Prospectus: The Association between Health Literacy and Compliance with Diabetes Treatment Therapy

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Evaluation Results

Overall comments: Regretfully we are unable to approve the prospectus just yet and believe this can be revised to meet the requirements. Remember the prospectus lays the foundation for your entire study. We just need to see this again, see below and attached for suggested revisions and need for clarification. Please work with your chair and do appreciate your work on this prospectus. Also be sure to use track changes on the attached document so we can see where you made the changes. Thank you. Nancy K. Rea, Program Director.  thank you for your very nice work and interest in this significant topic. However there are still some issues which need to be addressed, please see below. Please pay special attention to my comments regarding the literature gap, social change implications, the variables and RQs, the clear statement of the use of secondary data, and your APA reference style. Please know that a well written Prospectus will be your guide for your Proposal and will save you a lot of time in next steps. Also, it will help you to get more easily URR and IRB approvals. Please work with your chair/committee on these issues and let me know if you have any questions. I am looking forward to your revised Prospectus and please let me know if you have any questions or concerns about my review.

  1. COMPLETE? (NOT Met)
    DOES THE PROSPECTUS CONTAIN ALL THE REQUIRED ELEMENTS?REFER TO THE ANNOTATED OUTLINE TO SEE THE REQUIRED PARTS OF THEDOCTORAL STUDY PROSPECTUS DOCUMENT.
    COMMENTS:IF NOT MET, WHICH ITEMS ARE MISSING?
  2. MEANINGFUL? (NOT Met)
    HAS A MEANINGFUL PROBLEM OR GAP IN THE RESEARCH LITERATURE BEEN IDENTIFIED?IN OTHER WORDS, IS ADDRESSING THIS PROBLEM THE LOGICAL NEXT STEP, GIVEN THE PREVIOUS EXPLORATORY AND CONFIRMATORY RESEARCH (OR LACK THEREOF) ON THIS TOPIC? IT IS NOT ACCEPTABLE TO SIMPLY REPLICATE PREVIOUS RESEARCH FOR A DOCTORAL DEGREE.
    COMMENTS: IF NOT MET, WHAT IS THE REASONING FOR THIS ASSESSMENT?
  3. JUSTIFIED? (NOT Met)
    IS EVIDENCE PRESENTED THAT THIS PROBLEM IS SIGNIFICANT TO THE DISCIPLINE AND/OR PROFESSIONAL FIELD?THE PROSPECTUS SHOULD PROVIDE RELEVANT STATISTICS AND EVIDENCE, DOCUMEN TABLE DISCREPANCIES, AND OTHER SCHOLARLY FACTS THAT POINT TO THE SIGNIFICANCE AND URGENCY OF THE PROBLEM.
    COMMENTS: IF NOT MET, IN WHAT AREAS IS ADDITIONAL EVIDENCE NEEDED?
  4. GROUNDED? (NOT Met)
    IS THE PROBLEM FRAMED TO ENABLE THE RESEARCHER TO EITHER BUILD UPON OR COUNTER THE PREVIOUSLY PUBLISHED FINDINGS ON THE TOPIC?FOR MOST FIELDS, GROUNDING INVOLVES ARTICULATING THE PROBLEM WITHIN THE CONTEXT OF ATHEORETICAL BASE OR CONCEPTUAL FRAMEWORK. ALTHOUGH MANY APPROACHES CAN GROUND A STUDY IN THE SCIENTIFIC LITERATURE, THE ESSENTIAL REQUIREMENT IS THAT THE PROBLEM IS FRAMED SUCH THAT THE NEW FINDINGS WILL HAVE IMPLICATIONS FOR THE PREVIOUS FINDINGS.
    COMMENTS: IF NOT MET, WHAT OTHER THEORIES OR FRAMEWORKS MIGHT BE MORE APPROPRIATE?
  5. ORIGINAL? (NOT Met)
