Capstone Project Change Proposal

Capstone Project

Assessment Description

In this assignment, students will pull together the capstone project change proposal components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. For this project, the student will apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.

Develop a 2,500-4,000 written project that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal: Background Clinical problem statement. Purpose of the change proposal in relation to providing patient care in the changing health care system. PICOT question. Literature search strategy employed. Evaluation of the literature. Applicable change or nursing theory utilized. Proposed implementation plan with outcome measures.

Discussion of how evidence-based practice was used in creating the intervention plan. Plan for evaluating the proposed nursing intervention. Identification of potential barriers to plan implementation, and a discussion of how these could be overcome. Appendix section, for evaluation tools and educational materials, etc. are created. Review the feedback from your instructor on the PICOT Question Paper, and Literature Review.

Use this feedback to make appropriate revisions to these before submitting. Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

 

Capstone Project Change Proposal

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Instructor’s Name

Date

Capstone Project Change Proposal

 

Background

Diabetes is a big threat to public health systems across the world. The incidence of diabetes mellitus is increasing across the world, making it a serious concern to governments and other healthcare stakeholders (Houghton et al. 2018). The National Diabetes Association has indicated that diabetes accounts for 8.3% of the total population globally and the number is expected to reach about 592 million people by 2030. Diabetes causes serious complications such as cardiovascular disease, neuropathy, hypertension, and others (Kim & Hur, 2021).

The core of diabetes care is self-management, which comprises lifestyle modification and self-monitoring of blood glucose levels. The use of non-pharmacological interventions has proven to be effective in managing blood sugar levels and other symptoms of diabetes, (Kim & Hur, 2021). Type 2 diabetes is a serious health problem that requires relevant evidence-based solutions to manage.

Type 2 diabetes mellitus (T2DM) is among the largest and fastest-growing health problems associated with high morbidity and mortality. Type 2 diabetes takes evidence-based solutions and nursing interventions to prevent or manage it (Correia et al., 2022). Proper patient education is required for people who are pre-diabetic to delay or prevent the disease onset and those with the disease to enhance management practices.

Clinical problem statement

The care setting had noticed an increased rate of type 2 diabetes incidences in the area and indicated that the incidences might rise if nothing is done about it. The assumption is that most people lack knowledge regarding diabetes including preventive measures (Correia et al., 2022). Therefore, there is a need to conduct community-based education regarding type 2 diabetes and a healthy lifestyle to reduce the incidences. Public education is considered a powerful evidence-based intervention to prevent type 2 diabetes (Saleh et al., 2017).

Knowledge is essential for both the prevention and management or treatment of type 2 diabetes. The American Diabetes Association recognizes that lack of knowledge about the disease among citizens is a major problem that supports this PICOT problem (ADA, 2022). Consequently, the American Diabetes Association offers educational programs to patients, families, and communities. Diabetes can lead to detrimental health effects on the individual (Rafie et al., 2021). It leads to heart failure, lower limb amputation, and others. Type 2 diabetes is associated with bad signs such as increased thirst, and urination, blurred vision, and tingling sensation (Harris, 2022). Therefore, there is an urgent need to reduce prevalence.

Purpose

The purpose of the capstone change proposal is to examine the effects of community-based diabetes and healthy lifestyle education on disease knowledge and prevalence over six months.

PICOT question

In patients residing in high prevalence areas (P), what are the impact of community-based diabetes and healthy lifestyle education (I) compared to no education (C) on the disease knowledge and prevalence (O) over six months (T)?

Literature search strategy employed

A good literature search strategy is important to retrieve only reliable and valid research studies. It involves an organized structure of key terms used to search databases to retrieve relevant articles. For this study, different databases were used to retrieve literature for use.

This study is based on credible and reliable sources of evidence (Harris, 2022). Peer-reviewed articles were searched using keywords such as diabetes, type 2 diabetes, diabetes education, patient education, community-based education, healthy lifestyle, and diabetes prevalence. Various types of research studies were selected for review, including a systematic review of randomized control trials, quasi-experimental studies, systematic review and meta-analysis, and randomized controlled trials.

Eight of these studies were searched from various online databases  These databases include Google Scholar, CINAHL Ultimate, Cochrane Library, PubMed Central, SAGE Journals, and ScienceDirect (Metonnou et al., 2022). These studies were published in different journals, including Research Square, Rural and Remote Health, Primary Care Diabetes, Oman Medical Journal, Diabetes Spectrum, and others.

