NRS 493 Literature Evaluation Table Paper

NRS 493 Literature Evaluation Table Paper

NRS 493 Literature Evaluation Table Paper

Literature Evaluation Table – DPI Intervention

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Learner Name: Emilia Wogu

Instructions: Use this table to evaluate and record the literature gathered for your DPI Project. Refer to the assignment instructions for guidance on completing the various sections. Empirical research articles must be published within 7 years of your anticipated graduation date. Add or delete rows as needed.

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PICOT-D Question: Among adult patients with type 2 diabetes in a nursing home, will the translation of Nelson et al’s research on the use of telehealth text messages compared to the current practice improve HbA1c levels in 12 weeks?

 Table 1: Primary Quantitative Research – Intervention (5 Articles)


APA Reference

(Include the GCU permalink or working link used to access the article.)

Research Questions/ Hypothesis, and Purpose/Aim of Study Type of Primary Research Design Research Methodology

·         Setting/Sample (Type, country, number of participants in study)

·         Methods (instruments used; state if instruments can be used in the DPI project)

·         How was the data collected?

Interpretation of Data

(State p-value: acceptable range is p= 0.000 – p= 0.05)

Outcomes/
Key Findings

(Succinctly states all study results applicable to the DPI Project.)

Limitations of Study and Biases Recommendations for Future Research

 

Explanation of How the Article Supports Your Proposed Intervention
Vinitha, R., Nanditha, A., Snehalatha, C., Satheesh, K., Susairaj, P., Raghavan, A., & Ramachandran, A. (2019). Effectiveness of mobile phone text messaging in improving glycaemic control among persons with newly detected type 2 diabetes. Diabetes Research and Clinical Practice158, 107919. https://doi.org/10.1016/j.diabres.2019.107919 Research question: Are SMS effective as educational tool for improving the glycaemic status of patients who have been recently diagnosed with T2D among the Indian population?

Aim of study: to evaluate the impact of text messaging in improving glycemic control among patients with type 2 diabetes.

Multicenter, randomized controlled trial design Setting/sample: Random sampling, India, 248 participants (122 in the control group and 128 in the intervention group)

Methods: Questionnaires were the instruments used for data collection and could also be used in the DPI project.

Data collection: Data was collected through interviews

p = 0.044

(intergroup analysis showed a lower value of HbA1c in the intervention group than the control group, p = 0.044)

Both groups of patients subjected to standard care and that with patients subjected to customized text messaging intervention registered a significant drop in HbA1c levels. However, that of the intervention group was much greater. The study failed to make an assessment of drug adherence. Since the study only focused on the newly detected diabetic patients for a period of two years, it is important to conduct research with a large number of participants analyzing varied components of therapy to determine the effectiveness of SMS based interventions in diabetes care. The article supposed the proposed intervention because its results show better improvement of glycaemic status for newly detected diabetic patients who have embraced SMS based intervention compared to those in the control group.
Riangkam, C., Sriyuktasuth, A., Pongthavornkamol, K., Kusakunniran, W., & Sriwijitkamol, A. (2021). Effects of a mobile health diabetes self-management program on HbA1C, self-management and patient satisfaction in adults with uncontrolled type 2 diabetes: a randomized controlled trial. Journal of Health Research, (ahead-of-print). https://doi.org/10.1108/JHR-02-2021-0126

 

Research question: what is the impact of a mobile health diabetes program (MHDSMP) intervention on diabetes self-management behavior and outcomes among patients with type 2 diabetes?

Aim of study: to determine the impact of a mobile health diabetes program (MHDSMP) intervention on diabetes self-management behavior and outcomes among patients with type 2 diabetes

Three-arm parallel group randomized controlled trial Setting/sample: Random sampling, Thailand, 129 adults with T2DM

Method: Self-administered questionnaires were utilized and could also be used in the DPI project.

Data collection: The data collection was done using a baseline assessment.

p < 0.001

(HbA1c reduced from 7.70 to 7.17% in the MHDSMP group, p < 0.001)

There was a statistically significant reduction in HbA1c for patients under the MHDSMP program as opposed to those in the control group. The study participants for the MHDSMP program were obtained from a tertiary level hospital and were only limited to adults with T2DM with HbA1C level ranging from 7.1-8.9%. the inclusion criteria considered limits the generalization of the results obtained in the study. There is need for studies carried out over longer time frames, across diverse healthcare levels, at a larger scale, with cases of different ages and varied HbA1c levels to thoroughly assess the effectiveness of MHDSMP on diabetes outcomes. The article supports the proposed intervention because it shows that the MHDSMP program which is a telehealth care intervention has a significant impact on reducing HbA1c for diabetic patients compared to those undergoing usual care.
Fortmann, A. L., Gallo, L. C., Garcia, M. I., Taleb, M., Euyoque, J. A., Clark, T., … & Philis-Tsimikas, A. (2017). Dulce Digital: an mHealth SMS-based intervention improves glycemic control in Hispanics with type 2 diabetes. Diabetes Care, 40(10), 1349-1355. https://doi.org/10.2337/dc17-0230  Hypothesis: Text messaging can provide the most rapid method of overcoming the digital divide to improve care.

Aim of study: the objective of the research was to evaluate if text messaging can be utilized as a strategy of overcoming the digital divide and improving care for patients with type 2 diabetes.

A randomized, nonblinded, parallel-groups clinical trial design Setting/sample: Stratified sampling, United States, 126 low-income Hispanic participants with poorly controlled type 2 diabetes.

Methods: Instruments used to collect data were questionnaires which can also be applicable in the DPI project.

Data Collection: Data was collected through participants self-reported sociodemographic features.

p = 0.03

(participants in the Dulce Digital intervention group recorded greater reduction in HbA1c over time compared to usual care group, p = 0.03)

The messaging program was established to be highly acceptable among the sample population with type 2 diabetes and led to more improvements in glycemic control compared with usual care. The sample population is not broad as it only considers those with Hispanic origins. There is need to study the impacts of the sustainability of the improved glycemic control contributed by the messaging program for more than 6 months.

It is important to consider other populations at risk of diabetes in future studies aiming at assessing the impact of the messaging apps on diabetes.

The article supports the intervention because by evaluating the effectiveness of the Dulce Digital platform among the Hispanic population with type two diabetes it shows how the use of telehealth text messages results in positive outcomes for the diabetic patients.
Dobson, R., Whittaker, R., Jiang, Y., McNamara, C., Shepherd, M., Maddison, R., … & Murphy, R. (2020). Long-term follow-up of a randomized controlled trial of a text-message diabetes self-management support programme, SMS4BG. Diabetic Medicine, 37(2), 311-318. https://doi.org/10.1111/dme.14182 Hypothesis: the long-term use of SMS4BG; an individually tailored text message diabetes self-management support program, lowers the concentration of HbA1c.

Aim: To evaluate the long-term effectiveness of SMS4BG on glycemic control for diabetic adults with HbA1c concentration of more than 8%.

Randomized-controlled trial. Setting/sample: Stratified sampling, New Zealand, 366 participants with type 1 or 2 diabetes.

Methods: The data was collected using follow-up telephone interviews. It may be applicable in the DPI project.

Data collection: Data was collected through follow up interviews.

p < 0.0001

(The decrease in HbA1c  at two years was significantly higher in the intervention group than control group, p < 0.0001)

There was a positive improvement in glycemic control for participants who had utilized the SMS4BG platform. Limited sample size due to time constraints and funding. More in-depth research should be conducted to determine if large scale implementation of similar programs can result in reducing health inequalities among the populations of interest. The article supports the intervention for the PICOT-D because it shows that programs involving messaging applications can be established to supplement current practices of controlling diabetes.
Nelson, L. A., Greevy, R. A., Spieker, A., Wallston, K. A., Elasy, T. A., Kripalani, S., … & Mayberry, L. S. (2021). Effects of a tailored text messaging intervention among diverse adults with type 2 diabetes: Evidence from the 15-month REACH randomized controlled trial. Diabetes Care, 44(1), 26-34. https://doi.org/10.2337/dc20-0961 Hypothesis: the use of Rapid Education/Encouragement and Communications for Health (REACH) can help to manage diabetes more effectively.

