High Risk of Developing Type 1 and Type 2 Diabetes Mellitus

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Identification of Focus for Community Teaching

Secondary Prevention/Screening for Vulnerable Populations: Rural Adult Citizens with Prediabetes Conditions at a High Risk of Developing Type 1 and Type 2 Diabetes Mellitus.

Epidemiological Rationale for Topic

Diabetes Mellitus is a highly dangerous disease, the epidemic of which has been affecting various populations worldwide. The number of people with this condition grows at a high rate. The statistical data show that “more than 29 million people in the United States and 420 million globally have diabetes, with a projected global prevalence of 642 million by 2040” (Reusch & Manson, 2017, p. 1). The need for providing teaching sessions for patients with prediabetes is vital due to the necessity of disseminating knowledge and self-management skills to prevent Type 1 and Type 2 Diabetes Mellitus, as well as the multiple complications that might accompany the disease. Indeed, according to Rutledge et al. (2017), patients suffering from diabetes are at risk of developing “microvascular and macrovascular complications (e.g., heart disease, stroke, kidney disease, and retinopathy) that lead to a decrease in quality of life” (p. 1). The scope of complications has psychological, social, and economic implications for individuals and communities.

Moreover, rural citizens demonstrate an elevated level of a tendency to have diabetes. At the same time, patients living in rural areas “face barriers and challenges to accessing diabetes care” and less frequently participate in preventative4 care practices (Rutledge et al., 2017, p. 2). Therefore, the high level of comorbidity risks, diabetes prevalence in rural citizens, and their low rate of access to preventative care include the essential elements of the rationale for community teaching. The rationale justifies the application of teaching methods that would help the target population adhere to self-management behaviors, including healthy dieting, physical activity, blood glucose monitoring, and eHealth application use.

Nursing Diagnosis

The risk for changing blood glucose level, the risk for insufficient self-management, insufficient treatment and management knowledge.

Readiness for Learning

The level of community readiness for learning is an important indicator of the overall success of the planned teaching sessions. The preventative educational efforts provided for a prepared and acknowledged community is expected to be effective. The readiness of the target population might be assessed with the help of interviews or questionnaires. As for the factors that would indicate the readiness to learn, they might include emotional preparedness, currently used community practices to prevent Diabetes Mellitus, the knowledge of the community members about the disease, awareness about the prevalence and complications, and the overall community climate. In essence, the willingness of the population to obtain the knowledge would be a driving force for the teaching process.

Learning Theory to Be Utilized

For the proposed community teaching project, the behavioral learning theory will be used. The primary goal of the teaching is the changes in participants’ behavioral patterns and lifestyle to reduce the risks for comorbidities and complications that might follow from the mismanagement of diabetes mellitus. Behaviorism-oriented learning theory will stimulate the practical skills of the students in changing and maintaining their daily health routine.

Goal

Healthy People 2020 objectives address diabetes from various angles to combat the disease and its multiple complications in all populations. The current community teaching plan targets the goals under the D-16 category, which necessitates to “increase prevention behaviors in persons at high risk for diabetes with prediabetes” (Healthy People 2020, n. d., para. 20). In particular, the teaching plan’s objectives for behavioral change deal with the subcategories of the D-16 objective. D-16.1 objective requires an increase in “the proportion of persons at high risk for diabetes with prediabetes who report increasing their levels of physical activity” (Healthy People 2020, n. d., para. 21). D-16.2 targets prevention for persons trying to lose weight, and D-16.3 – for persons trying to reduce “the amount of fat or calories in their diet” (Healthy People 2020, n. d., para. 22-23). These objectives are prioritized in the teaching plan and are addressed in the interventions for the students.

How Does This HP2020 Objective Relate to Alma Ata’s Health for All Global Initiatives

The presented Healthy People 2020 objectives concerning the prevention of diabetes relate to the Alma-Ata Declaration’s initiatives. When taken to the dimension of rural communities, Alma-Ata’s initiative identifies the disparities and inequalities in access to healthcare, which requires substantial improvement of preventative and educational efforts on the community level (Kalra et al., 2018). Within the context of the contemporary high rates of diabetes morbidity, diabetes care and prevention must be addressed by multiple stakeholders.

Develop Behavioral Objectives (Including Domains), Content, and Strategies/Methods.

