How Older People Manage Diabetes - Research Proposal Example

Running Head: TITLE OF THE WORK Title Name Subject Name of instructor Institution Date Abstract Diabetes is touching the lives of many people in the society every year. According to the World Health Organization (WHO), diabetes is a chronic disease that occurs mostly when pancreas fail to produce enough insulin. It can alternatively occur, when the body cannot efficiently make use of the insulin it produces. Considering the greater impact that diabetes has on public health, researchers, health educators, and physicians are trying to find out how to reduce the complications connected with diabetes. A major constituent of this effort concerns how keenly people manage their diabetes condition and, hold on to treatment recommended. This paper elucidates the research method and techniques that would be used in conducting the research on how old people manage diabetes. Introduction Treatment for diabetes involves more than a few ways mostly depending on the intensity of disease development, with each treatment option offering potential benefits and risks. Benefit and risk assessment is the process of examining the benefits and various risks of a treatment, and using this information to make an informed decision. Literature indicates that, people normally requires information regarding both treatment benefits and risks. They require more information about different risks, management and side effects of diabetes than they are currently given than by the existing system (Wortham, 2010). A key aspect of diabetes management is the invalid to adhere to the various method prescribed for treatment. Treatment is influenced by many factors such as, understanding of a treatment’s benefits and risks. Perception, views and experience of diabetes in the old people with two types of diabetes was explored. The research method was based on a structured program of group of education sessions with an objective of enabling self-management of diabetes. In very few minutes, two people are developing diabetes disease in the whole world while, someone dies from diabetes related problem. Globally, diabetes is the fourth leading cause of death not only to the old people, but also to the young generation (Jamison, 2007). The problem is experiencing the crisis of diabetes, and which if not checked it would prove a burden worldwide. World Health Organization (WHO) estimates that about one hundred and eighty million people in the whole world are suffering from diabetes and this number may double by the year 2030. Over ninety percent of the older people with two types of diabetes are usually diagnosed with insulin resistance or insulin deficiency (Jamison, 2007). Analysis from some parts of the world found that diabetes was attributed to genetic and environmental factors, endurance, changes of lifestyles, and overeating. Prevalence of diabetes is much higher in the rural areas than in the urban area, but ethnic, social economic and different lifestyles are also greater factors for the spread of diabetes in old generation. Background Different guidelines for diabetes management are not only for the older diabetic population, but also to the general adult population. There are no different diabetes treatments that are directed to the older generation. American Diabetes Association in the year 2009 revisions addressed the new standards that would be applied to different patients suffering from diabetes. They made sure that children, teenagers and youths were included in this revision. Some unique recommendations were made to the people with over forty years of age. Diabetes education is carried out using pedagogical approach which mainly consist lecture content, knowledge tested for accuracy and demonstration of the necessary skills for self-managing and protection against diabetes. An older person has accrued years of established patterns and behaviors, making diagnosis of diabetes in their system very difficult. There unique problems in the management people with diabetes who are aged over 65-year. Visual disturbances occur as an effect of the ageing process, which is much accelerated by poor glucose control. Decrease in daily living activities results in decreased food intake, which may in turn contribute to better ground for diabetes. Methodology Keywords: Qualitative research, patient perspective, diabetes, nursing, older people, phenomenology, self-management. Research question How do older people manage diabetes? The research method was based on a structured program of group of education sessions with an objective of enabling self-management of diabetes. The study would presume a qualitative approach. This technique would be employed since it gives a broader view in the contextualization of the phenomena and, experiences that would be carried out on the given subjects who are the participants (Kahn, 2000). This approach tends to be more flexible and gives room for more responsiveness. Having this research question that revolves about the social lives of human being; this approach suffices well to give elaborate study about the realm of our interest. The term ‘treatment’ was conceptualized to mean any clinical recommendation or action that the participants considered best in taking or doing for the management of diabetes. This measure may include oral agents, lifestyle modification, or insulin. Benefits and risks are considered to be the constructive and unconstructive aspects, respectively, of each management