Synthesis Discussion Paper
Synthesis of evidence is a process of systematically identifying, selecting, and compiling information from different to inform a particular topic or assist in decision-making on a certain issue. It should be unbiased to produce evidence that can identify gaps in research, inform policy development and changes, and practice. This paper focuses on the evidence synthesis of the diabetes national practice problem, based on two quantitative and one qualitative articles. The level and quality of evidence, a translation science model, and the integration of stakeholders using the selected model.
Introduction of the National Practice Problem
Diabetes is the selected national practice problem. It has long been identified as a practice problem following high pressure on the healthcare system and various health populations. Diabetes is a group of chronic metabolic conditions characterized by high blood glucose levels due to problems in regulation or having low to no insulin in the body. The three types of diabetes are type 1, type 2, and gestational diabetes.
Type 2 diabetes is the most common type, which occurs when the body is resistant to insulin or does not produce enough insulin. Type 1 diabetes, however, is where the body makes little to no insulin. Gestational diabetes occurs in pregnancy and disappears after birth. However, individuals with gestational diabetes are more likely to have type 2 diabetes later.
Diabetes prevalence, new cases and complications have significantly increased in the past few decades. About 422 million people are diabetic globally, with most of them coming from low and middle-income countries. Diabetes is attributed to 1.5 million deaths annually. Healthy People 2030 (n.d.) notes that over 30 million people in the US are diabetic, and they are not aware. More so, diabetes is the seventh leading cause of death and the costliest to manage and treat.
Sources of Research Evidence
The qualitative article is “Challenges to Diabetes Self-Management for Adults with Type2 diabetes in Low-Resource Settings in Mexico City: A Qualitative Descriptive Study” by Whittemore et al. (2019). The research in this article studied the perceptions of type 2 diabetes patients and care providers to identify the challenges patients from low-resource settings encounter in diabetes self-management. The findings are that challenges faced by type 2 diabetes patients in diabetes self-management include inadequate social support and resources, difficulties in lifestyle modification, and mental health issues.
The first quantitative article is “Factors influencing Healthcare Providers’ attitude and willingness to use information technology in diabetes management” by Seboka, Yilma & Birhanu (2021). With the increased use of healthcare technology, the study seeks to understand the willingness and attitude of care providers to use information technology in managing diabetes patients. The findings are that care providers are willing and have a positive attitude toward using information technology to help diabetes patients.
The second quantitative article is Diabetes and the risk of hospitalization for infection: The Atherosclerosis Risk in Communities (ARIC) study by Fang et al. (2021). The study’s primary objective was to identify and assess the relationship between diabetes and the risk of infection-associated hospitalization and mortality. The study found that diabetes confers a higher risk for infection-related hospitalization.
Analysis of the Practice Problem
The significance of diabetes practice problem is felt locally, nationally, and globally. Type 2 diabetes is the main type of diabetes and a major cause of diabetes complications. Diabetes complications include vision loss, diabetic foot leading to amputations, and retinopathy. Despite being expensive, diabetes complications are the major cause of cost rise in diabetes treatment and management. The high costs exert pressure on the healthcare system, the individual and the family. The patient is required to adjust their lifestyle to suit diabetes self-management and care.
Additionally, disparities exist in diabetes care access, affecting different populations disproportionately. Patients from low-resource settings encounter various challenges in diabetes self-management. Diabetes is also a leading cause of hospitalization, morbidity and mortality.
Significance and Prevalence of the Practice Problem
The impact of diabetes on an individual is mainly seen in their quality of life. Diabetes increases the risk of comorbidities, and early death. Its complications may also lead to life-threatening conditions and disabilities. Diabetes is associated with cardiovascular conditions, stroke, blindness, amputations, and kidney failure.
More so, research shows a profound relationship between diabetes, various cancers, and hearing loss (Abudawood, 2019). Stigmatization of diabetes in the communities exists, leading to poor social relationships that affect the attitude toward diabetes self-management, increasing the risk of complications.
Furthermore, diabetes negatively impacts patients’ mental health through anxiety, depression and diabetes-related distress. As mentioned earlier, about 422 million people have diabetes. About 10.5% of the US population has diabetes, yet most are unaware. About 95% of the total diabetes cases are type 2 diabetes cases, mainly caused by obesity and physical inactivity (WHO, n.d.). About 9 million people worldwide have type 1 diabetes, with a majority of them living in high-income countries.
The selected articles can adequately contribute to addressing the practice problem. The main themes in the 1st,2nd, and 3rd articles are diabetes self-management and low-resource settings, diabetes management and healthcare technology, and diabetes and hospitalization risk, respectively.
These are vital aspects of diabetes as a practice concern. Given the disparities in diabetes, more so in type 2 diabetes, self-management in low-resource settings informed the understanding of its prevalence and how the problem can be addressed. Healthcare technology, on the other hand, is resourceful in diabetes management, and helps improve patient outcomes. Additionally, diabetes and its contribution are significant causes of hospitalization.
The salient evidence emerging from the sources is that addressing challenges faced by diabetes patients in self-management can go a long way in improving their health outcomes and quality of life. More so, care providers should be trained on the use of emerging diabetes management technology to improve care delivery to diabetes patients. Appropriate diabetes care and management reduces the risk of complications, infections and hospitalization.
The three sources have diabetes management as the major theme in common. They also have a similar aim: understanding diabetes management, thus reducing complications, hospitalizations, and mortality rates. However, the first source focuses on the challenges patients face in diabetes self-management; the second is the use of healthcare technology in diabetes management; and the third focuses on diabetes and the risk of hospitalization.