Evaluation of the literature

These studies exploited research questions that are relevant to the proposed research. For Gutierrez (2020), the research question states: Can online diabetes education programs in schools enhance the diabetes management of students with the disease? Harris. (2022) hypothesized that diabetes self-management education for patients with type 2 diabetes can improve patients’ self-efficacy and glycemic control.

For Rafie et al. (2021) the study question is what is the effect of the Balanced Living with Diabetes program (BLD) on blood glucose control, self-management, and lifestyle behaviors. T-Malek & Ahmad, (2022) hypothesized that Web-based educational programs will improve diabetic self-efficacy management (DSEM) and diabetic self-care behavior management (DSCM).

In addition, Moreno et al.  (2019) hypothesized that Spanish Diabetes Self-Management Program (SDSMP) is more effective for type 2 diabetes care. The hypothesis by Dietz et al. (2022) is that community-based diabetes self-management support (DSMS) will improve Patient Activation Measure (PAM) scores. Metonnou et al. (2022) hypothesized that community-based education on lifestyle changes will improve metabolic indicators and intensity of leisure activity and dietary score in type 2 diabetes patients. Finally, Alkaabi et al. (2021) hypothesized that community-based (family-oriented) diabetes education is effective in the prevention of type 2 diabetes mellitus.

Gutierrez (2020) used the purpose-sampling method. The sampling population includes employees from 36 rural school districts within South Central Texas. Participants included those who completed level two (non-medical personnel) and level three (continuing nursing education (CNE)) training. The sampling population included nurses, teachers, principals, bus drivers, and food service staff. Harris (2022) recruited six patients with type 2 diabetes mellitus in a primary care setting. Initially, the 11 participants agreed to take part however, 5 did not show up for the training. The sample population recruited by Rafie et al. (2021) included adults with type 2 diabetes. A total of 291 participants were recruited for the study.

Furthermore, T-Malek & Ahmad, (2022) carried out a study whose sampling population was type 2 diabetes patients who attended an orthopedic treatment clinic at Hospital Sultanah Nur Zahirah (HSNZ) Kuala Terengganu. There were 120 participants divided into intervention groups (IG) (n = 60) and control groups (CG) (n = 60). Dietz et al. (2022) recruited participants at community-based locations such as churches and activity centers.

Participants included adults who had a clinical diagnosis of either type 1 or type 2 diabetes. Additionally, Moreno et al. (2019) recruited adult patients diagnosed with type 2 diabetes mellitus. Patients aged 80 years and above and those with mental disorders were excluded. The sample population Metonnou, (2022) were residents of the municipality of Tchaourou, aged 15 to 60 years, of both sexes, and at risk of type 2 diabetes mellitus. Lastly, Alkaabi et al. (2021) recruited a sample population that included e people who are overweight or obese, between 18 and 55 years old, and having one parent with type 2 diabetes mellitus.

Besides the strengths of the studies including clear research methodologies, they also have some limitations. Gutierrez (2020) identified some limitations including that the data were limited to school workers (the nurses and other laypersons who completed the online program) in South Central Texas. This situation could have affected the study’s generalizability. Harris. (2022) had a small sample size whereby only six individuals participated in the study. Rafie et al. (2021) was not a randomized study. T-Malek & Ahmad (2022) was a single-site study, which has a negative influence on its generalizability.

Moreno et al. (2019) conducted a study based on a convenience sample; hence, people willing to participate may have not been representative of the target population. Dietz et al. (2022) reported that only those who completed the intervention collected post-intervention PAM scores, however, there is a possibility that people who did not complete the full intervention differed from those who did.

Limitations of the study done by Metonnou (2022) did not include a clear number of all participants. However, the treatment group has between 8 and 10 participants, which is a small sample size. For Alkaabi et al. (2021), the limitations of this pilot study are its nonrandomized observational design, small sample size, and unequal gender ratio. About 75% of all participants were female. A literature evaluation table is provided in the appendix.

Applicable change or nursing theory utilized

In this capstone change project, Kurt Lewin’s change model will be used to implement the proposed change. This change theory has three stages unfreezing, change, and freezing. Using this theory, the unfreezing stage represents a time when stakeholders receive information regarding the project (Hussain et al., 2018). Here, the researchers and those responsible will try to find means to help people let go of an old pattern of practice.

This stage can be achieved in three ways. One is by increasing the driving forces that keep behavior away from the status quo. Two is to reduce the barriers that hinder migration from the existing practice. The third one involves a combination of the two methods (Hussain et al., 2018). People will naturally resist the change; therefore, it is necessary to create awareness about how the status quo is hindering the facility from achieving its goals.