    DOES THIS STUDY HAVE POTENTIAL TO MAKE AN ORIGINAL CONTRIBUTION?THE PROBLEM MUST BE AN AUTHENTIC “PUZZLE” THAT NEEDS SOLVING, NOT MERELY A TOPIC THAT THE RESEARCHER FINDS INTERESTING. ADDRESSING THE PROBLEM SHOULD RESULT IN AN ORIGINAL CONTRIBUTION TO THE FIELD OR DISCIPLINE.
    COMMENTS: IF NOT MET, HOW COULD THE STUDY MAKE A MORE ORIGINAL CONTRIBUTION?
  6. IMPACT?(NOT Met)
    DOES THIS STUDY HAVE POTENTIAL TO AFFECT POSITIVE SOCIAL CHANGE?AS DESCRIBED IN THE SIGNIFICANCE SECTION, THE ANTICIPATED FINDINGS HAVE POTENTIAL TO SUPPORT THE MISSION OF WALDEN UNIVERSITY TO PROMOTE POSITIVE SOCIAL CHANGE.
    COMMENTS: IF NO, HOW COULD THE STUDY ADDRESS SOCIAL CHANGE MORE DIRECTLY?
  1. FEASIBLE?(NOT Met)
    CAN A SYSTEMATIC METHOD OF INQUIRY BE USED TO ADDRESS THE PROBLEM?THE TENTATIVE METHODOLOGY DEMONSTRATED THAT THE RESEARCHER HAS CONSIDERED THE OPTIONS FOR INQUIRY AND HAS SELECTED AN APPROACH THAT HAS POTENTIAL TO ADDRESS THE PROBLEM.
    COMMENTS: IF NOT MET, WHAT OTHER APPROACHES TO RESEARCH SHOULD BE CONSIDERED?
  2. ALIGNED?(NOT Met)
    DO THE VARIOUS ASPECTS OF THE PROSPECTUS ALIGN OVERALL?THE NATURE OF THE STUDY SHOULD ALIGN WITH THE PROBLEM, RESEARCH QUESTIONS, AND TENTATIVE APPROACHES TO INQUIRY.
    COMMENTS:IF NO, IN WHAT WAYS COULD ASPECTS OF THE PROJECT BE BETTER ALIGNED?
  3. OBJECTIVE?(NOT Met)
    IS THE TOPIC APPROACHED IN AN OBJECTIVE MANNER?THE FRAMING OF THE PROBLEM SHOULD NOT REVEAL BIAS OR PRESENT A FOREGONE CONCLUSION. EVEN IF THE RESEARCHER HAS A STRONG OPINION ON THE EXPECTED FINDINGS, THE RESEARCHER MUST MAXIMIZE SCHOLARLY OBJECTIVITY BY FRAMING THE PROBLEM IN THE CONTEXT OF A SYSTEMATIC INQUIRY THAT PERMITS MULTIPLE POSSIBLE CONCLUSIONS.
    COMMENTS: IF NOT MET, PLEASE IDENTIFY THE POINTS OF SUBJECTIVITY
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Prospectus: The Association between Health Literacy and Compliance with Diabetes

Treatment Therapy

Doctor of Public Health

Problem Statement

Diabetes Mellitus is a common health condition affecting individuals, their loved ones as well as the society. Diabetes affects many communities in the U.S. as well as other parts of the world. Diabetes can be managed; however, the existing treatment options require patient’s full engagement in the treatment plan by complying to manage their blood sugar levels (“2014 Statistics Report | Data & Statistics | Diabetes | CDC”, 2017). According to the American Diabetes Association report (2014), as at 2012, a total of 29.1 million people or 9.3% of the American population had diabetes. Also according to the report, among the 21.0 million cases, 8.1 million people equivalent to 27.8 percent of the diabetes cases were undiagnosed. There are significant associations between diabetes complications and other major issues such as premature death, diminished quality of life, decreased life expectancy (Chinenye, Oputa, & Oko-Jaja, 2012), increased preventable hospital visits, high use of emergency departments, and multiple hospital readmissions (DHHS, 2016). Poor health literacy according to Safeer, Cooke, and Keenan, (2006) has a significant association between treatment noncompliance and poor health status.

