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  • Subject Name : Health Research Methodology

Assessment 2 – Practice Change Proposal

Applicants Details: 

Being a registered nurse, followed by an advocate for diabetes and then diabetes educator, I have gone through a number of patients having diabetes and those who are at risk of diabetes, it has become clear to me that much more diabetic patients and people itself are responsible for getting entered in the list of diabetic patients and thus increases the overall ratio of the total suffered population. Therefore, I personally feel that there must be a comprehensive and exhaustive change in practice in this current scenario of lifestyle. I am completing my Ph.D. in general health sciences and being an educator, my future profession will require a strong potential towards the communication with the engagement of patients and physicians as well, therefore I think this is a phase of level where I and people like me can bring a change in the existing scenario of lifestyles and thus, can results in the generation of better community with greatly immunized health of well-being and improved quality of life of diabetic, prediabetic and non-diabetic patients. 

Overview of the project:

 This is a Practice Change (PC) project having an aim at improving the condition and level of sensitivity in patients having diabetes and those which are non-diabetic, by improving their dietary conditions along with the change in their general practices and lifestyles. The improvisation of the targeted dimension and depth of the concept will be addressed by and attained through the different relevant concepts from literary sources and protocols such as, the diabetes prevention program, the alphabet strategy, nutrition therapy recommendations (Gray, 2015), change in techniques of diet behavior, the NICE guidelines for HCP’s while preparing the care plan for the patients having diabetes and for those who are at risk (Cradock, Laighin, Finucane, et al., 2017). 

Both physicians and patient have equal roles and responsibilities towards the concept and its improvisation, so a significant relationship should be developed efficiently in between them. Therefore, the implementation of these proposed strategies will be conducted at the physician, nursing, and patient level and completed as well (Ellis, 2013).

Need for the project:

The need of this study was to serve the purpose of awareness about the dietary interventions to be taken care of, in patients with diabetes along with those who are at risk of development and examine the status of people, who are aware of their prediabetes symptoms. These are usually those persons who are with normal glucose level to report the lifestyle changes like intake of fat/calorie, physical exercises, sugar consumption, and weight control (Okosun, Lyn, 2010). Also, diabetic retinopathy is found associated with diabetes mellitus recently. Around 90 years ago, i.e., before the discovery of insulin, it was unknown, but nowadays it is found that this is responsible for causing life-threatening effects like blindness. About 1/3rd population from type 2 diabetic patients and every other type1 patient, is at risk of developing sight-threatening retinopathy once within their life span, shown in an epidemiological study. This also called as diabetic macular edema shows a significant threat to vision followed by blindness, therefore must need medical and dietary intervention (Stefansson,2011). Also, the improvement in the elevated levels of the HbA1c should be processed in order to reduce the total count, and this can be achieved by diet management (Sami, Ansari, 2017). Furthermore, the found evidence says that there is no such protocol or developed strategies which govern, the optimal relationship between the patient and the consultant who in future will be responsible for the better outcome (Burgers, Beukeboom, and Sparks, 2012). Therefore, there is a need to improve this particular dimension in the healthcare sector. 

Background of the project:

Around 1500 BC diabetes was first recognized by the ancient Egyptians and around the same Indian physicians have also identified the disease and called it "madhumeha." As the physicians get to know more about diabetes, they cover all the factors. The first treatment they prescribed for this involves exercises, horseback riding, which was supposed that it would relieve excessive urination. About 1800 century, some physicians realize that a change in dietary habits can help in managing this type of situation and a hypothesis was made. They started advising the patient to take a large amount of meat, fat, and sugars. Later on, in the 19th century a scientist named Elliott Joslin in his textbook “The Treatment of Diabetes Mellitus” reported that a fasting type of diet along with a regular exercise could result in a better outcome with a reduced risk of death due to diabetes (McCoy, 2009). 

The aim of the project:

The project study is based on some major goals to be achieved and is as follows: 

Aim 1: To enhance and improve the quality of life by changing dietary habits and attitude of living, thereby reducing the count of diabetic people and better control of the disease. 

Objective 1 – The primary objective of the study will be to create some major interventions in the dietary schedule and habits which will promote the total well-being of the individuals.

Objective 2 – The secondary objective will be focused on providing the life with quality and quantity by improving day by day thereby increasing the overall period of life-span.

Objective 3 –The tertiary objective of this project will be focused on the issue of the rising number in the context of prediabetic patients and those who are at close risk of developing diabetes. 

Aim 2: To create awareness about the concept of prediabetes so that the preventive measures can be attained and furthermore, leads to a better health of a community. 

Objective 1 – The primary objective will be to make the physicians and nurses aware of the proper concept of diseased conditions.

Objective 2 – The secondary goal will be to make them know about the proper preventive measures in case of a prediabetic condition. 

Objective 3 – To educate people about public health.

