PICOT QUESTION
�Do African American male ages 30-65 suffering from diabetes mellitus type 2
improve their health when staying in compliance with their medications and adhering to
education on how to manage the disease as compare to when they do not receive proper
education on diabetes and options to help them better manage the disease other than take
their medications?
Part 2: Research Article Chart
Using the articles acquired in Part 1, provide a summary review of each component
using the “Research Article Chart” template.
Part 3: Synthesis of Research Studies
Based upon your review of the 15 research articles, identify at least five major
concepts that relate to your project topic, and three subthemes related to each concept.
Using the information from the completed “Research Article Chart,” and the major
concepts and subthemes you have identified, write a 2,000 word paper that synthesizes the
content of the 15 research studies.
Summarize each major concept and focus on providing a detailed synthesis of the
three identified subthemes that support that concept by addressing the following.
- Introduction of the identified subtheme
- Summary of the research questions posed by the studies
- Summary of the sample populations used
- Summary of the limitations of the studies
- Summary of the conclusion and recommendations for further research
INTRODUCTION TO THE LITERATURE REVIEW 2
Introduction to the Literature Review
Patient education on management of Diabetes type 2 (T2D) impacts on five central
concepts: Control of symptoms, changes in the quality of life, behavioral changes, prevention of
complications and knowledge, attitude and practice on T2D management. The following essay
discusses three subthemes under each of the above concepts by reviewing 15 relevant articles on
the PICOT question: “Do African American male aged 30-65 suffering from diabetes mellitus
type 2 improve their health when staying in compliance with their medications and adhering to
education on how to manage the disease as compared to when they do not receive proper
education on diabetes and options to help them better manage the disease other than taking their
medications?”
Symptomatic Control
Blood Glucose Control. Ruggiero, Riley, Hernandez, Quinn, Gerber, Castillo, & Butler,
(2014) investigated the effects of patient education among low-income ethnicities including
African American T2D patients as indicated by blood glucose control and self-care behavior.
Maintaining blood glucose levels within the normal range has been one of the objectives
of patient education programs.
The research question for the study was: What is the effect of patient education on blood
glucose levels among minority adult ethnicities diagnosed with diabetes type 2?
The study sample was comprised of 270 low-income ethnicity adult male T2D patients
who had been on patient education for 12 months.
The study limitation included the possibility of other factors to contribute to the control
of blood glucose level such as anti-insulin medication.
INTRODUCTION TO THE LITERATURE REVIEW 3
The study concludes that patients’ education contributes positively to the maintenance of
blood glucose levels in African American males patients diagnosed with T2D. However,
patients’ education did not significantly reduce levels of blood glucose. The authors recommend
more studies to determine the effect of patient education on other indicators and across other
social-economic groups, races and age groups (Ruggiero, Riley, Hernandez, Quinn, Gerber,
Castillo, & Butler, 2014).
Glycosylated Hemoglobin Control. Prolonged increased levels of blood glucose lead to
some of the blood glucose to attach to blood hemoglobin, increasing levels of A1C, which is
measured as laboratory investigation. Gaillard, Amponsah, & Osei, (2015) investigated the
effects of patient education at the point of care on glycosylated hemoglobin (A1C) levels.
The research question was: What is the effect of patient education on control of the level
of A1Cmeasured at the point of care?
The sample size was 124 male African Americans diagnosed with T2D and aged 35 to 50
years attending the primary care clinic.
The limitation of the study was the contribution of other interventions, for instance, the
level of education at the level of A1C.
The study concludes that the levels of A1C can be normalized through patient educating
programs and recommends increased at the point of care patient education programs (Gaillard,
Amponsah, & Osei, 2015).
Medication Adherence. Anti-diabetic medication works by lowering the level of blood
glucose through various mechanisms. Adherence is one of the components of the patient’s self-
care programmes. The article investigated the impact of intensified education of African
INTRODUCTION TO THE LITERATURE REVIEW 4
American patients diagnosed with type 2 diabetes medication adherence (American Diabetes
Association, 2016).
The research question was: What is the level of anti-diabetic medication adherence in
male adult African American patients diagnosed with T2D compared to patients who did not
receive the education?