Acquisition of diabetes literacy advocates for the need to establish the relationship between diabetes management and health literacy. American Association of Diabetes Educators (2013) established that literacy skills are high for most Americans living with diabetes.  According to their report, lack of health literacy has been blamed for creating a vacuum as regards to the attitude of most diabetes patients to manage the disease. Previous researchers have identified the positive correlation between health literacy and self-diabetes management. These studies include patient behavior about self-management and have concluded that adequate health literacy is central to achieving diabetic control. Comparable research carried out in Europe and established the same results (Broucke, 2016). The different implications of these study efforts in diabetic control, however, call for the adoption of more feasible techniques. One such area that needs comprehensive exploration is the design of interventions that can efficiently accommodate low health literacy that is largely represented in the 27.8 percent undiagnosed cases. This includes identifying and determining the efficacy of techniques that can cater for the needs of patients with low health literacy, in a bid to enhance the health outcomes of diabetes therapies (Kim & Lee, 2016)

This proposal will go beyond the evaluation of the association between health literacy and compliance with diabetes treatment therapy in the US to identify and evaluate particular techniques for low health literacy patients that make up a significant number of the diabetes cases. The variables for the study will be health literacy (Independent variable), compliance with exclusive diabetes treatment therapy and Self-care maintenance (Dependent variables)

Significance

The statistics established by Hass and Maryniuk (2014), indicated that over 18 million Americans had been diagnosed with diabetes. According to American Diabetes Association (2012), the percentage of Americans aged 65 and older remains high, at 25.9%, or 11.8 million seniors (diagnosed and undiagnosed), and 86 million Americans age 20 and older had prediabetes. About 1.4 million Americans are diagnosed with diabetes every year. In an updated 2015 CDC report, diabetes remains the 7th leading cause of death in the United States. More than 24 per 100,000 of population deaths have been observed in death certificates listing it as the underlying cause of mortality. The study also reports a total of 234,051 death certificates listing diabetes as an underlying or contributing cause of death (American Diabetes Association, 2017).

Lack of basic health literacy is a problem that needs to be addressed to achieve the goal of prevention and management of diabetes. Health literacy has a significant association with poor health status as those with low health literacy often ignore necessary preventive measures and disease management protocols. Poor health literacy, according to Safeer, Cooke, and Keenan, (2006) has a significant association between treatment noncompliance and poor health status. Jones, Treiber, and Jones, (2014), and Zimmerman, et.al, 2015, supported that by inferring that noncompliance to prescribed medication therapy accounts for poor health outcomes and complications, whereas adherence to the medication therapy plays a significant role in the treatment of chronic diseases such as diabetes. Most diabetes medications such as insulin are titrated (through the sliding scale) according to the result of the blood glucose, thus requiring the knowledge of numbers as well as time (Khunti, Davies, and Kalra, 2013). Thus, the knowledge of numerical values, as well as the ability to read and understand the drug labels or instructions, is required for adequate compliance.

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American Association of Diabetes Educators (2013), pointed out that most Americans are short of basic knowledge concerning medical care and that is a major issue. Health literacy has been singled out as the main threat for handling cases such as diabetes cases in most communities living in America (Center for Healthcare Strategies, 2013). Unfortunately, as the prevalence of diabetes is predicted to be on the continuous rise, the literacy levels, on the other hand, has remained flat. Low health literacy is associated with uneven implications of diabetes-related challenges, especially within the disadvantaged populations. This has given the growing numbers of concerns regarding diabetes literacy; this study stands to provide useful information needed for the design of interventions that could effectively cater for the needs of individuals with low health literacy.

