Diabetes mellitus: Web based intervention
Introduction
Diabetes mellitus is one of the most prevalent non-communicable diseases in the world. The disease is associated with societal and economic burden particularly among patients from low and middle income countries. Particularly, Diabetes is an important public health concern in the USA as it affects about 29.2 million people (Centers for Disease Control and Prevention, 2014).
The burden of morbidity and mortality caused by diabetes mellitus is evident among the Americans as more than 4% of people diagnosed with Type 2 diabetes mellitus are diagnosed with diabetes related health complications. The management strategies are complex processes as they entail controlling multiple risk factors that cause complications. There is emerging evidence on effective socio- behavioral interventions that are effective in diabetes management and prevention of chronic diseases such as diabetes but most effective strategy is self management practices (Ramadas et al., 2015).
Web based media have improved patient knowledge, lifestyle modifications and clinical outcomes for a range of health conditions. Web-based interventions have the potential to close the gaps in diabetes self care and self management intervention on the clinical (glycemic control, blood pressure and weight) and psychological (self care and quality of life) outcomes (Kalsen et al., 2016). However, previous web- based interventions have focused on the principles of effective education behavioral modification in diabetic patients and very few have emphasized on diet.
The proposed study is unique as it puts into consideration the ethnic and cultural background of diabetic patients to tailor the dietary change based on individual needs and preferences. Therefore, the proposed study will explore a web-based dietary intervention program (myDIDeA) for people diagnosed with Type 2 Diabetes Mellitus to evaluate the interventions feasibility and acceptability by the population.
Proposed PICOT
Despite the extensive actions to educate the diabetic population on effective management strategies for diabetes mellitus, there are still several issues that hinder this goal. One of the obstacles that have not been explored adequately is educating the patients about the most effective dietary changes.
Health care providers use the strategy of ‘one size fits all’ strategy, ignoring the fact that dietary needs and preferences are unique for each patient. Consequently, most of the patients diagnosed with diabetes report poor control associated with inappropriate diabetes management and preventive measures (Plaete et al., 2016).
There is need to narrow the gap between nursing knowledge regarding diabetes management and preventive processes (Kalsen et al., 2016). The purpose of this evidence based project is to develop a web- based intervention that incorporates diabetic dietary management practices in patient’s diagnosed with diabetes mellitus with the aim of reducing HbA1c levels within a period of nine weeks.
In this context, the PICOT statement is: In patients diagnosed with diabetes Mellitus (P), web-based dietary intervention program (myDIDeA) (I) is more effective than the standard care (C) in maintaining the Hb1Ac within normal range, (O) within a period of nine weeks (T).
The primary aim of this study is to evaluate the effect of web based diet intervention on patient’s knowledge, attitude and behavior in patients diagnosed with diabetes mellitus. The study aims to determine the impact of the intervention on blood biomarkers and nutrient intake. The eligible participants will be randomly allocated to the control group and the web based diet intervention.
The control group will receive standard treatment to patients with diabetes mellitus. The web-based dietary intervention program (myDIDeA) is borrowed from Ramadas and colleagues. The dietary plans developed based on the Nutrition Recommendations and Interventions for diabetic patients by American Diabetes Association (Kalsen et al., 2016).
The content of each lesson plan will be studied for its relevance to local community and fine tuned to suit each patient. Each lesson plan will have five Likert scale items that start from strongly agree =5 to strongly disagree =1). The participants will be assigned to the dietary recommendations will be based on scores generated. The recommendations aims at addressing the dietary barriers in order to motivate the participants based in the lesson plans.
The participants will be briefed on web-based dietary intervention program (myDIDeA) and will be given unique username and password through e-mail and SMS after randomization. Login reminders will be emailed each time the website is updated with new lesson plan. Participants will be also encouraged to send their questions to nutritionist through the email.
Reflection
Given the fact that diabetic patient control their health, self management training is an important strategy to improve the quality of care. Patient self management interventions have been indicated to be beneficial in both glycemic control and quality of life, but its participation is low and its effectiveness wanes over time. In addition, accessing professional support for self management is limited. This calls for strategic interventions that are promising and those that offer ease of access for patients who are computer literate or illiterate as they can be scaled up at a little cost (Kalsen et al., 2016).
Health care limited to clinic visit is not meeting the demands of the patients diagnosed with diabetes. Healthcare systems that use Web-based communication offer a great opportunity to shift focus from office based healthcare towards daily lives at home. This health information technology is important because it improves the interaction between the service user and the healthcare providers which enhance effectiveness of chronic illness (Yu et al., 2014).
However, there is little research on the impact of web based interventions and shared electronic records in primary care for patients diagnosed with diabetes. The internet has emerged as an effective medium for exchange of information. The healthcare industry has recognized the internet’s potential and web- based education programs and is slowly being integrated in nursing prevention and management of chronic care in diabetes management. They have demonstrated some favorable outcomes thereby bridging gaps in diabetes self care and management (Pal et al., 2013).
Conclusion
Diabetes has become a very important health issue in the world. There is urgent need to improve the overall self management education on best strategies for diabetes self management. Increasing use of web based interventions by consumer for promoting health information is an ongoing revolution in the health information technology, and it implies that the service users are accepting the new era of health information technology.
However, the full potential of this technology is yet to be achieved due to high attrition rates as well as limited uptake. This study aims to shed light in these limitations by identifying the characteristics related to web base interventions and attrition and in suggesting effective strategies that will help optimize these clinical outcomes.
References
Centers for Disease Control and Prevention. (2014). National diabetes statistics report: estimates of diabetes and its burden in the United States, 2014. Atlanta, GA: US Department of Health and Human Services, 2014. Retrieved from https://www.cdc.gov/diabetes/pdfs/data/2014-report-estimates-of-diabetes-and-its-burden-in-the-united-states.pdf
Karlsen, B., Oftedal, B., Lie, S. S., Rokne, B., Peyrot, M., Zoffmann, V., & Graue, M. (2016). Assessment of a web-based Guided Self-Determination intervention for adults with type 2 diabetes in general practice: a study protocol. BMJ open, 6(12), e013026.
Ramadas, A., Chan, C. K. Y., Oldenburg, B., Hussien, Z., & Quek, K. F. (2015). A Web-Based Dietary Intervention for People with Type 2 Diabetes: Development, Implementation, and Evaluation. International Journal of Behavioral Medicine, 22(3), 365–373. http://doi.org/10.1007/s12529-014-9445-z
Pal, K., Eastwood, S. V., Michie, S., Farmer, A. J., Barnard, M. L., Peacock, R., … & Murray, E. (2013). Computer‐based diabetes self‐management interventions for adults with type 2 diabetes mellitus. The Cochrane Library.
Plaete, J., Crombez, G., Van der Mispel, C., Verloigne, M., Van Stappen, V., & De Bourdeaudhuij, I. (2016). Effect of the Web-Based Intervention MyPlan 1.0 on Self-Reported Fruit and Vegetable Intake in Adults Who Visit General Practice: A Quasi-Experimental Trial. Journal of medical Internet research, 18(2).
Yu, C. H., Parsons, J. A., Mamdani, M., Lebovic, G., Hall, S., Newton, D., … Straus, S. E. (2014). A web-based intervention to support self-management of patients with type 2 diabetes mellitus: effect on self-efficacy, self-care and diabetes distress. BMC Medical Informatics and Decision Making, 14, 117. http://doi.org/10.1186/s12911-014-0117-3
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