Aim of study: To determine the long term efficacy of  custom-made text messaging interventions focused towards addressing the challenge of diabetes

Randomized controlled trial Setting/sample:  Strategic purposeful sampling, United States, 506 participants (adults with type 2 diabetes)

Method: Instruments used to collect data on physical activity and dietary behavior were questionnaires which can also be applicable in the DPI project.

Collection: Participants self-reporting

p = 0.039

(Statistical significant treatment effects were found at 6 months, p = 0.039)

REACH reduced barriers to adherence and engaged at-risk patients of diabetes to effectively enhance self-management and improve short term HbA1C. The research finding may be compromised because of the data on behavioral outcomes was collected through self-reporting.

There are chances of social desirability bias.

More in-depth research with text messaging should be done across different patients at risk of the disease.

There should be efforts to establish more robust text messaging interventions into clinical care to enhance effective interventions of diabetes among its patients.

The article supports the proposed intervention because it illustrates how a telehealth program (REACH) works for patients with diabetes within the United States. It provides a reflection of how the intervention proposed is likely to impact the target population.

 

 

Table 2: Additional Primary and Secondary Quantitative Research (10 Articles)


APA Reference

(Include the GCU permalink or working link used to access the article.)

Research Questions/ Hypothesis, and Purpose/Aim of Study Type of Primary or Secondary Research Design Research Methodology

·         Setting/Sample (Type, country, number of participants in study)

·         Methods (instruments used; state if instruments can be used in the DPI project)

·         How was the data collected?

Interpretation of Data

(State p-value: acceptable range is p= 0.000 – p= 0.05)

Outcomes/
Key Findings

(Succinctly states all study results applicable to the DPI Project.)

Limitations of Study and Biases Recommendations for Future Research

 

Explanation of How the Article Supports Your Proposed DPI Project
Azami, G., Soh, K. L., Sazlina, S. G., Salmiah, M., Aazami, S., Mozafari, M., & Taghinejad, H. (2018). Effect of a nurse-led diabetes self-management education program on glycosylated hemoglobin among adults with type 2 diabetes. Journal of diabetes research2018. https://doi.org/10.1155/2018/4930157

 

Hypothesis: Nurse led DSME intervention would result in HbA1c improvement compared to usual care.

Aim of the study: to study the effectiveness of nurse-led diabetic self-management education on glycosylated hemoglobin.

A two-arm parallel-group randomized controlled trial Setting/sample: Random sampling, Iran, 142 participants (adults with type 2 diabetes)

Method: Questionnaires were used in data collection and they can be useful in the DPI project.

Data collection: The data analyzed were collected by interviewing the participants.

p < 0.001

(more than 21% of individuals in the intervention group achieved a reduction in HbA1c of more than 7% compared to none in the control group, p < 0.001)

Patients in the intervention group recorded significant improvement in HbA1c between baseline and 12 and 24 weeks after randomization. The follow up period for the study was short. Again there is the risk of type 2 error since the study trial may have been underpowered to registered all the significant changes. There is need to increase the follow up duration for future research and use more powerful trials to capture all possible changes in the sample population. The article supports the DPI project because it illuminates on strategies that are being undertaken in different parts of the world to enhance the management of diabetes. Additionally, it article supports the role of nonpharmacological self-management care for diabetes which is in line with the DPI project.
Huo, X., Krumholz, H. M., Bai, X., Spatz, E. S., Ding, Q., Horak, P., Zhao, W., Gong, Q., Zhang, H., Yan, X., Sun, Y., Liu, J., Wu, X., Guan, W., Wang, X., Li, J., Li, X., Spertus, J. A., Masoudi, F. A., … Zheng, X. (2019). Effects of mobile text messaging on glycemic control in patients with coronary heart disease and diabetes mellitus. Circulation: Cardiovascular Quality and Outcomes12(9). https://doi.org/10.1161/circoutcomes.119.005805 Hypothesis: interventions by text messaging programs are vital for diabetes management.

Aim of the Study: The purpose of the study was to assess the efficacy of a text messaging-based intervention to enhance glycemic control among patients with diabetes and coronary heart disease in China.

A multicenter, parallel-design, single-blind, randomized clinical trial. Setting/sample: Random sampling, China, 502 participants (patients with both coronary heart disease and diabetes mellitus)

Methods: tests were the instruments used to collect the data. Tests can be utilized in the DPI project to collect accurate data.

Data collection: Data was collected through self-report questionnaires.

p = 0.003

(at six months, the intervention group had a greater reduction in HbA1c than the control group, p = 0.003)

Text messaging can have a significant role in enhancing the efficacy and feasibility of text messaging for the secondary prevention of diabetes. More focus was on clinical outcomes instead of risk factor controls More in-depth research should be undertaken to ensure feasibility of text messaging applications in management of the conditions. The article supports my proposed intervention because it illuminates how text based intervention have been instrumental in glycemic control for patients with comorbidities such as coronary heart disease and diabetes within the Chinese population.
Ward, L. A., Shah, G. H., Jones, J. A., Kimsey, L., & Samawi, H. (2023). Effectiveness of telemedicine in diabetes management: A retrospective study in an urban medically underserved population area (UMUPA). Informatics10(1), 1-12. https://doi.org/10.3390/informatics10010016 Hypothesis: Telemedicine technology is more efficient compared to the traditional face-to-face visits in the management of diabetes for individuals residing in medically underserved areas.

Aim of study: to elaborate the effectiveness of telemedicine technology in the management of diabetes.

The study combined retrospective, quantitative study design, and regression models to evaluate unique, real-time, PHR data. Setting/sample: Convenience sampling, United States, 1685 participants (patients with uncontrolled diabetes and prediabetes)

Methods: retrospective electronic patient health records examination. Data for the DPI project could also be retrieved from electronic health records.

Data collection: data examination

p < 0.001

(patients using telemedicine recorded fewer visits than those relying of face to face visits, p < 0.001)

Patients using telemedicine were likely to record 0.34 lower HbA1c level on average compared to those who had face to face visits among the medically underserved population. Obtaining the data was challenging because the secondary data was initially collected for purposes of clinical practice. There is need to consider actually data collection from the participants in future research instead of using secondary data. The article directly supports the DPI project because it advocates for telemedicine intervention in place of the traditional face to face visits for the management of diabetes among sample population with uncontrolled diabetes.
Sartore, G., Caprino, R., Ragazzi, E., & Lapolla, A. (2023). Telemedicine and its acceptance by patients with type 2 diabetes mellitus at a single care center during the COVID-19 emergency: A cross-sectional observational study. PLOS ONE18(2). https://doi.org/10.1371/journal.pone.0269350 Research Question: can telemedicine work as an integrated care providing solution that can be acceptable to T2DM patients and allow the diabetes linked challenges that they are experiencing to be managed?

Purpose of the study: to analyze patients’ perception of, and satisfaction with the telehealth services offered during the COVID-19 emergency at an outpatient diabetes care unit in Italy.

A cross-sectional survey Setting/sample: random sampling, Italy, 250 participants (patients with type 2 diabetes mellitus regularly attending a diabetes care unit)

Multivariate method of data collection (Instrument used was survey and it can be applicable in the DPI project).

Data was collected by means of telephone interviews.