The sample size was 727 African American patients, whose data on the days of missed
anti-diabetic dosages were acquired, of one month after prescription.
The study concludes that patients’ education improves glycemic control and recommends
more education to facilitate patients’ control of blood glucose levels (Bray, Cummings,
Morrissey, Thompson, Holbert, Wilson, & Tanenberg, 2013).
Quality of Life
Self-Care. Self-care involves activities that an individual performs to maintain healthy
living. Self-care affects an individual’s quality of life. The article by Anderson, Funnell,
Nwankwo, Gillard, & Fitzgerald, (2015) is an evaluation of the effectiveness of an educational
program to the quality of life of African American male T2D patients aged above 30 years as
indicated by the ability to achieve self-care.
Study question formulated was: What is the effect of the patient education on the
patients’ quality of life in T2D patients among African American populations as indicated by
self-care?
The study limitations encountered were the complexity of linking the educational
programs to the quality of life while excluding other factors.
The study recommends the application of the educational program with the aim of
improving patient quality of life (Anderson, Funnell, Nwankwo, Gillard, & Fitzgerald, 2015).
INTRODUCTION TO THE LITERATURE REVIEW 5
Activities of Daily Living. ADLs are a measure of the patient’s ability to meet their healthcare
needs. Ability to perform ADLs contributes towards the health condition and thus QOL of the
patient. The article by Cunningham, Crittenden, White, Mills, Diaz, & LaNoue, (2018) is a
review of articles documenting the change in the levels of ADLs among African American T2D
male patients after the initiation of Diabetes Self-Management Education (DSME).
The question for the research was: What is the impact of DSME on the level of the ability
to perform ADLs among the male patients of African American origin diagnosed with T2D?
The study sample was fourteen articles reviewed, on the ability to perform ADLs such as
bathing, dressing, and feeding.
The main limitation was the complexity in determining the level of ability to perform
ADLs since various studies used different indicators for ADLs.
The study concludes that DSME alone does not contribute to the improvement of ability
to perform ADLs among type 2 diabetes patients of African American origin. The study
recommends further investigation into the factors that affect responsible for the ability to
perform ADLs among T2D patient across all ages and races and in both the males and females
(Cunningham, Crittenden, White, Mills, Diaz, & LaNoue, 2018).
Mortality Rates. The study by Siminerio, Albright, Fradkin, Gallivan, McDivitt,
Rodríguez, & Wong, (2018) aimed at evaluating the effectiveness of the National Education
Diabetes Program (NEDP) among adult African American males diagnosed with T2D through
measuring the changes in the knowledge, mortality rates, and prevention of T2D complications
(Geiss et al, 2014).
The research question is; what is the impact of the NEDP among African Americans
diagnosed with T2D on mortality rates and prevention of complications?
INTRODUCTION TO THE LITERATURE REVIEW 6
The study population comprised of T2D patients who had received NEDP in the past 20
years and are of African American origin.
The limitations of the study were that most of the research subjects had been enrolled
some years after the start of the program and therefore, the data did not reflect on the
effectiveness of all the activities done through the NEDP.
The study indicated a general improvement in the patients’ quality of life as a result of
NEDP among adult male African American as compared to adult African Americans who did not
receive the NEDP. The study recommends an investigation into the personal factors that affect
the effectiveness of educational programs on T2D patients (Siminerio, Albright, Fradkin,
Gallivan, McDivitt, Rodríguez, & Wong, 2018).
Behavioral Changes
Diet. T2D patients are required to modify their diet. The diet aims at maintaining blood
sugar level. The research article measures the impact of type 2 diabetes education on specific
eating and nutritional behavior prescribed to T2D patients (American Diabetes Association,
2016).
The research question is; what is the effectiveness of various patients’ education
modalities on nutritional modification among adult African male patients diagnosed with type 2
diabetes indicated as a behavioral change?
The population sampled was 82 participants of African American origin, diagnosed with
T2D. The baseline data were obtained before and after patient education on nutritional change.
The study limitations presented was the inability to determine the cultural contribution to
nutritional behavior.
INTRODUCTION TO THE LITERATURE REVIEW 7
The study concludes that patients’ education maintains appropriate nutrition among male
adult African Americans (Fitzpatrick, Golden, Stewart, Sutherland, DeGross, Brown, & Briggs,
2016).
