barriers, cues to action, and self-efficacy. African Americans with type 2 diabetes must
recognize the perceived severity of the condition and its related complications
before they see the need for consistent self-management behaviors. Additionally, an awareness of perceived
benefits to self-management is instrumental for positive behavior change and
any perceived barriers to diabetes self-management in rural communities must be
overcome. Furthermore, cues to action
for self-management behavior could be early signs of complications, such as changes
in vision or non-healing ulcers.
Finally, self-efficacy can be achieved when a subject identifies and
develops self-confidence in his or her ability to routinely perform diabetes
self-management behaviors.
Program Goal and Objectives
Goal
Goals for the Control Risks, Control Health Diabetes Self-Management Intervention
are:
1. Increased
levels of compliance with diabetes self-management behaviors in program
participants.
-
Process
objectives
a.
By completing the pre-test
questionnaire, participants will show a willingness to assess their knowledge
of self-management behaviors. (Affective)
b.
During the program intervention,
participants will identify two diabetes self-management strategies. (Cognitive)
c.
50% of program participants will accurately
construct a meal comprised of healthy food choices during the hands-on
activity. (Psychomotor)
-
Outcome
objectives
a.
At the conclusion of the program,
participants will identify a total of five diabetes self-management strategies.
(Cognitive)
b.
The computation of diabetes
self-management self-efficacy levels on the Self-Efficacy
for Diabetes scale will result in a mean average of 6.0 or above for
program participants. (Psychomotor)
2. Reduced
diabetes-related complications in program participants.
-
Process
objectives
a.
Participants will demonstrate their
knowledge of diabetes complications by completing the pre-test questionnaire.
(Psychomotor)
b.
After distribution of the Diabetes Facts brochure, participants
will list three common complications associated with poorly controlled
diabetes. (Cognitive)
c.
After the topic presentation, participants
will be willing to share any concerns about availability or lack of diabetes
health care resources in their community. (Affective)
-
Outcome
objectives
a.
The Post-test questionnaire results will
reflect 75% accuracy in knowledge regarding potential diabetes-related
complications. (Cognitive)
b.
At the conclusion of the program, 30% of
participants will express their intent to seek a nutritional consult.
(Affective)
c.
80% of program participants who complete
the program evaluation will describe the program as effective in helping them
understand the severity of diabetes-related complications and how to prevent
them. (Cognitive)
Procedures
Introduction:
o
Program facilitator – name, credentials,
and why the program intervention is important
Distribution
and completion of pre-test questionnaire & pencils
o
Three minutes for completion
Distribution
of Diabetes Facts brochure & Type
2 Diabetes Presentation
o
20 minutes
o
Presentation:
“You are participating in this program today because you have been clinically
diagnosed with type 2 diabetes. By the
time you leave here today you will have a clear understanding of what type 2
diabetes is, the potential complications that can result if the disease is not
properly controlled, and what actions you should take to manage your diabetes
so that you can still live a high quality life.
At the conclusion of the program, there will also be an opportunity for
you to obtain additional information about resources that can aid in your
ability to manage your condition.”
“Type 2 diabetes results
from the body’s inability to make enough, or properly use insulin, which is a
hormone that is needed to convert sugar, starches and other food into energy
for daily life. It occurs most often in
older people and minorities. If action is not taken to control diabetes,
numerous health complications can arise.
These complications include increased risk of heart disease and stroke,
high blood pressure, blindness and eye problems, kidney disease, lower-limb
amputations, or even death (Refer to the
‘Potential Complications’ section of the brochure). It
is also important to note that African Americans experience higher rates of
diabetes-related complications than the general population, which is why you
are the population targeted for this important health education program.
“The key to reducing
potential type 2 diabetes-related complications and maintaining a high quality
of life is not just dependent on quality medical care, which includes routine
medical check-ups and eye and foot examinations (provide information here on how
often these should take place), it is also highly dependent upon the
consistency of diabetes self-management behaviors. Self-management empowers the individual to make
informed decisions and implement behaviors such as daily blood glucose
monitoring, healthy eating, and remaining physically active.”
-
At
this point, refer to the section of the brochure that pertains to diabetes
self-management behaviors. Discuss in
detail how often blood glucose monitoring should take place, when to be
concerned about blood glucose levels, healthy dietary options, and recommended
levels of physical activity.
o
Cooperative learning/group work –
meal construction activity (15 minutes)
o
Question & Answer session (5
minutes) – also provide information regarding additional resources
Complete
End of Program Questionnaires & Evaluation Measures (15
minutes)
o
Post-test questionnaire (see Appendix A)
o
Self-Efficacy
for Diabetes questionnaire (see Appendix B)
o
Evaluation of program effectiveness (see
Appendix C)
Anticipated
Problems & Solutions
o
Problem:
Audiovisual
equipment may not function properly _
Solution: handouts containing power
point presentation will be distributed
o
Problem:
All participants may not want to participate in hands-on activity _
Solution: take volunteer groups who
are willing to complete the activity or offer incentives for the three groups
who construct the healthiest meals
o
Problem:
Attendance
may be greater than expected _
Solution: Additional tables and
seating can moved from the back of the room to accommodate the overflow since
maximum capacity of Central Community Center is 75.
o
Problem:
Transportation
to the program may be a problem in this rural setting _
Solution: Work with Chicot Baptist
Church to have their church van provide transportation for community residents
who do not otherwise have transportation.