 

p < 0.0001

There was a strong correlation between patients’ perception of telemedicine and satisfaction ratings, p < 0.0001)

Based on the data obtained from the interviews patients had high appreciation of telehealth approaches and were able to embrace and continue their care through it. The sample size is limited. Other factors such as level of education have not been integrated in the study. A study utilizing data obtained post pandemic should be carried out to assess if the findings change. The article supports the proposed intervention because it provides significant background information around the concept of telehealth which encompass text messaging in care provision.
Haghighinejad, H., Liaghat, L., Malekpour, F., Jafari, P., Taghipour, K., Rezaie, M., Jooya, P., Ghazipoor, H., & Ramzi, M. (2022). Comparing the effects of SMS-based education with group-based education and control group on diabetes management: a randomized educational program. BMC Primary Care23(1). https://doi.org/10.1186/s12875-022-01820-w

 

Hypothesis: Owing to the high penetration rate of SMS, they are among the best methods of transferring healthcare education and information.

Aim of study: the objective of the study was to compare the effects of SMS and group based education in the management of type 2 diabetes to that of a control group.

Three-arm randomized experimental study. Sample: Random sampling, Iran, 168 participants (patients with type 2 diabetes)

Method: The instruments for collecting the data analyzed were a diabetes self-management questionnaire and tests. Tests and questionnaires can be utilized in the DPI project to collect accurate data

Data collection: Participants self-reporting and tests results.

p = 0.035

(2 hours postprandial sugar scores were significantly different between the control group and the intervention group that received SMS-based education, p = 0.035)

The study established that SMS and group based education have the same impact compared to the control group hence the need to embrace SMS education which is cost friendly and time efficient. Although the duration of the intervention (3 months) was acceptable an increase in the time may have a different effect on the outcome. It is important to increase the intervention duration in future studies and compare the efficacy of sending text messages with different intervals to show which frequencies of messaging has better effects. The articles supports the DPI project because it focuses on comparing an SMS intervention which the project supports to an already existing intervention used in the dissemination of education on diabetes to patients.
Kundury, K. K., & Hathur, B. (2020). Intervention through Short Messaging System (SMS) and phone call alerts reduced HbA1C levels in ~47% type-2 diabetics-results of a pilot study. PloS one15(11), e0241830. https://doi.org/10.1371/journal.pone.0241830 Hypothesis: SMS and phone call based interventions can be highly instrumental in enhancing the management of diabetes due to the wide acceptance and utilization of mobile phones and availability of SMS systems in various languages.

Aim of study: to find out the feasibility and utility of phone call and SMS based interventions in diabetes management by comparing HbA1c values.

Pilot Study Setting/sample: Convenience sampling, India, 380 participants (patients with confirmed type 2 diabetes).

Method: The instruments used were structured questionnaire and Bio-Rad Hemoglobin Testing System which can also be applicable in the DPI project.

Data collection: Participants self-reporting and tests results

p < 0.05

(there was a reduction in HbA1c by 0.3 to 2.6 units among the participants educated for 14 months, p < 0.05)

After a phone call intervention that lasted for 8 months there was a significant increase in the number of individuals with HbA1c in the range of 5.1 to 7.0 and more improvements were recorded after 14 months. The study design provides outcomes that are temporary and which may not be completely attributed to the intervention.

Exact p-values for varied tests are not provided.

There is need for case control studies to be conducted in the future to establish the utility of phone-call based interventions. Future studies should avoid generalization of the p-values and provide specific values. The article supports the DPI project because its supports the proposed intervention and also provides background information supporting the use of telehealth in the management of diabetes among patients.
Askari, H., Azarang, S., & Moulaei, N. (2022). The effect of education with an automatic SMS reminder system on type 2 diabetes patients’ medication adherence. Medical – Surgical Nursing Journal10(4), 1-7. https://doi.org/10.5812/msnj.126447 Hypothesis: education with an automatic SMS reminder system can help to reduce non-adherence to the medication regimen due to forgetfulness and negligence.

Aim of study: to investigate the effect of education with an automatic SMS reminder system on type 2 diabetes patients’ medication adherence.

Quasi-experimental study Setting/sample: Convenience sampling, Iran, 120 participants (patients with type 2 diabetes)

Method: Instruments used include a demographic information questionnaire and the Morisky Medication Adherence Scale which may be applicable in the DPI project if considered.

Data collection: data were collected by interviewing the patients and observing their medical records.

p = 0.001

(the mean score for medication adherence was significantly higher in the intervention group than the control group, p = 0.001)

The mean score for medication adherence before the intervention is similar to in both groups although it is quite significantly different between the intervention and control group after the training with automatic SMS reminder system was adopted. Number of diabetic patients referred to the diabetes clinic were few during the time in which the study was conducted (COVID-19 pandemic) There is need to carry out a similar study during  the pot-COVID 19 era. The article supports the DPI project because it supports the projects intervention. It provides important understanding on the need to adopt management practices for diabetes and incorporates SMS as part of the telehealth interventions necessary in contemporary times in management of diabetes.
Ansari, R. M., Harris, M. F., Hosseinzadeh, H., & Zwar, N. (2022). Implementation of chronic care model for diabetes self-management: a quantitative analysis. Diabetology3(3), 407-422. https://doi.org/10.3390/diabetology3030031 Hypothesis: The mean difference of HbA1c (%) between males and females at the follow-up after 6-months would be equal in the two groups of participants.

Aim of study: to implement the Chronic Care Model (CCM) for the self-management of type 2 diabetes in primary health care settings of rural areas of Pakistan and identify its effectiveness and develop strategies for overcoming its challenges

Quantitative content analysis Setting/sample:  Random sampling, Pakistan, 30 participants with type 2 diabetes and 20 healthcare professionals.

Method: Questionnaires were the instruments used in data collection and they can be useful in the DPI project.

Data Collection: Face to face interviews

p = 0.039

(the difference in HbA1c between males and females at 6 months was statistically significant, rejecting the null hypothesis p = 0.039 (p < 0.05)

The study established that the adoption of the two chronic care model components was critical in enhancing self-management education and assistance. Therefore it is important to consider integrating long term diabetes self-management education as a way of improving the outcomes of healthcare systems. There were limitations linked to the delivery system such as limited workforce structure in the rural setting. In the future, it is important to include family members in the study as they have the capacity to provide important insight regarding their perspective of diabetes self-management practices. The article supports the DPI project because it provides examples of interventions that have been used in the self-management of diabetes. Therefore, it gives a good background knowledge on the effectiveness and implementation of models that have been put into use when managing diabetes.
Farmer, A., Bobrow, K., Leon, N., Williams, N., Phiri, E., Namadingo, H., Cooper, S., Prince, J., Crampin, A., Besada, D., Daviaud, E., Yu, L., N’goma, J., Springer, D., Pauly, B., Tarassenko, L., Norris, S., Nyirenda, M., & Levitt, N. (2021). Digital messaging to support control for type 2 diabetes (StAR2D): a multicenter randomized controlled trial. BMC Public Health21(1), 1-14. https://doi.org/10.1186/s12889-021-11874-7 Research question: Is SMS-text messaging effective in improving outcomes for adults with type 2 diabetes?

Aim of study: to establish if mobile phones and SMS texts could be utilized as low cost intervention for diabetes management.

Two-arm randomized trial Setting/sample: Purposive sampling, South Africa and Malawi, 1186 participants (patients with type 2 diabetes).

Method: A locally adopted questionnaire and the EuroQol 5-Dimension 3-Level (EQ-5D-3L) instrument were utilized. The questionnaire can be embraced in the DPI project.