Physical Exercises. The comprehensive patient education program contains
incorporation of physical exercises as tolerated by the patient. A study by Collins, Ten &
Campbell (2017), aimed at evaluating the effectiveness of education on physical exercises on
blood glucose control and blood pressure control on patients diagnosed with T2D and of African
American origin.
The research question was: What is the effect of patient education on physical exercises?
The limitations of the study included the inability to determine the contribution of other
factors such as medication on physical exercises.
The study concludes that patient education on physical exercises significantly contributes
towards BP and Glucose control (Collins, Ten & Campbell, 2017).
Weight Control. Body weight contributes to complications of T2D. Weight
management is one of the interventional objectives. Samuel-Hodge, Kesselring, Park, Johnston,
Gizlice, & Bangdiwala, (2013) investigated the effectiveness of the church-based patient
education program aiming at the enrolled African American individuals aged between 40 and 50
years. The effects measured are the patient’s ability to exercise control over their body
metabolism, as indicated by the body mass index (BMI).
The research question in this study is: What is the effect of patient control on metabolism
for the African American male patient under the church based patient education programs?
The sample size chosen was comprised of 204 participants in 24 churches where the
program has been carried out.
INTRODUCTION TO THE LITERATURE REVIEW 8
The study concludes that patient education improves the ability of the patient to have
control on their body metabolism and recommends more studies to establish the effect of patient
education on another indicator in T2D management such as blood glucose levels (Samuel-
Hodge, Kesselring, Park, Johnston, Gizlice, & Bangdiwala, 2013).
Prevention of Complications
Prevention of CVD. The prevalence of Cardiovascular Disease (CVD) among male
African Americans T2D patients in urban areas and who have been undergoing patient education
as compared to the same group of subjects who did not receive the patient education is reported
in this article (American Diabetes Association, 2016).
The research question presented is: What is the prevalence of CVD among T2D African
American male adult patients receiving a patient education?
The sample size was 60 male adults diagnosed with T2D living in urban areas in the
USA. Half of the patients had received a comprehensive diabetes patient education while the
other 30 patients had not.
The research limitation was the detailed process of assessing all the patients for the
devolvement of CVD. Additionally, there might have been some possible misdiagnosis and
missed the diagnosis of CVD.
The study concluded that the prevalence of CVD reduces among adult African Americans
who received comprehensive patients’ education of self -T2D management. The study
recommends further research on the impact of self-education on other associated complications
among other patient populations (Hill-Briggs, Renosky, Lazo, Bone, Hill, Levine, & Peyrot,
2016.
INTRODUCTION TO THE LITERATURE REVIEW 9
Hypertension Prevention. Elevated blood pressure is a risk factor towards aggravation
of T2D symptoms. Periodic blood pressure monitoring is one of the interventions as per patients’
education programs. A research study by Tang, Funnel, & Oh (2013), is an evaluation of self-
empowerment educational program targeting African Americans diagnosed with D2T.
The research question formulated was: What is the impact of self-empowerment
education program on blood pressure control among African Americans diagnosed with type
2diabetes?
The sample size was 50 male African Americans aged 50 years and diagnosed with type
2 diabetes.
The study was limited by the fact that several subjects joined the program after it started.
The study concludes that patient education positively influences the improvement of T2D
symptoms among African American male adults (Tang, Funnel, & Oh, 2013).
Hospitalization. T2D complication such as hyperglycemia may lead to admissions for
continued care. The article reports on the findings obtained through a study seeking to establish
the effects of patient education on the rate of hospitalization to emergency rooms for T2D related
complications. The study compared the baseline data on the patients’ health care seeking
behavior and their health status (American Diabetes Association, 2016).
The research question for the study was: What is the impact of patient education on the
rate of hospitalizations for associated complications?
The study sample comprised of 242 male patients diagnosed with T2D who had been
receiving the University-based educational program on diabetes type 2. The patients were of
American origin and aged above 35 years.