practices that the participants earlier had discussed with his or her physician. The philosophical underpinning associated with qualitative research is the fact that, this approach culminates the description of patterns and the way of life unlike the employment of quantitative approach (Liamputtong, 2009). The study is planned to be supported by the interpretive perspective as there would be the collection of qualitative data that base on the ethnographic studies. The critical perspective would come in handy in enhancing the use of euphemism. The methodology has moved from the traditional way of quantitative methodology to modern way of qualitative research. It is known that, quantitative methods involve relating outcomes and variables that can be measured while the qualitative methodology which will be involved in finding the inconsistency and pattern of the management of diabetes among the older people. The position of this research is going where the qualitative research is involved to give flexibility in the research work. The researcher is able to know the knowledge of their position which is crucial to when it comes to the assumptions and, the effects of the research on the diabetic patients. The researchers will also be aware of how to develop the design, collect data as well as interpreting them. Therefore, the methodology will put the researchers in a position to acknowledge the analytical procedures that are needed to interpret what people mean, their values, how they behave and respect their opinions. It is also in this methodology, the relationship that will exist between the researcher and the person giving information compels the researcher to have a neutral stand and never to take sides. This will mean that the research of how the old people manage their diabetes, the results obtained will be highly reliable to health practitioners as well as other people. Consequently, the theoretical underpinnings are the assumptions that will be involved in the methodology. Phenomenological approach will be used in order to understand what the patients will say during sampling and information seeking. The methodology will believe the possibility of interpreting the events that will be described in different ways by the patients. Symbolic interactions will be deployed as well. It will be put together with the phenomenological approach during the research. This will ensure that, the patients will provide their familiarity and interpreting them will be crucial. The methodology presumes not to take a secondary or accidental approach but ensure the information obtained is true. In this research, the researchers will be feminists, who understand theories in a critical way as well as post modernists. Individual interviews would be carried out with thirty eight old patients, of whom fifteen have ever attended structured program and, the rest had been randomized to receive the usual care. Unstructured interview starting with an open question were carried out. Analysis of the data was grounded on the constant comparative method. Three principal orientations towards diabetes on old people and its management were identified: `resisters', `identity resisters, consequence accepters', consequence resisters' and `accepters'. Those who were interviewed presented different account of the degree of individual responsibility that required an assumption in response to the diagnosis. Many of the people gave varying account on the kind of education that is offered to them, many reported that health care education was beneficial, while some expressed their disappointment. No one single approach to management of diabetes can suit all the old people diagnosed with diabetes, though structured education can be of great benefit to many. To live with poorly controlled diabetes led many of those who were interviewed to introspection and existential questioning. Many of those who participated felt that they had not received enough information about the benefits and risk when treatment were prescribed or suggested. Currently designed from a medical standpoint, diabetes education to the old people should be grounded on a nursing model. This should incorporate the client’s insights and experiences. Managing diabetes in the old people should be viewed from a client’s viewpoint. Nurses should know the need to reframe the problem by excluding the cooperative and, uncooperative model and develop a conceptual perspective on self-management that is based on care to the old people suffering from diabetes. Study methodology that was applied, was influenced by the phenomenology of French philosopher Maurice Merleau-Ponty which gives direct description of experience as it is, without taking explanation of its psychological origin and sociologist provided (Greenfield, 2002). Based on the assumptions of ‘Merleau-Ponty’s, phenomenology was the means used to capture the experience of older people with diabetes. Merleau-Ponty focused his work on perceptions of a lived experience. Bracketing and phenomenological reduction are the most important components of this methodology (Greenfield, 2002). The procedure that was defined by Thomas and Pollio required a bracketing consultation of the principal investigator. This is intended to enhance awareness of any biases arising from personal experiences and lessen the possibility of data distortion during collection and analysis. Purposive sample would be drawn from local agencies on the ageing and consisted of the people aged between sixty five years