Behavioral Objective and Domain	Content	Strategies/Method
Healthy diet The students will understand the key principles of healthy dieting when managing diabetes. They will be able to identify what products to include in their diet and what foods to avoid. (Affective Domain)	1. The products useful for people at high risk of diabetes development contain healthy fats, be organic, and high in fiber. The patients should avoid foods high in carbs, high in sugar, flavored drinks, and food containing trans fats to maintain stable blood glucose levels.	1. Firstly, the role of carbs, fats, and protein will be demonstrated in the illustrations and explained by the instructor. Secondly, the skills of reading labels for nutrients information when shopping for groceries will be cultivated (initially by the teacher’s demonstration and then by students). Thirdly, the lists of foods that are healthy and those to be avoided will be distributed via flyers and reviewed by the group. Students will participate in role-playing to mock dialogues about healthy and non-healthy foods. Questions will be encouraged and properly answered.
Physical activity The students will be familiar with the importance of physical activity in managing diabetes. They will be able to adhere to a sporting routine on a regular basis. (Cognitive Domain)	2. The importance of regular exercise is essential for maintaining a healthy weight, heart functioning, and mental wellness.	2. Students will be provided with the information demonstrating the necessity of physical activity. Exercising plans will be distributed among the students to familiarize them with possible sporting routines.
Blood Glucose Self-Monitoring The students will know how to use home tests for blood glucose monitoring. They will be able to use the test strips and interpret the results independently. (Psychomotor Domain)	3. Home tests for self-monitoring of blood glucose help track the level of sugar and identify the need for an appointment with a doctor or an adjustment in lifestyle.	3. Students will be given tests and demonstrated how to use them. The indicators of normal and increased glucose levels will be provided for effective self-monitoring.
MySugr App Use The students will know how to use a mobile phone application to assist in managing their lifestyle. The students will be able to download, log in, and use the multiple features of the application for their benefits. (Psychomotor Domain)	4. The usage of a mobile phone application helps to monitor one’s progress in physical activity, obtain knowledge about diabetes management, track glucose level, and find dietary ideas is an important and useful tool (“Explore mySugr app features,” n. d.).	4. Students will be provided with a guide on how to use the application. They will be supported in downloading the app and demonstrated with the features it provides.

Creativity

The techniques and methods used for the teaching plan are creative due to the utilization of various approaches of participants’ engagement in the learning process. Teamwork, visualization, and role-playing all contribute to the creativity of the project and are aimed at facilitating the most effective outcomes.

Planned Evaluation of Objectives

For the healthy diet knowledge objective, the ability of the participants to choose healthy products from the list of foods and beverages will be measured. Multiple-choice tests will be created to evaluate the students’ knowledge.
Students’ ability to name an anticipated number of hours necessary to spend for exercising and the vital signs to maintain effective and safe training will be measured via questions and answers.
Students’ ability to use the tests according to instructions and interpret the results will be measured in the mode of observation.

Students’ independent usage of the main features of the app will be evaluated by tasking them to find specific data in their application.

Planned Evaluation of Goal

The achievement of the goal of increased prevention behaviors in the target population will be evaluated in three months after the sessions’ ending. The questionnaires and interviews with the participants will be conducted to retrieve their perception of their preventative behavior. The results will be compared with the pre-teaching indicators.

Planned Evaluation of Lesson and Teacher

The teacher will be evaluated by anonymous student feedback. The lesson effectiveness will be evaluated by the participants by allocating a particular score on a scale from 1 to ten.

Barriers

The barriers that might obstruct the learning process might include participants’ lack of attention, distractions, insufficient attendance rate, and misunderstanding. To address these barriers, the teacher will engage all the participants in the learning process by initiating dialogues. Distractors, such as phones or other devices, will be prohibited. Attendance will be tracked and encouraged; any misunderstanding will be resolved with the help of question and answer sections within each class.

Therapeutic Communication

The presentation will start with the teacher’s introductory encouragement that people with diabetes can live a qualitative life if the disease is properly managed. At the stage of the new content presentation, the audience will be asked follow-up questions and will be encouraged to give feedback on the pieces of information obtained from the lecture to monitor their active listening. Active listening will be encouraged by the continuous establishment of a dialogue with the participants and between them in small discussion groups. The teaching sessions will be concluded with the summation of the learning information and the encouragement of using it in daily life. Facial expressions of smiling, brow movements, and head nods will be used to encourage the students to speak and act.

References

Explore mySugr app features. (n. d.). Web.

Healthy People 2020. (n. d.). Diabetes [Data set]. Web.

Kalra, S., Akanov, Z. A., & Pleshkova, A. Y. (2018). Thoughts, words, action: the Alma-Ata declaration to diabetes care transformation. Diabetes Therapy, 9(3), 873–876.

Reusch, J. E., & Manson, J. E. (2017). Management of type 2 diabetes in 2017: Getting to goal. Journal of the American Medical Association, 317(10), 1015-1016.

Rutledge, S. A., Masalovich, S., Blacher, R. J., & Saunders, M. M. (2017). Diabetes self-management education programs in nonmetropolitan counties – United States, 2016. MMWR Surveillance Summaries, 66(10), 1-6.

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