INTRODUCTION TO THE LITERATURE REVIEW 10
The study limitation was the absence of a method to determine the contribution of other
factors in the development of symptoms leading to hospitalization apart from T2D symptoms
The study concludes that education on self-care of T2D against decreases the possibility
of admissions due to associated symptoms. The authors recommend more research studies to
investigate other indicators of patient education in type 2 diabetes patients (Gary, Turner, Bone,
Yeh, Wang, Hill-Briggs, & McGuire, 2014).
Knowledge, Attitude, Practice
Knowledge. Determination of knowledge is a measure of the effectiveness of educational
programs to the T2d patient. Peña-Purcell, Jiang, Ory, & Hollingsworth, (2015) compared the
level of knowledge from the evidence-based educational program on diabetes type 2 among
African America male patients living in the rural area with the patients of African American
origin and who did not receive patient education. The indicators measured were; the level of
knowledge and health status.
The research question is; what is the level of knowledge from of evidence-based patient
education on diabetes type 2 among African American patients living in rural settings?
The sample population included in the study composed 206 male African American adult
patients diagnosed with diabetes type 2. 103 patients received evidence of education on diabetes
while the rest did not receive the education.
The limitation of the study was that no method was used to determine whether the control
group of patients had not received any form of education from other sources such as the social
and mass media.
The researchers concluded that evidence-based education had significant effects on
improving patients’ knowledge on self-efficacy, improving the health status and increasing the
INTRODUCTION TO THE LITERATURE REVIEW 11
level of knowledge on diabetes self-management (Peña-Purcell, Jiang, Ory, & Hollingsworth,
2015).
Attitude. The attitude of T2D towards the educational programs affects the effectiveness
of the programs. The article by Walker, Stevens, & Persaud, (2014) investigated the
improvement on the attitude of T2D management after educational program among Africa
American male patients aged 40 years and above.
The research question for the study was: What is the level of attitude education programs
among male African America T2D patients?
The study sample composed of 40 T2D African American aged 40 years and above. The
respondents had been receiving care in a local primary care facility.
The study limitation was that there was the possibility of the contribution of other
educational programs that may have influenced the change in the patient’s attitude of T2D
(Walker, Stevens, & Persaud, 2014).
Practice. The article reports the findings of research by Kesselring, Hodge, Ammerman,
Ainsworth, Roldán, Elasy, & Bangdiwala, (2013) on the effects of educating male African
American T2D patients on the practice of physical exercises. Baseline and post-intervention data
on the level of physical exercise was conducted.
The research question was; what is the effect of patient counseling and education on the
practice of implementation of physical exercise?
The sample of the subject population composed of two hundred male African American
T2D patients aged 40 years and above and who had been receiving counseling on the importance
of physical exercises.
INTRODUCTION TO THE LITERATURE REVIEW 12
The limitation of the study was the prevalence of other conditions such as hypertension
on this respondents group, therefore, affecting the ability of the patient in practicing physical
activities.
The researchers concluded that patients’ education contributed moderately towards
patients’ participation in physical exercise as part of the T2D management among adult African
American type 2 diabetes populations (Kesselring, Hodge, Ammerman, Ainsworth, Roldán,
Elasy, & Bangdiwala, 2013).
INTRODUCTION TO THE LITERATURE REVIEW 13
References
Agurs-Collins, T. D., S. K., Ten Have, T. R., & Adams-Campbell, L. L. (2017). A randomized
controlled trial of weight reduction and exercise for diabetes management in older
African-American subjects. Diabetes Care, 20(10), 1503-1511.
American Diabetes Association. (2016). Standards of medical care in diabetes—2016 abridged
for primary care providers. Clinical diabetes: a publication of the American Diabetes
Association, 34(1), 3.
Anderson, R. M., Funnell, M. M., Nwankwo, R., Gillard, M. L., Oh, M., & Fitzgerald, J. T.
(2015). Evaluating a problem-based empowerment program for African Americans with
diabetes: results of a randomized controlled trial. Ethnicity and Disease, 15(4), 671.
Bray, P., Cummings, D. M., Morrissey, S., Thompson, D., Holbert, D., Wilson, K., … &
Tanenberg, R. (2013). Improved outcomes in diabetes care for rural African Americans.
The Annals of Family Medicine, 11(2), 145-150.