and eighty five years and who were willing to talk about their diabetes condition. Among the group fifteen had attended structured programme and the rest had been randomized to receive the usual care. Every one of those interviewed, were beneficially of social security as their source of income. Amount of time that they had diabetes ranged between seven to thirty years. All had evidence of diabetes related complication and one chronic condition apart from diabetes. Recruitment and Sampling All participants should volunteer to take part in the above mentioned study. The inclusion criteria included: age between sixty five years to seventy five years and diagnosis of two type diabetes for more than two years. A range of treatment modalities is to be checked; diet control, oral hypoglycaemic medication and insulin. Participants are to be recruited through advertisement in the local diabetes newsletter and in the local hospitals and also through website request to the participant at the university. Purposeful and convenience sampling are to be used to elicit large amount of data. As the study goes on more specific criteria are to be used for theoretical sampling to target the search for people who could provide data. The research will also involve sampling and recruitment strategies to determine how older people manage their diabetes. This will help in testing conditions and also aid in standardizing the research. The researchers will use two sampling procedures to eliminate biasness as well as improving the reliability of the results. One of them will be random sampling. The researchers will obtain a list of old patients that surfer diabetes. Their names or identification cards will be used to generate random numbers. Then the researchers will randomly select patients who will be subjected to research. The other method will be the non random sampling where the researcher will choose the patient say ten who surfer the type one diabetes and ten who surfer type two diabetes. Then the researcher will carry out interviews on them in order to know how they manage their diabetes as prescribe by the physician. Data collection Would entail a number of techniques such as, observation interviews in which their approach would be discussed. All the interviews are to be carried face to face in the patients’ place of stay, and at the time they were willing. They take part in a single, individual, and in-depth interview. Interview should also take place at a location determined by the participants, with reimbursement given for any transportation costs. All interviews are to be conducted using semi-structured guide and are to be modified throughout the process of data collection to accommodate the various themes that may emerge. Directions are to be given to the participant. Interviews are to be audio taped and transcribed verbatim by professional transcribers. The participant is free to discuss life experience that represent their diabetic condition, and the experience with self management issues. Ample time is to be given to the participant to talk about their diabetic condition. Interviews are to begin with prompt: ‘Please tell me what it is like for you living with diabetes’. The participants are to be given a chance to take the discussion in the way they want. Any private and personally identifying information that can be used to identify the participant is to be removed from the transcript and a unique code is to be given to the participant. This is for the matter of protection of one’s private information. It will help in hypothesis evaluation and good conclusion of the findings. The methods will include the interviews, document reviews and observations. The interviews will be involved as patients will be asked questions directly as they attend the health clinics. The patient health documents will also be used to gather information about the patient who will be under the sampling. The researchers will as well use direct observation to collect data during the interviews. Observation will aid the researcher to know whether the patient is obese or he or she has the right weight compared to his height. Advantages of interviews in data collection It gives the comprehensive technique in which data may be obtained from the participants. It also has the advantage of being easily transformed to the capability of the interviewee (Johnson, 2008). Carrying out interviews gives the overall impression of a given sample that is being studied. It is usually more correct as compared to other techniques. Data management In this case data of the patients will be stocked and categorized in order to make sense of what was researched. Stocking of data simply means how the data is held and where is kept. In this methodology the data collected will be stored in computers which will be given high security code to ensure the confidentiality of the patient’s information. The information is also going to have back up in hard copies that will be used later if the computers crush or accidentally the data in computers get lost. Tape recorders will also be used to in order to increase reliability of the data during interviews. The tapes give evidence of the information that had been said by the patient. The information on the tapes does not change with time and can be listened as it was said without any distortion. Computer will also increase the speed with which the information is accessed and a lot of information can be stored on single computer. Data analysis Analysis is a process of