Literature review:

Diabetes is a type of disease in which insulin impairment occurs, or the ability of a body to respond or produce insulin hormone is getting impaired. This results in defected or flawed metabolism of carbohydrates and glucose produced by the body and elevate the level of glucose into the blood. Two type of diabetes is there type 1 and type 2 in which type 2 diabetes is more prone to the person having diabetes. Type 1 diabetes is the one in which the pancreas is not able to produce insulin, therefore, also called as juvenile diabetes and is often diagnosed in teen adults and children which counts 5-10 % of the total. On the other end, type 2 diabetes is the one in which the pancreas produces insulin but, in an amount, which is inadequate for the body to metabolize the level of glucose also known as insulin resistant and is 90-95 % of total (Ansari, 2017). Type 1 diabetes occurs due to beta-cell destruction which results in absolute insulin deficiency, and individuals who are at risk can be evidenced by autoimmune pathologic processes occurs at the pancreatic islets (Sudhakaran, Surani, 2015). The etiology of T2DM (type 2 diabetes mellitus) is very complex and usually results in the complexity of the moduled factors such as age, gender, cultural behaviors, race, genetic features, ethnicity, and most important factors such as diet, physical activity, lifestyle pattern, and smoking. Recently, the development of some microvascular and some macrovascular complications has been recorded from the elevated HbA1c level (Sami, 2017). Patients having altered glycemic level are critically managed in type 2 diabetes, as hyperglycemia may result in many comorbid conditions such as, CVD (cardiovascular diseases), retinopathy, neuropathy, nephropathy, and some foot pathologies (Surani, 2015). T2D (type 2 diabetes) is the most common and occur in 80% - 90% of the people having diabetes. A study was revealing the fact that a total of 425 million people especially adults currently presented with diabetes which is around 9.2% of the total adults with the rampancy varies with age, sex, and population count (Hussain,2018). Prediabetes is a condition where impairment occurs in glucose tolerance and fasting glucose having a higher value of it, but cannot be considered and classified as type 2 diabetes. It is determined by using a term fasting plasma glucose (FPG) and oral glucose tolerance (OGT). In this contrast, both of the above have a different value of the measurement. According to WHO, it defines the range of FPG and OGT in between 110 and 125mg/dl whereas ADA (American diabetes association) defines it in between as 100 and 125mg/dl (WHO consultation.1999). Children with type 1 diabetes are often suffered from a condition called diabetic ketoacidosis which is a life-manacing condition and is recorded as a major cause of morbidity and mortality. Due to the deficiency of insulin, it leads to metabolic failure of organs, which causes hyperglycemia but can be resolved by using therapeutic ketosis approach, considered as a valid alternative, in treating patients affected with type 1 and type 2 diabetes. (Pilla, 2018).

Research Methodology:

There are three approaches available to conduct this study and are as follows: 

  1. Exploratory (Qualitative)
  2. Descriptive (Quantitative)
  3. Mixed methods

Exploratory and descriptive, both of these approaches did not fall in a distinct category or considered as dichotomies. Instead, they must be represented as two different ends of a continuous process (Newman & Benz, 1998). Mixed methods of research are the middle part of this continuous process because it follows and incorporates both elements of exploratory and descriptive.

  1. Exploratory or qualitative research methods are those who approach exploration and proper understanding of social and human problems. The data analytical process used is the inductive approach which builds from the particulars of general themes. The researcher makes these themes a meaningful interpretative data and thus, the final report arises flexible in structure.  

  2. Descriptive or quantitative approach on the other end, these studies identify the characteristics of a problem through its description. This strategic approach fixes their objective theories by examining properly the relationship between the variables. These variables are then measured usually by using various instruments so that the obtained data will be analyzed by using different statistical tools. The final report has a fixed structure as the introduction, theoretical reviews, the methodology used, data analysis, results, and conclusion.

  3. Mixed methods of research are approaches which use both above strategies, i.e., collect data by both processes, integrate it, and provide the evidence that this type of approach provides with the more complete understanding of the concept (Creswell, 2014).

The research work will follow the descriptive or quantitative type of research design because help in conducting the study will use the existing evidence since the related protocols for practice change were introduced in the pre-studies conducted so far but are not implemented properly. Therefore, this study focused on a research and review work as well, that whether the people or patients are following these protocols or not and if following, then to what extent. This study will be conducted at levels of examining properly the relationship between various variables. 