Data collection: Semi structured interviews and focus groups.

p = 0.001

(the proportion of patients meeting treatment goals was higher (36%) in the intervention group than in the control group (26.8%, p = 0.001)

The proportion of study participants who were meeting the treatment goals in the control group were 26.8% while those meeting the goals in the intervention group were 36.0%. However, although the participants found the messages useful and acceptable they still encountered other challenges. Some participants had challenges acting on the messages due to the challenges that they were already experiencing. Future research should focus on what health service and self-management components are needed in combination with targeted digital communication using a wider range of approaches, to support diabetes adherence behavior. The article supports the DPI project because it considers the use of SMS intervention on diabetes paying interest on different outcomes. It provides a significant background information on how text messaging intervention can be utilized to manage diabetes and other comorbidities linked to it.
Mayberry, L. S., Bergner, E. M., Harper, K. J., Laing, S., & Berg, C. A. (2019). Text messaging to engage friends/family in diabetes self-management support: Acceptability and potential to address disparities. Journal of the American Medical Informatics Association26(10), 1099-1108. https://doi.org/10.1093/jamia/ocz091 Hypothesis: engaging family/friends in patients’ type 2 diabetes (T2D) self-management using text messaging is highly effective.

Aim of study: to explore acceptability of engaging family/friends in patients’ type 2 diabetes (T2D) self-management using text messaging.

Randomized Trial Setting/sample: Random sampling, United States, 123 participants

Method: Questionnaires were the instruments used in data collection and they can be useful in the DPI project.

Data collection: Data was collected through interviews

p = 0.03

(patients who had invited friends/family benefitted more through text messages than those who did not through increased awareness and improved health behaviors , p = 0.03)

Patients who had invited friends/family had higher need hence they may have a higher chance of benefiting more when they are engaged through text messages. Collecting data from support persons who decided not to enroll was a significant challenges since they could not be reached. Future research should have a better strategy for support persons to determine their impact on diabetes patients when reached through text messaging. The article supports the DPI project because although it focuses mainly on support persons as the main activators of change for the persons with diabetes it uses text messaging as the medium for the interaction.

 Table 3: Theoretical Framework Aligning to DPI Project

Nursing Theory Selected APA Reference – Seminal Research References

(Include the GCU permalink or working link used to access each article.)

Explanation for the Nursing Theory Guides the Practice Aspect of the DPI Project
Dorothea Orem’s self-care theory Orem, D. E., & Calnan, M. E. (1972). NURSING. Nursing Management (Springhouse), 3(1), 43-46. https://doi.org/10.1097/00006247-197201000-00013 This theory is composed of three major supporting sub-theories. They include the theory of nursing systems, the self-care deficit theory, and the theory of self-care. The theory will be used as a supporting theory in implementing the DPI project on diabetes management. As earlier indicated, the chronic nature of diabetes requires that individuals undertake self-management activities for better outcomes. Therefore, the theory supports actions to be taken by the individuals, such as performing actions learned through educational initiatives and attending to the self-care needs for better outcomes. According to the theory, self-care is more natural to adults and can be taught; as such, this underpinning will be key in guiding the DNP project in promoting self-care and self-maintenance among patients living with diabetes through the DSMES integrated with telehealth messages. Another aspect of the theory is that it indicates the possibility of the patients and the caregivers having deficits in terms of sufficient information and resources. For example, the patient’s inability to undertake self-care makes them need support. This theory helps the project by linking what the patients need to do for better outcomes. This, therefore, fits the use of the proposed intervention to help the patients have better outcomes. Participating in the telehealth-supported diabetes self-management education program will ensure that the patients have a diminished incidence of emergency room visits.
Change Theory Selected APA Reference – Seminal Research References

(Include the GCU permalink or working link used to access each article.)

Explanation for How the Change Theory Outlines the Strategies for Implementing the Proposed Intervention
Kurt Lewin’s change theory Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge3(3), 123-127. https://doi.org/10.1016/j.jik.2016.07.002 The theory is instrumental in addressing stakeholder concerns, attitudes, and fears. This theory has three major phases; unfreezing, change, and refreezing. In addition, the theory states that during a change process, there are two predominant forces; the restraining and the driving forces, which bar change and foster change, respectively. As such, a change can only occur successfully when the driving forces overcome the restraining forces. The first phase of the theory is the unfreezing stage, where an urgent need or urge for change is created. This stage helps the project by linking the urgent need for change and ensuring that the patients and the nurses see the urgent need to improve their patient’s HbA1c levels. Therefore, the nurses will help the patient see the need to use more effective strategies to improve their HbA1c levels hence the importance of participating in the project. The change stage involves implementing the proposed change, which involves rolling out the DSMES integrated with telehealth messages to help improve outcomes. The third stage, which is the refreezing stage, will entail making use of the intervention to be part and parcel of the normal management strategy at the practice site. As such, the healthcare professionals involved in diabetes management will be required to use the intervention and support the patients for improved outcomes.

Table 4: Clinical Practice Guidelines (If applicable to your project/practice)

APA Reference –
Clinical Guideline

(Include the GCU permalink or working link used to access the article.)

APA Reference –
Original Research (All)

(Include the GCU permalink or working link used to access the article.)

Explanation for How Clinical Practice Guidelines Align to DPI Project
Nelson, L. A., Greevy, R. A., Spieker, A., Wallston, K. A., Elasy, T. A., Kripalani, S., … & Mayberry, L. S. (2021). Effects of a tailored text messaging intervention among diverse adults with type 2 diabetes: Evidence from the 15-month REACH randomized controlled trial. Diabetes Care, 44(1), 26-34. https://doi.org/10.2337/dc20-0961 Nelson, L. A., Greevy, R. A., Spieker, A., Wallston, K. A., Elasy, T. A., Kripalani, S., … & Mayberry, L. S. (2021). Effects of a tailored text messaging intervention among diverse adults with type 2 diabetes: Evidence from the 15-month REACH randomized controlled trial. Diabetes Care, 44(1), 26-34. https://doi.org/10.2337/dc20-0961 The clinical practice guideline points towards adopting text messaging intervention for adults suffering from type 2 diabetes. It is an important critical practice guideline that is key in answering the PICOT-D question, which depends on intervention by Nelson et al. (2021). Studies have shown that tele messaging interventions have more positive results compared to other interventions for people with the diabetes condition.

References

Ansari, R. M., Harris, M. F., Hosseinzadeh, H., & Zwar, N. (2022). Implementation of chronic care model for diabetes self-management: a quantitative analysis. Diabetology3(3), 407-422. https://doi.org/10.3390/diabetology3030031

Askari, H., Azarang, S., & Moulaei, N. (2022). The effect of education with an automatic SMS reminder system on type 2 diabetes patients’ medication adherence. Medical – Surgical Nursing Journal10(4), 1-7. https://doi.org/10.5812/msnj.126447

Azami, G., Soh, K. L., Sazlina, S. G., Salmiah, M., Aazami, S., Mozafari, M., & Taghinejad, H. (2018). Effect of a nurse-led diabetes self-management education program on glycosylated hemoglobin among adults with type 2 diabetes. Journal of diabetes research2018. https://doi.org/10.1155/2018/4930157

Dobson, R., Whittaker, R., Jiang, Y., McNamara, C., Shepherd, M., Maddison, R., … & Murphy, R. (2020). Long-term follow-up of a randomized controlled trial of a text-message diabetes self-management support programme, SMS4BG. Diabetic Medicine, 37(2), 311-318. https://doi.org/10.1111/dme.14182

Fortmann, A. L., Gallo, L. C., Garcia, M. I., Taleb, M., Euyoque, J. A., Clark, T., … & Philis-Tsimikas, A. (2017). Dulce Digital: an mHealth SMS-based intervention improves glycemic control in Hispanics with type 2 diabetes. Diabetes Care, 40(10), 1349-1355. https://doi.org/10.2337/dc17-0230