Background

  1. Khunti, Davies, and Kalra, (2013) provided information regarding the importance of the knowledge of numbers as well as time in insulin are titration (through the sliding scale) based on blood glucose level.
  2. Safeer, Cooke, and Keenan, (2006) offer vital information on the impact of health literacy on cardiovascular disease.
  3. Aikens, Piette, (2009) presented views why diabetic patients underuse diabetes treatment therapy.
  4. Mendoza and Rosenborg (2013) have critically probed into the efficiency of self management diabetes and health literacy. They offer useful insights that point at the inefficiency of this approach using CDC statistics.
  5. Chinenye, Oputa, and Oko-Jaja, (2014) offer recommendations of the need for improved primary care in rural communities as well as others which align with the possible approach to be used in this study.
  6. DHHS Office of Disease Prevention and Health Promotion (2016) provided information about how poor health literacy is significantly associated with poor health status as those with low health literacy often ignore necessary preventive measures and disease treatment therapy.

 

 

Framework

The theoretical foundation for this study will be Tannahill’s interventional-based model (2009). This model consists of three overlapping spheres of activity namely health education, disease prevention and health protection.

  1. Health education- which is designed to change the knowledge, beliefs, attitudes, and behavior that enhances health.
  2. Disease Prevention which encompasses primary, secondary and tertiary stages of disease prevention is designed to decrease risk factors and reduce the implications of the disease.
  3. Health protection emphases proper controls and policies and voluntary codes of practice aimed at preventing ill health and enhancing well-being (Raingruber, 2009).

The model is in line with the core of this proposal, health advocacy to give the population the basic health education on the disease process, prevention and management of diabetes.

Research Question(s) and Hypotheses

  1. What are some of the intervention techniques that may be suitable to cater for patients with low health literacy?
  2. What is the impact of increased percentage of diabetes cases and low literacy levels in the society?
  3. What is the relationship between health literacy and compliance to diabetes treatment?
  4. What is the role and efficiency of modern technology use in self management diabetes and health literacy?
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Nature of the Study

The research design of the study will be a quantitative analysis of secondary data. The research question will be examined by analyzing the correlation between the two variables, existing variance as well as a chi-square test for homogeneity with regards to previous studies. The independent variables are health literacy, and the dependent variable will be diabetes treatment therapy. SPSS will be computed to generate logistic regression which will be used to interpret the p-values. The null hypothesis will be rejected if p < .05.

Secondary Data Types and Sources of Information

  • American Diabetes Association accumulated data.
  • Articles are from MEDLINE, CINAHL, PsycINFO, PUBMED, Walden library databases and other reliable internet sources.
  • Health and Adult Literacy Survey (HALS).
  • Others

Possible Analytical Strategies (Optional)

Other Relevant Information (Optional)

 

References

American Diabetes Association. (2011, June 7). American Diabetes Association’s Guidelines Are Killing Diabetics! Retrieved from American Diabetes Association: http://www.anh-usa.org/american-diabetes-association-guidelines-killing-diabetics/

American Diabetes Association. (2016). Statistics about diabetes: Overall numbers, diabetes and prediabetes. Retrieved from American Diabetes Association: http://www.diabetes.org/diabetes-basics/statistics/?referrer=https://www.google.com/

American Association of Diabetes Educators. (2013). Communicating Effectively with Patients: The Importance of Addressing Health Literacy and Numeracy. Retrieved February 9, 2017, from American Association of Diabetes Educators: https://www.diabeteseducator.org/docs/default-source/legacy-docs/_resources/pdf/research/aade_health_literacy_and_numeracy_white_paper_final.pdf?sfvrsn=2

American Diabetes Association. (2017). Standards of Medical Care in Diabetes- 2017. Retrieved February 9, 2017, from Volume 40, Supplement 1: http://professional.diabetes.org/sites/professional.diabetes.org/files/media/dc_40_s1_final.pdf

Aikens, E., Piette, D. (2009). Diabetic patients’ medication underuse, illness outcomes, and beliefs about antihyperglycemic and antihypertensive treatments. Diabetes Care, 32 (1),  19-24.