The approach will be followed is deductive type since it is concerned with “developing a hypothesis based on existing theories of the related concept” and then the research strategies are designed and tested for the hypotheses. Deductive means were producing reasons behind the particular concept to the general. Therefore it is involved with deducing the conclusion from propositions (Dudovskiy, 2011). Therefore, it will follow the deductive approach with a positivism paradigm and descriptive design to gain the better understanding of the topic by improving accuracy and giving the fuller picture of the topic. Also, an additional approach will be used called triangulation approach. According to the definition, triangulation stands for viewing things from more than one perspective by using different methods, different sources of data or even by using different researchers’ perspectives within the study (Torrance, 2012). The research thesis will consider these factors more in detail. More precisely, it will begin by considering changes and factors of conducting research leading to the research approach and strategy. Paragraphs given below will introduce the data collection method.

Data collection 

For collecting data, various tools are used such as survey questionnaires, interviews, case studies, literary sources, online sources, and journal articles. To be able to analyze and compare existing theories, this research will use documents as a secondary data collection method. This includes official statistics and governmental publications as well as articles, books, journals, and online sources. Data collected in this report contains prior literature findings as secondary sources as well as raw data which has been obtained in prior studies and official publications. Also, the tool for conducting a good clearance about the concept form patient’s perspectives will include a survey both online and offline. The promoted way of representing the survey questionnaire will be online survey as it facilitates the ease with presenting questions on a web page. The planning for surveys using text messages will also be done for a specific area. However, the online survey will be used more because it provides the researchers with ease and can get answers from so many people at a time in a single day (Survey blog, 2016). Sampling will be done randomly, and sample size will be dependable on the available sources at the time of conduction of studies. Survey research will provide the quantitative or numeric description and the account of trends, attitudes, and opinions of a population by considering the sample of the involved population. This will include a cross-sectional and longitudinal study of the concept research study using survey questionnaires and structured interviews for collecting data with the aim of generalizing from the sample to a population (Fowler, 2008). The data analysis techniques used to analyze data are so many as thematic analysis, descriptive analysis, graphical representation, and by using SPSS software. This study will use graphical representation and analyzing data by SPSS software online. These techniques used because illustrations to be given will be efficiently presented by the graphical pictures and online software will provide an adequate data analyzation of the concept about the existing theories.

APPENDIX: PROJECT TIMELINE – GANTT CHART

image of a Ghantt Chart

The research study is focused upon the problem of increasing the total count of the patients having diabetes along with those who are at risk of developing it and those who are having symptoms of prediabetes. The study considering all the parameters related to the context will be successful in creating awareness about the concept and providing the guideline-based evidence that change in dietary habits and lifestyle will be able to develop a new, well-synchronized community with better health in context to the most leading diseased condition called diabetes. This project study will help people to understand all the related factors and thus will be useful in creating recognition and realization about the facts and myths of the concept disease.Conclusion: 

References

Hussain, A. (2018). Diabetes in Asia: Special challenges and solutions. Journal of diabetology. 9(3). 69-72.  

WHO Consultation: Definition, Diagnosis, and classification of diabetes mellitus and its complications. Report no. 99.2. Geneva, 1999. 

Okosun, S.L. Lyn, R. (2010). Prediabetes awareness, healthcare provider’s advice, and lifestyle changes in American adults. International Journal of Diabetes Mellitus. 3(1). 11-18.

Steffanson, E. Einarsdottir, B.A (2011). Public health and prevention of blindness in diabetes. International Journal of Diabetes Mellitus. 3(1). 1-3.

Sami, W. Ansari, T. Hamid, A.R. (2017). Effect of diet on type 2 diabetes mellitus: A review. International Journal of Health Science. 11(2). 65-71. 

Pilla, R. (2018). The Ketogenic Diet and its Clinical Applications in Type I and II Diabetes. 

International Journal of Diabetes and Clinical Research. 5(3). 1-6.

The selection of a research approach. Retrieved September 21, 2018. From,

https://us.sagepub.com/sites/default/files/upm-binaries/55588_Chapter_1_Sample_Creswell_Research_Design_4e.pdf

Ellis, P. (2013). Listening is paramount when discussing sensitive topics with patients. British Medical Journal. 347(1). 347-363.

The Diabetes Times. Retrieved September 20, 2018. From, 

http://www.qualityincare.org/diabetes/case_studies/the_alphabet_strategy_for_diabetes_care_a_patient-centred_approach_to_multifactorial_intervention#Top

The selection of a research approach. Retrieved September 21, 2018. From,

https://us.sagepub.com/sites/default/files/upm-binaries/55588_Chapter_1_Sample_Creswell_Research_Design_4e.pdf

Deductive Approach. Research Methodology. Dudovskiy, J. (2011). Retrieved September 21, 2018. From,

https://research-methodology.net/research-methodology/research-approach/deductive-approach-2/

Torrance, H. (2012). Triangulation, respondent validation, and democratic participation in mixed methods research. Journal of Mixed Methods Research. 6(2). 111-123.

Survey Tools For Different Data Collection Methods. Retrieved September 21, 2018. From,

https://www.surveysystem.com/blog/survey-tools-for-different-data-collection-methods/


 

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