Haghighinejad, H., Liaghat, L., Malekpour, F., Jafari, P., Taghipour, K., Rezaie, M., Jooya, P., Ghazipoor, H., & Ramzi, M. (2022). Comparing the effects of SMS-based education with group-based education and control group on diabetes management: a randomized educational program. BMC Primary Care23(1). https://doi.org/10.1186/s12875-022-01820-w

Huo, X., Krumholz, H. M., Bai, X., Spatz, E. S., Ding, Q., Horak, P., Zhao, W., Gong, Q., Zhang, H., Yan, X., Sun, Y., Liu, J., Wu, X., Guan, W., Wang, X., Li, J., Li, X., Spertus, J. A., Masoudi, F. A., … Zheng, X. (2019). Effects of mobile text messaging on glycemic control in patients with coronary heart disease and diabetes mellitus. Circulation: Cardiovascular Quality and Outcomes12(9). https://doi.org/10.1161/circoutcomes.119.005805

Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge3(3), 123-127. https://doi.org/10.1016/j.jik.2016.07.002

Kundury, K. K., & Hathur, B. (2020). Intervention through Short Messaging System (SMS) and phone call alerts reduced HbA1C levels in ~47% type-2 diabetics-results of a pilot study. PloS one15(11), e0241830. https://doi.org/10.1371/journal.pone.0241830

Leon, N., Williams, N., Phiri, E., Namadingo, H., Cooper, S., Prince, J., Crampin, A., Besada, D., Daviaud, E., Yu, L., N’goma, J., Springer, D., Pauly, B., Tarassenko, L., Norris, S., Nyirenda, M., & Levitt, N. (2021). Digital messaging to support control for type 2 diabetes (StAR2D): a multicenter randomized controlled trial. BMC Public Health21(1), 1-14. https://doi.org/10.1186/s12889-021-11874-7

Mayberry, L. S., Bergner, E. M., Harper, K. J., Laing, S., & Berg, C. A. (2019). Text messaging to engage friends/family in diabetes self-management support: Acceptability and potential to address disparities. Journal of the American Medical Informatics Association26(10), 1099-1108. https://doi.org/10.1093/jamia/ocz091

Nelson, L. A., Greevy, R. A., Spieker, A., Wallston, K. A., Elasy, T. A., Kripalani, S., … & Mayberry, L. S. (2021). Effects of a tailored text messaging intervention among diverse adults with type 2 diabetes: Evidence from the 15-month REACH randomized controlled trial. Diabetes Care, 44(1), 26-34. https://doi.org/10.2337/dc20-0961

Orem, D. E., & Calnan, M. E. (1972). NURSING. Nursing Management (Springhouse), 3(1), 43-46. https://doi.org/10.1097/00006247-197201000-00013

Riangkam, C., Sriyuktasuth, A., Pongthavornkamol, K., Kusakunniran, W., & Sriwijitkamol, A. (2021). Effects of a mobile health diabetes self-management program on HbA1C, self-management and patient satisfaction in adults with uncontrolled type 2 diabetes: a randomized controlled trial. Journal of Health Research, (ahead-of-print). https://doi.org/10.1108/JHR-02-2021-0126

Sartore, G., Caprino, R., Ragazzi, E., & Lapolla, A. (2023). Telemedicine and its acceptance by patients with type 2 diabetes mellitus at a single care center during the COVID-19 emergency: A cross-sectional observational study. PLOS ONE18(2). https://doi.org/10.1371/journal.pone.0269350

Vinitha, R., Nanditha, A., Snehalatha, C., Satheesh, K., Susairaj, P., Raghavan, A., & Ramachandran, A. (2019). Effectiveness of mobile phone text messaging in improving glycaemic control among persons with newly detected type 2 diabetes. Diabetes Research and Clinical Practice158, 107919. https://doi.org/10.1016/j.diabres.2019.107919

Ward, L. A., Shah, G. H., Jones, J. A., Kimsey, L., & Samawi, H. (2023). Effectiveness of telemedicine in diabetes management: A retrospective study in an urban medically underserved population area (UMUPA). Informatics10(1), 1-12. https://doi.org/10.3390/informatics10010016

ORDER A PLAGIARISM-FREE PAPER HERE

Literature Evaluation Table – DPI Intervention

Learner Name: Emilia Wogu

Instructions: Use this table to evaluate and record the literature gathered for your DPI Project. Refer to the assignment instructions for guidance on completing the various sections. Empirical research articles must be published within 7 years of your anticipated graduation date. Add or delete rows as needed.

PICOT-D Question: Among adult patients with type 2 diabetes in a nursing home, will the translation of Nelson et al’s research on the use of telehealth text messages compared to the current practice improve HbA1c levels in 12 weeks?

 

Table 1: Primary Quantitative Research – Intervention (5 Articles)


APA Reference

(Include the GCU permalink or working link used to access the article.)

Research Questions/ Hypothesis, and Purpose/Aim of Study Type of Primary Research Design Research Methodology

·         Setting/Sample (Type, country, number of participants in study)

·         Methods (instruments used; state if instruments can be used in the DPI project)

·         How was the data collected?

Interpretation of Data

(State p-value: acceptable range is p= 0.000 – p= 0.05)

Outcomes/
Key Findings

(Succinctly states all study results applicable to the DPI Project.)

Limitations of Study and Biases Recommendations for Future Research

 

Explanation of How the Article Supports Your Proposed Intervention
Vinitha, R., Nanditha, A., Snehalatha, C., Satheesh, K., Susairaj, P., Raghavan, A., & Ramachandran, A. (2019). Effectiveness of mobile phone text messaging in improving glycaemic control among persons with newly detected type 2 diabetes. Diabetes Research and Clinical Practice158, 107919. https://doi.org/10.1016/j.diabres.2019.107919 Research Question: Are SMS effective as educational tool for improving the glycaemic status of patients who have been recently diagnosed with T2D among the Indian population.

Aim: To Evaluate the impact of text messaging in improving glycemic control among patients with type 2 diabetes.

Multicenter randomized controlled trial design Sampling: Random sampling, India, 248 participants

Methods: Questionnaires were the instruments used for data collection.

Data collection: Data was collected through interviews

p= 0.044 Both groups of patients subjected to standard care and that with patients subjected to customized text messaging intervention registered a significant drop in BbA1c levels although that of the intervention group was much greater. The study failed to make an assessment of drug adherence. Since the study only focused on the newly detected diabetic patients for a period of two years, it is important to conduct research with a large number of participants analyzing varied components of therapy to determine the effectiveness of SMS based interventions in diabetes care. The article supposed the proposed intervention because its results show better improvement of glycaemic status for newly detected diabetic patients who have embraced SMS based intervention compared to those in the control group.
Riangkam, C., Sriyuktasuth, A., Pongthavornkamol, K., Kusakunniran, W., & Sriwijitkamol, A. (2021). Effects of a mobile health diabetes self-management program on HbA1C, self-management and patient satisfaction in adults with uncontrolled type 2 diabetes: a randomized controlled trial. Journal of Health Research, (ahead-of-print). https://doi.org/10.1108/JHR-02-2021-0126

 

Research Question:

Aim: To determine the impact of a mobile health diabetes program (MHDSMP) intervention on diabetes self-management behavior and outcomes among patients with type 2 diabetes

Three-arm parallel group randomized controlled trial Sampling: Random sampling, Thailand, 129 participants

Method: Self-administered questionnaires were utilized and could also be used in the DPI project.