In addition, the 1st and 3rd source emphasize diabetes burden on patients from low-resource settings. On the contrary, 2nd source’s main focus is the care providers and does not mention any population.
The overall objective for the practice problem, as seen in the evidence presented in the sources, is that proper diabetes management, especially self-management facilitated by healthcare technology, can help address diabetes by reducing diabetes complications and hospitalizations, thus improving health outcomes and quality of life for diabetes patients.
Appraisal of the Evidence to Address the Practice Problem
Both quantitative sources present a level of evidence 3, while the qualitative source has a level of evidence 5. Quantitative experimental studies fall under the level of evidence 3, while qualitative studies present a level of evidence 5. The evidence from these sources is valid and reliable since the methodologies used in the research are known to provide valid results. Additionally, understanding the practice problem acquired from these sources can contribute to addressing it.
The quality rating of the evidence is level A since the recommendations are based on consistent, sound, and reliable scientific evidence. The evidence obtained from the above-discussed sources adequately addresses the practice problem.
However, I believe that adequately addressing a practice problem such as diabetes requires a consideration of the prevention of the disease rather than management and treatment only. The sources of evidence discussed above did not mention how new cases of diabetes can be prevented, which is an essential factor in addressing the problem. However, it is worth noting that there is no known prevention of some types of diabetes, including type 1 and gestational diabetes.
Translation Science Model and its Components
The selected translation science model that can be used in addressing the practice problem is the RE-AIM framework. RE-AIM is a translation science model initially developed to enhance the planning, evaluation, and implementation of public health evidence-based programs and interventions (Titler, 2018). It emphasizes five significant dimensions: reach, effectiveness, adoption, implementation, and maintenance.
According to Esmail et al. (2020), RE-AIM is currently applied in planning the implementation stages of diverse areas of healthcare, such as disease management, prevention, and health promotion in various settings. It is also used to report the results of evidence-based practice implementation.
Diabetes affects the entire society, with its effects felt across different health populations. It mandates the healthcare system to carry out proper diabetes management, prevention, and health promotion using diabetes best practices and the available evidence-based practice. Therefore, the RE-AIM model can perfectly address the practice problem.
Stakeholder Integration into the RE-AIM model
Stakeholder integration into the RE-AIM model while addressing the practice problem is essential in influencing the successful implementation of addressing the practice problem. Among the stakeholders that will be part of the interprofessional team in implementing practice change include the American Diabetes Association, diabetes support groups, nurses, doctors, endocrinologists, nutritionists, and community groups.
Each of these stakeholder groups will impact the implementation of the project since they include people who will be affected by the practice change’s outcome and people who will participate in practice change implementation. The care providers and diabetes patients will be in the model’s implementation, adoption and maintenance parts. The American Diabetes Association will be resourceful in evaluating the effectiveness of the steps taken to address the practice problem.
Diabetes is a significant health concern and a national practice problem. It is the most expensive health condition to treat and manage. Research is used to inform evidence-based practice in diabetes treatment and management. The synthesis of evidence from the three research articles, discussed above, can adequately contribute to addressing the practice problem.
The central theme of the evidence presented above is diabetes patient management. The quality of evidence is high since the evidence is justifiable, applicable, and reliable in addressing the practice problem. RE-AIM translation science model can be used to facilitate the implementation of the practice problem change. Stakeholder integration in the translation science model is essential in ensuring the successful implementation of diabetes practice problem change.
Abudawood, M. (2019). Diabetes and cancer: a comprehensive review. Journal of Research in Medical Sciences: The Official Journal of Isfahan University of Medical Sciences, 24. https://doi.org/10.4103%2Fjrms.JRMS_242_19
Esmail, R., Hanson, H. M., Holroyd-Leduc, J., Brown, S., Strifler, L., Straus, S. E., Niven, D. & Clement, F. M. (2020). A scoping review of full-spectrum knowledge translation theories, models, and frameworks. Implementation Science, 15(1), 1-14. https://doi.org/10.1186/s13012-020-0964-5
Fang, M., Ishigami, J., Echouffo-Tcheugui, J. B., Lutsey, P. L., Pankow, J. S., & Selvin, E. (2021). Diabetes and the risk of hospitalization for infection: the Atherosclerosis Risk in Communities (ARIC) study. Diabetologia, 64(11), 2458-2465. https://doi.org/10.1037/hea0000710
Healthy People 2030. (n.d.).Diabetes, Overview, and Objectives. Retrieved from https://health.gov/healthypeople/objectives-and-data/browse-objectives/diabetes
Seboka, B. T., Yilma, T. M., & Birhanu, A. Y. (2021). Factors influencing healthcare providers’ attitude and willingness to use information technology in diabetes management. BMC Medical Informatics And Decision Making, 21(1), 1-10. https://doi.org/10.1186/s12911-021-01398-w
The World Health Organization. (n.d.). Diabetes. https://www.who.int/health-topics/diabetes#tab=tab_1
Titler, M.G., (2018) “Translation Research in Practice: An Introduction” OJIN: The Online Journal of Issues in Nursing, 23(2). https://doi.org/10.3912/OJIN.Vol23No02Man01
Whittemore, R., Vilar-Compte, M., De La Cerda, S., Marron, D., Conover, R., Delvy, R., Lozano, A. M. & Pérez-Escamilla, R. (2019). Challenges to diabetes self-management for adults with type 2 diabetes in low-resource settings in Mexico City: a qualitative descriptive study. International Journal For Equity In Health, 18(1), 1-10. https://doi.org/10.1186/s12939-019-1035-x