Cunningham, A. T., Crittendon, D. R., White, N., Mills, G. D., Diaz, V., & LaNoue, M. D.
(2018). The effect of diabetes self-management education on HbA1c and quality of life
in African-Americans: a systematic review and meta-analysis. BMC health services
research, 18(1), 367.
Fitzpatrick, S. L., Golden, S. H., Stewart, K., Sutherland, J., DeGross, S., Brown, T., … & Hill-
Briggs, F. (2016). Effect of DECIDE (Decision-making Education for Choices In
Diabetes Everyday) program delivery modalities on clinical and behavioral outcomes in
urban African Americans with type 2 diabetes: a randomized trial. Diabetes care,
dc160941.
INTRODUCTION TO THE LITERATURE REVIEW 14
Gaillard, T., Amponsah, G., & Osei, K. (2015). Patient-Centered Community Diabetes Education
Program Improves Glycemic Control in African-American Patients with Poorly
Controlled Type 2 Diabetes: Importance of Point of Care Metabolic Measurements.
Journal of National Black Nurses’ Association: JNBNA, 26(1), 50-57.
Gary, T. L., Batts-Turner, M., Bone, L. R., Yeh, H. C., Wang, N. Y., Hill-Briggs, F., … &
McGuire, M. (2014). A randomized controlled trial of the effects of nurse case manager
and community health worker team interventions in urban African-Americans with type
2 diabetes. Controlled clinical trials, 25(1), 53-66.
Geiss, L. S., Wang, J., Cheng, Y. J., Thompson, T. J., Barker, L., Li, Y., … & Gregg, E. W.
(2014). Prevalence and incidence trends for diagnosed diabetes among adults aged 20 to
79 years, United States, 1980-2012. Jama, 312(12), 1218-1226.
Hill-Briggs, F., Renosky, R., Lazo, M., Bone, L., Hill, M., Levine, D., … & Peyrot, M. (2016).
Development and pilot evaluation of literacy-adapted diabetes and CVD education in
urban, diabetic African Americans. Journal of general internal medicine, 23(9), 1491-
1494.
Keyserling, T. C., Samuel-Hodge, C. D., Ammerman, A. S., Ainsworth, B. E., Henríquez-
Roldán, C. F., Elasy, T. A., … & Bangdiwala, S. I. (2013). A randomized trial of an
intervention to improve self-care behaviors of African-American men with type 2
diabetes: impact on physical activity. Diabetes Care, 25(9), 1576-1583.
Peña-Purcell, N. C., Jiang, L., Ory, M. G., & Hollingsworth, R. (2015). Translating an evidence-
based diabetes education approach into rural African-American communities: the
“wisdom, power, control” program. Diabetes Spectrum, 28(2), 106-115.
INTRODUCTION TO THE LITERATURE REVIEW 15
Ruggiero, L., Riley, B. B., Hernandez, R., Quinn, L. T., Gerber, B. S., Castillo, A., … & Butler,
P. (2014). Medical assistant coaching to support diabetes self-care among low-income
racial/ethnic minority populations: randomized controlled trial. Western Journal of
nursing research, 36(9), 1052-1073.
Samuel-Hodge, C. D., Keyserling, T. C., Park, S., Johnston, L. F., Gizlice, Z., & Bangdiwala, S.
I. (2013). A randomized trial of a church-based diabetes self-management program for
African Americans with type 2 diabetes. The Diabetes Educator, 35(3), 439-454.
Siminerio, L. M., Albright, A., Fradkin, J., Gallivan, J., McDivitt, J., Rodríguez, B., … & Wong,
F. (2018). The National Diabetes Education Program at 20 years: lessons learned and
plans for the future. Diabetes Care, 41(2), 209-218.
Tang, T. S., Funnell, M. M., & Oh, M. (2013). Peer Reviewed: Lasting Effects of a 2-Year
Diabetes Self-Management Support Intervention: Outcomes at 1-Year Follow-Up.
Preventing chronic disease, 9.
Walker, E. A., Stevens, K. A., & Persaud, S. (2014). Promoting diabetes self-management
among African Americans: an educational intervention. Journal of health care for the
poor and underserved, 21(3), 169-186.