Data collection: The data collection was done using a baseline assessment.

p<0.001 There was a statistically significant reduction in HbA1c for patients under the MHDSMP program as opposed to those in the control group. The study participants for the MHDSMP program were obtained from a tertiary level hospital and were only limited to adults with T2DM with HbA1C level ranging from 7.1-8.9%. the inclusion criteria considered limits the generalization of the results obtained in the study. There is need for studies carried out over longer time frames, across diverse healthcare levels, at a larger scale, with cases of different ages and varied HbA1c levels to thoroughly assess the effectiveness of MHDSMP on diabetes outcomes. The article supports the proposed intervention because it shows that the MHDSMP program which is a telehealth care intervention has a significant impact on reducing HbA1c for diabetic patients compared to those undergoing usual care.
Fortmann, A. L., Gallo, L. C., Garcia, M. I., Taleb, M., Euyoque, J. A., Clark, T., … & Philis-Tsimikas, A. (2017). Dulce Digital: an mHealth SMS-based intervention improves glycemic control in Hispanics with type 2 diabetes. Diabetes Care, 40(10), 1349-1355. https://doi.org/10.2337/dc17-0230  Hypothesis: Text messaging can provide the most rapid method of overcoming the digital divide to improve care.

Aim: the objective of the research was to evaluate if text messaging can be utilized as a strategy of overcoming the digital divide and improving care for patients with type 2 diabetes.

A randomized, nonblinded, parallel-groups clinical trial design Sampling: Stratified sampling, United States, 126 participants.

Methods: Instruments used to collect data were questionnaires which can also be applicable in the DPI project.

Data Collection: Data was collected through participants self-reported sociodemographic features.

P= 0.03 The messaging program was established to be highly acceptable among the sample population with type 2 diabetes and led to more improvements in glycemic control compared with usual care. The sample population is not broad as it only considers those with Hispanic origins. There is need to study the impacts of the sustainability of the improved glycemic control contributed by the messaging program for more than 6 months.

It is important to consider other populations at risk of diabetes in future studies aiming at assessing the impact of the messaging apps on diabetes.

The article supports the intervention because by evaluating the effectiveness of the Dulce Digital platform among the Hispanic population with type two diabetes it shows how the use of telehealth text messages results in positive outcomes for the diabetic patients.
Dobson, R., Whittaker, R., Jiang, Y., McNamara, C., Shepherd, M., Maddison, R., … & Murphy, R. (2020). Long‐term follow‐up of a randomized controlled trial of a text‐message diabetes self‐management support programme, SMS4BG. Diabetic Medicine, 37(2), 311-318. https://doi.org/10.1111/dme.14182 Hypothesis: the long-term use of SMS4BG; an individually tailored text message diabetes self-management support program, lowers the concentration of HbA1c.

Aim: To evaluate the long-term effectiveness of SMS4BG on glycemic control for diabetic adults with HbA1c concentration of more than 8%.

Randomized-controlled trial. Setting: Stratified sampling, 366 participants, New Zealand.

Methods: The data was collected using follow-up telephone interviews. It may be applicable in the DPI project.

Data collection: Data was collected through follow up interviews.

p=0.0001 There was a positive improvement in glycemic control for participants who had utilized the SMS4BG platform. Limited sample size due to time constraints and funding. More in-depth research should be conducted to determine if large scale implementation of similar programs can result in reducing health inequalities among the populations of interest. The article supports the intervention for the PICOT-D because it shows that programs involving messaging applications can be established to supplement current practices of controlling diabetes.
Nelson, L. A., Greevy, R. A., Spieker, A., Wallston, K. A., Elasy, T. A., Kripalani, S., … & Mayberry, L. S. (2021). Effects of a tailored text messaging intervention among diverse adults with type 2 diabetes: Evidence from the 15-month REACH randomized controlled trial. Diabetes Care, 44(1), 26-34. https://doi.org/10.2337/dc20-0961 Hypothesis: The use of Rapid Education/Encouragement and Communications for Health (REACH) can help to manage diabetes more effectively.

Aim: To determine the long term efficacy of  custom-made text messaging interventions focused towards addressing the challenge of diabetes

Randomized controlled trail Setting:  Strategic purposeful sampling, United States, 506 participants

Method: Instruments used to collect data on physical activity and dietary behavior were questionnaires which can also be applicable in the DPI project.

Collection: Participants self-reporting

p=0.049 REACH reduced barriers to adherence and engaged at-risk patients of diabetes to effectively enhance self-management and improve short term HbA1C. The research finding may be compromised because of the data on behavioral outcomes was collected through self-reporting.

There are chances of social desirability bias.

More in-depth research with text messaging should be done across different patients at risk of the disease.

There should be efforts to establish more robust text messaging interventions into clinical care to enhance effective interventions of diabetes among its patients.

The article supports the proposed intervention because it illustrates how a telehealth program (REACH) works for patients with diabetes within the United States. It provides a reflection of how the intervention proposed is likely to impact the target population.

 

 

Table 2: Additional Primary and Secondary Quantitative Research (10 Articles)


APA Reference

(Include the GCU permalink or working link used to access the article.)

Research Questions/ Hypothesis, and Purpose/Aim of Study Type of Primary or Secondary Research Design Research Methodology

·         Setting/Sample (Type, country, number of participants in study)

·         Methods (instruments used; state if instruments can be used in the DPI project)

·         How was the data collected?

Interpretation of Data

(State p-value: acceptable range is p= 0.000 – p= 0.05)

Outcomes/
Key Findings

(Succinctly states all study results applicable to the DPI Project.)

Limitations of Study and Biases Recommendations for Future Research

 

Explanation of How the Article Supports Your Proposed DPI Project
Azami, G., Soh, K. L., Sazlina, S. G., Salmiah, M., Aazami, S., Mozafari, M., & Taghinejad, H. (2018). Effect of a nurse-led diabetes self-management education program on glycosylated hemoglobin among adults with type 2 diabetes. Journal of diabetes research2018. https://doi.org/10.1155/2018/4930157

 

Hypothesis: Nurse led DSME intervention would result in HbA1c improvement compared to usual care.

Aim of the study: To study the effectiveness of nurse-led diabetic self-management education on glycosylated hemoglobin.

A two-arm parallel-group randomized controlled trial Sampling: Random sampling, Iran, 142 participants

Method: Questionnaires were used in data collection and they can be useful in the DPI project.

Data collection: The data analyzed were collected by interviewing the participants.

P< 0.001 Patients in the intervention group recorded significant improvement in HbA1c between baseline and 12 and 24 weeks after randomization. The follow up period for the study was short. Again there is the risk of type 2 error since the study trial may have been underpowered to registered all the significant changes. There is need to increase the follow up duration for future research and use more powerful trials to capture all possible changes in the sample population. The article supports the DPI project because it illuminates on strategies that are being undertaken in different parts of the world to enhance the management of diabetes. Additionally, it article supports the role of nonpharmacological self-management care for diabetes which is in line with the DPI project.
Huo, X., Krumholz, H. M., Bai, X., Spatz, E. S., Ding, Q., Horak, P., Zhao, W., Gong, Q., Zhang, H., Yan, X., Sun, Y., Liu, J., Wu, X., Guan, W., Wang, X., Li, J., Li, X., Spertus, J. A., Masoudi, F. A., … Zheng, X. (2019). Effects of mobile text messaging on glycemic control in patients with coronary heart disease and diabetes mellitus. Circulation: Cardiovascular Quality and Outcomes12(9). https://doi.org/10.1161/circoutcomes.119.005805 Hypothesis: interventions by text messaging programs are vital for diabetes management.

Aim of the Study: The purpose of the study was to assess the efficacy of a text messaging-based intervention to enhance glycemic control among patients with diabetes and coronary heart disease in China.

