Improving Diabetes Self-Care Among African-American Women 50 Years and Older Thesis

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Improving Diabetes Self-Care among African-American Women 50 years and older

Diabetes is the fourth leading cause of death worldwide (International Diabetes Foundation, 2007). Diabetes is a condition that can cause serious side effects, in addition to the potential for death, if not managed properly. For a majority of patients management is not difficult. It requires monitoring of blood sugar levels on a daily basis and adherence to a diet and exercise regime. Yet, many do not manage their diabetes properly and experiences serious complications as a result.

Certain populations are at greater risk for diabetes and are at a greater risk of complications due to improper management. These tendencies towards lack of management can be culturally based, making certain populations prone to diabetes and the risk of complications due to lack of management. African-American women over the age of 50 represent one of these high-risk groups and must take special care to manage their diabetes.

Symptoms are outward signs of inward disease process. They represent signals from the body that can give clues into the effectiveness of management strategies. Symptoms can give the patient and caregivers information about what needs to be done in the care regime. This study will use the UCSF symptom management model and apply it to the management of type 2 Diabetes in African-American women aged 50 and older.

Problem Statement

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This study will examine the effectiveness and applicability of the UCSF symptom management model to the management of type 2 diabetes in African-American women aged 50 an older. The model was originally used to manage the symptoms of HIV infections in women. This study will help to determine its effectiveness in the management of type 2 diabetes in a population that is considered particularly at-risk for complications of the disease. The study will address the problem of whether the UCSF symptom management group model can be used for the management of symptoms of type 2 diabetes in African-American women over the age of 50.

Purpose

Thesis on Improving Diabetes Self-Care Among African-American Women 50 Years and Older Assignment

The purpose of this investigation is to determine if the UCSF symptom management group model is an effective means to manage type 2 diabetes in the chosen population. The goal of the research is to aid in the development of better management practices in the management of type 2 diabetes in the chosen population. The investigation will help in the development of a tool that can be used to help type 2 diabetes patients in the target population to self-manage their diabetes more effectively through monitoring their symptoms and taking appropriate actions accordingly.

Research Questions

This research will focus on the application of the UCSG symptom management group model as a means for increasing diabetes management behaviors in a group of African-American women over the age of 50. Cultural constructs will play an important role in the effectiveness of the model in increasing this behavior. It will support the following hypothesis.

H1: The UCSF symptom management group model will have a positive affect on increasing diabetes management behavior in African-American women over the age of 50

with Type 2 diabetes.

However, another element of this study focuses on cultural aspects of African-American culture that affect the ability of healthcare providers to motivate their patients into self-care behaviors that help to control their diabetes. The following research questions will help to explore how cultural issues among African-American women affect the ability of the model to manage diabetes.

1. How do the social aspects of food in African-American culture limit the ability of African-American women with type 2 diabetes in controlling their diets?

2. How do social attitudes affect their willingness to reveal minor symptoms that provide clues into their ability to manage diabetes?

3. How do social attitudes affect the ability of African-American women to monitor the occurrence of seemingly minor symptoms of their diabetes?

4. How do social attitudes affect the willingness of African-American women to ask for help from their support network in monitoring their diabetes?

Conceptual Framework

The symptom-focused model developed for this study was based on the University of California at San Francisco (UCSF) symptom management group model. The model was first developed at the Nursing faculty the University of North Carolina at Chapel Hill for the management of symptoms of HIV infections in women (Skelly, A.H., Leeman, J., Carlson, J., Soward, A.CM., & Burns, D., 2008). This research will examine the application of this instrument to a different disease for which it was developed.

Literature Review

Diabetes is one of the most prevalent diseases on a global basis. According to the World Health Organization, diabetes affects more than 180 million people worldwide (WHO, 2006). Diabetes is a special concern for the African-American population. Nearly 11% of all African-Americans over the age of 20 have diabetes (American Diabetes Association, 2005). This literature review will explore the problem of diabetes among the African-Americans, as well as symptoms and treatment options. It will then examine the usefulness of the instrument as a means of assessing and monitoring the effectiveness of diabetes regimes. This literature review will only use academic research articles within the past five years and studies based on academic research from credible organizations.

Culture and Diabetes

Diabetes is a problem for almost every population around the globe. However, certain populations seem to be affected more than others. The number of African-Americans affected by diabetes is disproportionate when compared to the rest of the population. African-Americans are 1.8 times more likely to have diabetes as Caucasians (American Diabetes Association, 2005). African-Americans are more likely to experience complications such as retinopathy, kidney failure, and amputations (American Diabetes Association, 2005). In addition, women are much more likely to experience diabetes than men (National Diabetes Information Clearinghouse, 2002). These statistics are the key reason for choosing African-American women over the age of 50 as the target population for this research.

The goal of control in the diabetic patient is to maintain metabolic control. Patients that control their diabetes often can prevent or delay the onset of complications and prevent life-threatening consequences. Control of diabetes involves adherence to a strict dietary plan, regular exercise, medications, monitoring of blood glucose levels, and daily foot care. This regime is quote complex and time consuming. It is an inconvenience for many. Caring for one's own diabetes takes time and effort. Many patients do not understand fully the consequences of failing to manage their diabetes until it is too late. Many individual variables can affect the willingness and ability of the patient to manage their own diabetes. The following will explore current literature regarding various programs to promote self-management and control of diabetes in the chosen population.

Symptoms and Diabetic Management

Symptoms are our body's way of telling us about the condition of a disease state. Symptoms can provide valuable clues as to the worsening of a condition. Depression was found to be connected with the severity and duration of diabetes symptoms in type 2 diabetes patients (Ciechanowski, Katon, Russo, & Hirsch, I., 2003). Several studies reported a causal relationship between depressive symptoms and management of type 2 diabetes symptoms (Ciechanowski, Katon, Russo, & Hirsch, I., (2003); McKellar, J. Humphreys, K, and Piette, J. (2004)). However, the direction of the causal relationship remains a topic of debate.

It is not known whether mismanagement of the diabetes caused depressive symptoms, or whether depressive symptoms caused mismanagement in those patients. However, these studies do indicate that depressive symptoms can provide important clues for the physician as to an important risk factor in the management of symptoms and patient adherence to self-care regimes.

Symptom-based approaches have proven to be important in many conditions including the reduction of fatigue in older women post-bypass surgery, fatigue and sleep disturbance in multiple sclerosis patients, and reduction in chemotherapy patients (Given C, Given B, & Rahbar M., (2004); Wassam, R. & Dudley, W. (2003); Zimmerman L, Barnason S, & Schulz P, (2007)). Symptom-based management is becoming an important method for management and assessment of patient conditions in many nursing settings. A reduction in symptoms could be used as a motivator in the management of many disease conditions, including diabetes.

One of the problems with diabetic symptoms is that the symptoms can be so subtle that the patient hardly notices them. They are easy to dismiss in many, until they develop into serious complications, but by then it is too late. Alleviation these seemingly minor symptoms is the key to prevention of more serious complications in the future.

Some of the more common symptoms of diabetes include polyuria, polydipsia, polyphagia, visual blurring, numbness and tingling in extremities, calf pain when walking, and impotence (Stover, Skelly, Holditch-Davis, & Dunn, 2001). The problem with these symptoms is that they seldom cause enough discomfort to merit mention by the patient to the physician. They are also associated with many other conditions and can be easily attributed to other causes. However, patients and doctors must learn to recognize them as important clues to the patient's condition and ability to manage their diabetes. For instance, obesity is closely related… [END OF PREVIEW] . . . READ MORE

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