seeking to understand and know the meaning of the whole by scrutinizing words and phrases line by line. Data analysis is to begin as soon as the interview starts using the constant comparative approach (Govaert, 2009). In this approach data are repeatedly examined for example data that will comprise the emerging theory model. Thematic analysis is to be carried out using open and axial coding techniques (Davies, 2002). Analysis is to be completed primarily by the principal of investigator, with co-investigator making sure that input and feedback were available regarding the analysis process. The patient age, sex and diabetes duration is to be obtained from the register. Some answers will be obtained from the Well-Being Questionnaire and 5% from the Treatment Satisfaction. Questionnaires will be used to calculate the aggregate well-being and treatment satisfaction scores. Missing answer will be estimated from their other answers using discriminant analysis. All participants to be audio taped and transcribed to ensure reliability of the data collected. All transcripts are to be read more than once, while listening to the audiotape to ensure credibility and accuracy of the data. Group comparisons are to be undertaken using Student’s tests, Mann-Whitney U tests for non-normally disseminated data, and 2 tests. The Bi-variate correlation would be undertaken, and it will use Pearson’ correlation. Multiple regression analysis would be carried on the collected data and would be used test interrelationships between questionnaire results and other obtained data. To determine rising themes, the data from selected transcripts is to be reviewed and read aloud by members the research group. This is because, the group members have extensive experience using the (Creswell & John, 2007) method of analyzing research data and, many have participated in this kind of work for many years. The group member consist phenomenological research students from a doctoral programme and doctoral prepared university staff member. (Creswell & John, 2007) analysis procedures are to be used for data analysis. Meaning units and themes are to identify and, be related to one another until a final thematic structure is obtained and presented to the research group. Data analysis will involve breaking the data; separate it into parts and pieces that can be managed easily through the process of sorting and sifting. The data collected by the researchers from the patients under the project will be analyzed to determine which type of diabetes the patient surfers. Through this process of noting, the information will be looked closely in order to compare to help seek the similarity and differences of the questions that were asked and the results obtained from the data. Ethical consideration This research will be approved by research ethics committee. Initial contact with those who would be interviewed will be accomplished through a visit to the agency’s home health nurse. The nurse will be supposed to provide the information on purpose of the study, nature of the data to be collected, approximate time required, benefits and risks related to participation in the study. Informed consent is to be obtained from each participant during the interview. The researchers will be expected to show high level of ethical standards since they will be handling matters that are considered private. During the research, each patient will be informed about the purpose of the research, his or her basic rights to accept to be the subject of the research. He or she will also be informed about his or her rights to end or participate. The researchers will as well ensure the confidentiality of the patient’s conversations and opinions. The researchers will also be expected not to disclose the identity of the persons involved and if the identity is revealed without consent, the information of the patient will be destroyed with immediate effect. Rigour The analyzing procedure is to present an analysis of the data that is organized, regimented, and reflective, and a meaningful comparison across all the data collected. The data obtained should be able to give a clear reflection of the actual percentage of people who are suffering from diabetes. Going by (Fujimori & Yoshikazu, 2008), they recommend that data presented to participants should be in response to its validity. Survey results Survey, administered during the interviews should reveal erratic diabetes self-management that is used by the old people. To obtain the result question should be presented to the participant for example, how often they self-tested for blood glucose, and haphazard testing. Conclusion It is ardent that the research would give out the background knowledge on haw older people manage diabetes. The methodological procedures are aimed at ensuring that stringent techniques followed are aimed at giving an over view on the mitigation measures that may be undertaken to ensure proper policies are structured and diabetes is effectively managed, References Cochran, G. (2006). Sampling Techniques. New York: J. Wiley, 2006. Print. Creswell, W. & John, C. (2007). Qualitative Inquiry & Research Design: Choosing among Five Approaches. Thousand Oaks: Sage Publications. Davies, A. (2002) "The Dictionary, the Reader and the Handbook: Approaches to Qualitative Research." Qualitative Research 2(3), 417-21. Flyvbjerg, B. (2006). "Five Misunderstandings About Case-Study Research." Qualitative Inquiry 12(2), 219-45. 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