A multicenter, parallel-design, single-blind, randomized clinical trial. Sample: Random sampling, China, 502 participants

Methods: tests were the instruments used to collect the data. Tests can be utilized in the DPI project to collect accurate data.

Data collection: Data was collected through self-report questionnaires.

P = 0.003 Text messaging can have a significant role in enhancing the efficacy and feasibility of text messaging for the secondary prevention of diabetes. More focus was on clinical outcomes instead of risk factor controls More in-depth research should be undertaken to ensure feasibility of text messaging applications in management of the conditions. The article supports my proposed intervention because it illuminates how text based intervention have been instrumental in glycemic control for patients with comorbidities such as coronary heart disease and diabetes within the Chinese population.
Ward, L. A., Shah, G. H., Jones, J. A., Kimsey, L., & Samawi, H. (2023). Effectiveness of telemedicine in diabetes management: A retrospective study in an urban medically underserved population area (UMUPA). Informatics10(1), 1-12. https://doi.org/10.3390/informatics10010016 Hypothesis: Telemedicine technology are more efficient compared to the traditional face-to-face visits in the management of diabetes for individuals residing in medically underserved areas.

Aim: The aim of the study was to elaborate the effectiveness of telemedicine technology in the management of diabetes.

The study combined retrospective, quantitative study design, and regression models to evaluate uniques, real-time, PHR data. Sample: Convenience sampling, United States, 1685 participants P=0.001 Patients using telemedicine were likely to record 0.34 lower HbA1c level on average compared to those who had face to face visits among the medically underserved population. Obtaining the data was challenging because the secondary data was initially collected for purposes of clinical practice. There is need to consider actually data collection from the participants in future research instead of using secondary data. The article directly supports the DPI project because it advocates for telemedicine intervention in place of the traditional face to face visits for the management of diabetes among sample population with uncontrolled diabetes.
Sartore, G., Caprino, R., Ragazzi, E., & Lapolla, A. (2023). Telemedicine and its acceptance by patients with type 2 diabetes mellitus at a single care center during the COVID-19 emergency: A cross-sectional observational study. PLOS ONE18(2). https://doi.org/10.1371/journal.pone.0269350 Research Question: Can telemedicine work as an integrated care providing solution that can be acceptable to T2DM patients and allow the diabetes linked challenges that they are experiencing to be managed?

Purpose of the Study: To analyze patients’ perception of, and satisfaction with the telehealth services offered during the COVID-19 emergency at an outpatient diabetes care unit in Italy.

 

A cross-sectional survey Random sampling, Italy, 250 participants

Multivariate method of data collection (Instrument used was survey and it can be applicable in the DPI project).

Data was collected by means of telephone interviews.

 

P= 0.0247 Based on the data obtained from the interviews patients had high appreciation of telehealth approaches and were able to embrace and continue their care through it. The sample size is limited. Other factors such as level of education have not been integrated in the study. A study utilizing data obtained post pandemic should be carried out to assess if the findings change. The article supports the proposed intervention because it provides significant background information around the concept of telehealth which encompass text messaging in care provision.
Haghighinejad, H., Liaghat, L., Malekpour, F., Jafari, P., Taghipour, K., Rezaie, M., Jooya, P., Ghazipoor, H., & Ramzi, M. (2022). Comparing the effects of SMS-based education with group-based education and control group on diabetes management: A randomized educational program. BMC Primary Care23(1). https://doi.org/10.1186/s12875-022-01820-w

 

Hypothesis: Owing to the high penetration rate of SMS, they are among the best methods of transferring healthcare education and information.

Aim: the objective of the study was to compare the effects of SMS and group based education in the management of type 2 diabetes to that of a control group.

Three-arm randomized experimental study. Sample: Random sampling, Iran, 168 participants

Method: The instruments for collecting the data analyzed was a diabetes self-management questionnaire and tests. Tests and questionnaires can be utilized in the DPI project to collect accurate data

Data collection: Participants self-reporting and tests results.

P= 0.035 The study established that SMS and group based education have the same impact compared to the control group hence the need to embrace SMS education which is cost friendly and time efficient. Although the duration of the intervention (3 months) was acceptable an increase in the time may have a different effect on the outcome. It is important to increase the intervention duration in future studies and compare the efficacy of sending text messages with different intervals to show which frequencies of messaging has better effects. The articles supports the DPI project because it focuses on comparing an SMS intervention which the project supports to an already existing intervention used in the dissemination of education on diabetes to patients.
Kundury, K. K., & Hathur, B. (2020). Intervention through Short Messaging System (SMS) and phone call alerts reduced HbA1C levels in ~47% type-2 diabetics-results of a pilot study. PloS one15(11), e0241830. https://doi.org/10.1371/journal.pone.0241830 Hypothesis: SMS and phone call based interventions can be highly instrumental in enhancing the management of diabetes due to the wide acceptance and utilization of mobile phones and availability of SMS systems in various languages.

Aim: To find out the feasibility and utility of phone call and SMS based interventions in diabetes management by comparing HbA1c values.

Pilot Study Sample: Convenience sampling, India, 380 participants.

Method: The instruments used were structured questionnaire and Bio-Rad Hemoglobin Testing System which can also be applicable in the DPI project.

Data collection: Participants self-reporting and tests results

P<0.05 After a phone call intervention that lasted for 8 months there was a significant increase in the number of individuals with HbA1c in the range of 5.1 to 7.0 and more improvements were recorded after 14 months. The study design provides outcomes that are temporary and which may not be completely attributed to the intervention.

Exact p-values for varied tests are not provided.

There is need for case control studies to be conducted in the future to establish the utility of phone-call based interventions. Future studies should avoid generalization of the p-values and provide specific values. The article supports the DPI project because its supports the proposed intervention and also provides background information supporting the use of telehealth in the management of diabetes among patients.
Askari, H., Azarang, S., & Moulaei, N. (2022). The effect of education with an automatic SMS reminder system on type 2 diabetes patients’ medication adherence. Medical – Surgical Nursing Journal10(4), 1-7. https://doi.org/10.5812/msnj.126447 Hypothesis: education with an automatic SMS reminder system can help to reduce non-adherence to the medication regimen due to forgetfulness and negligence.

Aims: To investigate the effect of education with an automatic SMS reminder system on type 2 diabetes patients’ medication adherence.

Quasi-experimental study Sample: Convenience sampling, Iran, 120 participants

Method: Instruments used include a demographic information questionnaire and the Morisky Medication Adherence Scale which may be applicable in the DPI project if considered.

Data collection: data were collected by interviewing the patients and observing their medical records.

P=0.001 The mean score for medication adherence before the intervention is similar to in both groups although it is quite significantly different between the intervention and control group after the training with automatic SMS reminder system was adopted. Number of diabetic patients referred to the diabetes clinic were few during the time in which the study was conducted (COVID-19 pandemic) There is need to carry out a similar study during  the pot-COVID 19 era. The article supports the DPI project because it supports the projects intervention. It provides important understanding on the need to adopt management practices for diabetes and incorporates SMS as part of the telehealth interventions necessary in contemporary times in management of diabetes.
Ansari, R. M., Harris, M. F., Hosseinzadeh, H., & Zwar, N. (2022). Implementation of chronic care model for diabetes self-management: A quantitative analysis. Diabetology3(3), 407-422. https://doi.org/10.3390/diabetology3030031 Hypothesis: The mean difference of HbA1c (%) between males and females at the follow-up after 6-months would be equal in the two groups of participants.

Aim: The main aim of this study was to implement the Chronic Care Model (CCM) for the self-management of type 2 diabetes in primary health care settings of rural areas of Pakistan and identify its effectiveness and develop strategies for overcoming its challenges

Quantitative content analysis Sample:  Random sampling, Pakistan, 340 participants

Method: Questionnaires were the instruments used in data collection and they can be useful in the DPI project.