Binh, T., Phuong, P., Nhung, B. (2015). Knowledge and associated factors towards type 2 diabetes among a rural population in the Red River Delta region, Vietnam. Rural And Remote Health , 15 (3), 3275.

Broucke, S. V. (2016). Diabetes literacy. Enhancing the Effectiveness of Diabetes Self-Management Education. Retrieved February 9, 2017, from Final Report. Louvain-la-Neuve: Universite Catholique de Louvain: http://cordis.europa.eu/docs/results/306/306186/final1-diabetesliteracyfinal.pdf

Chinenye, Oputa, and Oko-Jaja, (2014). Diabetes and related diseases in Nigeria: Need for improved primary care in rural communities. Journal of Health Science, 2(2), April/June.

Center for Healthcare Strategies. (2013). Health Literacy. Retrieved February 9, 2017, from Fact Sheet 1: http://www.chcs.org/media/CHCS_Health_Literacy_Fact_Sheets_2013.pdfDiabetes Association of Nigeria. (2013). Clinical practice guidelines for diabetes management in Nigeria. Retrieved from Diabetes Nigeria: http://diabetesnigeria.org/clinical-practice-guidelines-for-diabetes-management-in-nigeria/

DeWalt, D., Berkman, N., Sheridan, S., Lohr, K., and Pignone, M. (2004). Literacy and health outcomes. Journal of General Internal Medicine, 19(12): 1228–1239. doi: 10.1111/j.1525-1497.2004.40153.x.

Department of Family and Community Medicine, University of Arizona College of Medicine. (2001). Health literacy: an important issue for communicating health information to patients. Zhonghua Yi Xue Za Zhi (Taipei). , 64(11):603-8.

Haas, L., & Maryniuk, M. (2014). National Standards for Diabetes Self-Management Education and Support. Retrieved February 9, 2017, from American Diabetes Association: Diabetes Care: http://care.diabetesjournals.org/content/37/Supplement_1/S144

International Diabetes Federation. (2015). Diabetes scorecard in Nigeria. Retrieved from International Diabetes Federation: http://www.idf.org/membership/afr/nigeria

Kim, H., & Lee, A. (2016). Health-Literacy-Sensitive Diabetes Self-Management Intervention: A Systematic Review and Meta-Analysis. Worldviews Evidence Based Nursing, 13(4), 324-3333. http://dx.doi.org/10.1111/wvn.12157

Mendoza, M., & Rosenborg, T. (2013). Self  Management of Type 2 Diabetes: A Good Idea or Not?. The Journal Practice, 62(5), 244-248.

Palumbo, R. (2015). Discussing the effects of poor health literacy on patients facing HIV: A narrative literature review. International Journal of Health Policy and Managemen, 4(7): 417–430. doi: 10.15171/ijhpm.2015.95.

U.S. Department of Health and Human Services. (2016). Health Literacy and Health Outcomes. Retrieved from U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion: https://library.sd.gov/LIB/DEV/training/institute/2016/files/Vacek-HealthLiteracyHealthOutcomes.pdf

Khunti, K., Davies, M. and Kalra, S. (2013, January 29). Self-titration of insulin in the management of people with type 2 diabetes: a practical solution to improve management in primary care. Retrieved from Wiley Online Library: http://onlinelibrary.wiley.com/doi/10.1111/dom.12053/abstract?systemMessage=Wiley+Online+Library+Journal+subscribe+and+renew+pages+for+some+journals+will+be+unavailable+on+Wednesday+11th+January+2017+from+06%3A00-12%3A00+GMT+%2F+01%3A00-07%3A00+EST+%2F+14

Safeer, R., Cooke, C., and Keenan, J. (2006). The impact of health literacy on cardiovascular disease. Vascular Health and Risk Management , 2(4): 457–464.

Zimmerman, B., Woolf, S., and Haley, A. (2015, September). Understanding the relationship between education and health. Retrieved from Agency for Healthcare Research and Quality: https://www.ahrq.gov/professionals/education/curriculum-tools/population-health/zimmerman.html.