References
American
Diabetes Association (2012). African
Americans & complications. Retrieved from http://www.diabetes.org/living-with-diabetes/complications/african-americans-and-complications.html
Arkansas
Department of Health (2011). The burden
if diabetes in Arkansas. Retrieved from http://www.healthy.arkansas.gov/programsServices/chronicDisease/diabetesPreventionControl/Documents/BurdenofDiabetesAR.pdf
Centers
for Disease Control & Prevention (2011). 2011 national diabetes fact sheet. Retrieved from http://www.cdc.gov/diabetes/pubs/estimates11.htm
Champion,
V. L. & Skinner, C. S. (2008). The health belief model. In K. Glanz, B. K.
Rimer, & K. Viswanath (Eds.), Health behavior and health education: Theory,
research, and practice (4th ed., pp. 45-65). San Francisco, CA: Jossey-Bass.
Leeman,
J., Skelly, A. H., Burns, D., Carlson, J., & Soward, A. (2008). Tailoring a
diabetes self-care intervention for use with older, rural African American
women. The Diabetes Educator, 34, 310-317. doi:10.1177/0145721708316623
Mayo
Clinic (2012). Type 2 diabetes:
Definition. Retrieved from http://www.mayoclinic.com/health/type-2-diabetes/DS00585
National
Diabetes Education Program (2011). The
diabetes epidemic among African Americans. Retrieved from http://ndep.nih.gov/media/FS_AfricanAm.pdf
Strom,
J. L., Lynch, C. P., & Egede, L. E. (2011). Rural/urban variations in
diabetes self-care and quality of care in a national sample of US adults with diabetes.
The Diabetes Educator, 37, 254-262. doi:10.1177/0145721710394875
U.S.
Department of Health and Human Services, Office of Minority Health (2012). Diabetes and African Americans.
Retrieved from http://minorityhealth.hhs.gov/templates/content.aspx?1v1=2&1v1ID=51&ID=3017
Utz,
S. W., Williams, I. C., Jones, R., Hinton, I., Alexander, G., Yan, G., …
Oliver, N. (2008). Culturally tailored intervention for rural African Americans
with type 2 diabetes. The Diabetes Educator, 34, 854-865.
doi:10.1177/0145721708323642
Appendix
A – Pre/Post-Test Questionnaire
1.
How often should I check my blood sugar?
a. every other day b. 2-3 times per day c. once per week
2.
Can I eat what I want as long as I take my diabetes medication?
a. Yes b. No
3.
Can stress affect my blood sugar levels?
a. Yes b. No
4.
Does weight gain make diabetes more difficult to control?
a. Yes b. No
5.
What types of foods should diabetics avoid?
a. foods with high fat content b. foods with lots of added sugar c. B only
d. both A and B
6.
What are common potential complications of uncontrolled diabetes?
a. problems with vision b. kidney disease c. lower-limb amputations
d. hair loss e. all are potential complications f. three are potential complications
7.
Can I have diabetes complications when I don’t feel bad?
a. Yes b. No
Appendix
B – Self-Efficacy of Diabetes Questionnaire
Diabetes
Self-Efficacy Scale
We
would like to know how confident you are in doing certain activities.
For each of the following questions, please choose the number that corresponds
to your confidence that you can do the tasks regularly at the present time.
|
|||||||||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||
Items (using the same format as above):
- How confident do you feel that you can eat your meals
every 4 to 5 hours every day, including breakfast every day?
- How confident do you feel that you can follow your diet
when you have to prepare or share food with other people who do not have
diabetes?
- How confident do you feel that you can choose the
appropriate foods to eat when you are hungry (for example, snacks)?
- How confident do you feel that you can exercise 15 to
30 minutes, 4 to 5 times a week?
- How confident do you feel that you can do something to
prevent your blood sugar level from dropping when you exercise?
- How confident do you feel that you know what to do when
your blood sugar level goes higher or lower than it should be?
- How confident do you feel that you can judge when the
changes in your illness mean you should visit the doctor?
- How confident do you feel that you can control your
diabetes so that it does not interfere with the things you want to do?
Scoring
The
score for each item is the number circled.
Higher number indicates higher self-efficacy.
(Self-Efficacy
for Diabetes Scale was developed by Stanford Patient Education Research Center
and is free to use. Retrieved from http://patienteducation.stanford.edu/research/sediabetes.html )
Appendix
C – Control Risks, Control Health Self-Management
Program Evaluation
Please provide your
feedback about the diabetes self-management program by responding to the
following items:
1.
The program provided information that detailed the significance of type 2
diabetes.
strongly agree agree neutral disagree strongly disagree
2.
The program thoroughly outlined the severity of potential diabetes-related
complications.
strongly
agree agree neutral disagree strongly
disagree
3. The
program clearly illustrated the importance of diabetes self-management
behaviors in reducing diabetes-related complications.
strongly
agree agree neutral disagree strongly
disagree
4. The program helped to increase my confidence
level regarding my ability to properly manage my type 2 diabetes?
strongly
agree agree neutral disagree strongly
disagree
5. In what way(s) could the program be improved?
_____________________________________________________________________________
No comments:
Post a Comment