Data Collection: Face to face interviews

P= 0.041 The study established that the adoption of the two chronic care model components was critical in enhancing self-management education and assistance. Therefore it is important to consider integrating long term diabetes self-management education as a way of improving the outcomes of healthcare systems. There were limitations linked to the delivery system such as limited workforce structure in the rural setting. In the future, it is important to include family members in the study as they have the capacity to provide important insight regarding their perspective of diabetes self-management practices. The article supports the DPI project because it provides examples of interventions that have been used in the self-management of diabetes. Therefore, it gives a good background knowledge on the effectiveness and implementation of models that have been put into use when managing diabetes.
Farmer, A., Bobrow, K., Leon, N., Williams, N., Phiri, E., Namadingo, H., Cooper, S., Prince, J., Crampin, A., Besada, D., Daviaud, E., Yu, L., N’goma, J., Springer, D., Pauly, B., Tarassenko, L., Norris, S., Nyirenda, M., & Levitt, N. (2021). Digital messaging to support control for type 2 diabetes (StAR2D): A multicenter randomized controlled trial. BMC Public Health21(1), 1-14. https://doi.org/10.1186/s12889-021-11874-7 Research questions: Are SMS-text messaging effective in improving outcomes for adults with type 2 diabetes.

Aim: the objective of the study was to establish if mobile phones and SMS texts could be utilized as low cost intervention for diabetes management.

Two-arm randomized trial Sample: Purposive sampling, South Africa and Malawi, 1186 participants.

Method: A locally adopted questionnaire and the EuroQol 5-Dimension 3-Level (EQ-5D-3L) instrument were utilized. The questionnaire can be embraced in the DPI project.

Data collection: Semi structured interviews and focus groups.

P= 0.001 The proportion of study participants who were meeting the treatment goals in the control group were 26.8% while those meeting the goals in the intervention group were 36.0%. However, although the participants found the messages useful and acceptable they still encountered other challenges. Some participants had challenges acting on the messages due to the challenges that they were already experiencing. Future research should focus on what health service and self-management components are needed in combination with targeted digital communication using a wider range of approaches, to support diabetes adherence behavior. The article supports the DPI project because it considers the use of SMS intervention on diabetes paying interest on different outcomes. It provides a significant background information on how text messaging intervention can be utilized to manage diabetes and other comorbidities linked to it.
Mayberry, L. S., Bergner, E. M., Harper, K. J., Laing, S., & Berg, C. A. (2019). Text messaging to engage friends/family in diabetes self-management support: Acceptability and potential to address disparities. Journal of the American Medical Informatics Association26(10), 1099-1108. https://doi.org/10.1093/jamia/ocz091 Hypothesis: Engaging family/friends in patients’ type 2 diabetes (T2D) self-management using text messaging is highly effective.

Aim: to explore acceptability of engaging family/friends in patients’ type 2 diabetes (T2D) self-management using text messaging.

Randomized Trial Sample: Random sampling, United States, 123 participants

Method: Questionnaires were the instruments used in data collection and they can be useful in the DPI project.

Data collection: Data was collected through interviews

P=0.03 Patients who had invited friends/family had higher need hence they may have a higher chance of benefiting more when they are engaged through text messages. Collecting data from support persons who decided not to enroll was a significant challenges since they could not be reached. Future research should have a better strategy for support persons to determine their impact on diabetes patients when reached through text messaging. The article supports the DPI project because although it focuses mainly on support persons as the main activators of change for the persons with diabetes it uses text messaging as the medium for the interaction.

 

 

 

Table 3: Theoretical Framework Aligning to DPI Project

Nursing Theory Selected APA Reference – Seminal Research References

(Include the GCU permalink or working link used to access each article.)

Explanation for the Nursing Theory Guides the Practice Aspect of the DPI Project
Dorothea Orem’s self-care theory Orem, D. E., & Calnan, M. E. (1972). NURSING. Nursing Management (Springhouse), 3(1), 43-46. https://doi.org/10.1097/00006247-197201000-00013 This theory is composed of three major supporting sub-theories. They include the theory of nursing systems, the self-care deficit theory, and the theory of self-care. The theory will be used as a supporting theory in the implementation of the DPI project on diabetes management. As earlier indicated, the chronic nature of diabetes requires that individuals undertake self-management activities for better outcomes. Therefore, the theory supports actions to be taken by the individuals, such as performing actions learned through educational initiatives and attending to the self-care needs for better outcomes. According to the theory, self-care is more natural to adults and can be taught; as such, this underpinning will be key in guiding the DNP project in the promotion of self-care and self-maintenance among patients living with diabetes through the DSMES integrated with telehealth messages. Another aspect of the theory is that it indicates the possibility of the patients and the caregivers having deficits in terms of sufficient information and resources. For example, the patient’s inability to undertake self-care makes them in need of support.  This theory helps the project by linking what the patients need to do for better outcomes. This, therefore, fits the use of the proposed intervention to help the patients have better outcomes. Participating in the telehealth-supported diabetes self-management education program will ensure that the patients have a diminished incidence of emergency room visits.
Change Theory Selected APA Reference – Seminal Research References

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Explanation for How the Change Theory Outlines the Strategies for Implementing the Proposed Intervention
Kurt Lewin’s change theory Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge3(3), 123-127. https://doi.org/10.1016/j.jik.2016.07.002 The theory is instrumental in addressing the stakeholder concerns, attitudes, and fears. This theory has three major phases including unfreezing, change, and refreezing phases. In addition, the theory states that during a change process, there are two predominant forces; the restraining and the driving forces, which bar change and foster change, respectively. As such, a change can only occur successfully when the driving forces overcome the restraining forces. The first phase of the theory is the unfreezing stage, where an urgent need or urge for change is created. This stage helps the project by linking the urgent need for change and ensuring that the patients and the nurses see the urgent need to improve their patient’s HbA1c levels. Therefore, the nurses will help the patient see the need to use more effective strategies to improve their HbA1c levels hence the importance of participating in the project. The change stage involves implementing the proposed change, which involves rolling out the DSMES integrated with telehealth messages to help improve outcomes. The third stage, which is the refreezing stage, will entail making use of the intervention to be part and parcel of the normal management strategy at the practice site. As such, the healthcare professionals involved in diabetes management will be required to use the intervention and support the patients for improved outcomes.

 

 

 

Table 4: Clinical Practice Guidelines (If applicable to your project/practice)

APA Reference –
Clinical Guideline

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APA Reference –
Original Research (All)

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Explanation for How Clinical Practice Guidelines Align to DPI Project
Nelson, L. A., Greevy, R. A., Spieker, A., Wallston, K. A., Elasy, T. A., Kripalani, S., … & Mayberry, L. S. (2021). Effects of a tailored text messaging intervention among diverse adults with type 2 diabetes: Evidence from the 15-month REACH randomized controlled trial. Diabetes Care, 44(1), 26-34. https://doi.org/10.2337/dc20-0961 Nelson, L. A., Greevy, R. A., Spieker, A., Wallston, K. A., Elasy, T. A., Kripalani, S., … & Mayberry, L. S. (2021). Effects of a tailored text messaging intervention among diverse adults with type 2 diabetes: Evidence from the 15-month REACH randomized controlled trial. Diabetes Care, 44(1), 26-34. https://doi.org/10.2337/dc20-0961 The clinical practice guideline points out towards the adoption of text messaging intervention on adults suffering from type 2 diabetes. It is an important critical practice guideline that is key in answering the PICOT-D question which depends on intervention by Nelson et al., (2021). The studies have shown that tele messaging interventions are having more positive results compared to other interventions for people with the diabetes condition.

 

 

 

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