The second stage changes, which involves a process of change in behavior, thoughts, and feeling, that in some way are more productive. In this study, this would mean healthcare professionals beginning to adopt the change to meet the project goals (Hussain et al., 2018). The third phase is refreezing which establishes the change as a new clinical practice that now becomes the standard operating procedure. This means patient or community education regarding diabetes and healthy lifestyle changes.

Proposed implementation plan with outcome measures

This study will involve educating patients without diabetes, with prediabetes, and people diagnosed with diabetes who come from high-prevalence areas. These individuals must be adults aged 18 years and above. Both males and females will be recruited. Participants will be briefed about the study and a consent form will be provided Purposive sampling will be used to recruit the right people for the study (Rafie et al., 2021). Before administering the educational programs, patients will use questionnaires to test their knowledge regarding diabetes and lifestyle behaviors.

Another set of questionnaires will be provided after the training to assess knowledge. These patients will be educated regarding diabetes and healthy lifestyle education Patients will be educated daily throughout the six months. Education will include risk factors, management, prevention, and other relevant topics. For people who have pre-diabetes and diabetes, a clinical examination will be conducted after 3 months and 6 months to check blood sugar levels (HbA1C) (Rafie et al., 2021). Follow-ups will be conducted to note a change in behavior among those who received training.

Proposed Outcome

The primary aim of any educational program is to improve participants’ knowledge about a certain topic. The project intervention is community-based diabetes and healthy lifestyle education. Therefore, it is expected that the participants will gain significant knowledge regarding these areas (Saleh et al., 2017). Education will cover diabetes, including risk factors, management, and prevention. Diabetes education is an essential tool because effective management of the disease is largely dependent on knowledge, the ability to pursue self-care, and motivation (Chawla et al., 2019). In their study, Chawla et al. (2019) concluded that effective health education improves knowledge, attitude, and practices.

The main problem that this project is trying to address is increasing incidences of diabetes in the community. This project is based on the assumption that diabetes and lifestyle education will increase participants’ knowledge of preventive measures and in turn reduce the incidences of diabetes. Healthy people and those with prediabetes can use the knowledge gained to prevent or delay the onset of diabetes. Shirvani et al. (2021) carried out a study whose aim was to assess the effectiveness of community-based education interventions in reducing the incidence rate of type 2 diabetes. In the study results, the authors noted that educational intervention can reduce diabetes incidence by 46%. Therefore, similar actions are anticipated in this capstone project.

This project will include various types of participants, including prediabetic patients, those already diagnosed with diabetes, and healthy people. It is expected that the blood sugar level of diabetic patients and prediabetic patients will improve. According to Shirvani et al. (2021), educational intervention has a positive influence on fasting blood sugar (FBS) and hemoglobin A1c. The results of a study done by Chawla et al. (2019) also indicated effective health education led to a significant reduction in HbA1C in intervention patients compared to the control group.

The researcher anticipates that diabetes and healthy lifestyle education will impact behavior change to help the participants prevent or manage type 2 diabetes. This project outcome is an important one since it forms the basis of diabetes prevention and management (Chawla et al., 2019). Patients will be educated regarding the importance of behavior change to embrace a healthy lifestyle. Effective health education improves knowledge, practices, and attitude toward lifestyle modifications and dietary management, resulting in better control of blood sugar levels (Chawla et al., 2019). Therefore, a similar outcome is anticipated in this capstone project.

Discussion of how evidence-based practice was used in creating the intervention plan

Evidence-based practice was utilized in creating the intervention plan. For instance, evidence from several articles was reviewed when creating the intervention plan. For instance, Metonnou et al. (2022) assessed the effects of a community-based intervention on the lifestyle and health of people at risk of type 2 diabetes in Benin.

Peer educators or nutritionists led 30-min sessions of moderate physical activity each day. Participants were also educated about diabetes and lifestyle changes Metonnou et al. (2022). The results of the study showed that community-based education and healthy lifestyle programs are effective in improving the health of people at risk of type 2 diabetes as well as patients already diagnosed with the disease.

Plan for evaluating the proposed nursing intervention

For this research study, data collected will include new type 2 diabetes incidences, blood sugar readings, and behavior changes to embrace a healthy lifestyle. In addition, patients’ knowledge regarding diabetes and healthy lifestyle will be assessed (Correia et al., 2022). To evaluate the outcomes of this capstone research study the evaluation team will determine the changes in incidence rates. A reduction in these incidences will indicate success. A positive change in healthy lifestyle behaviors will also show success (Harris, 2022). In addition, increase in knowledge and improvement of blood sugar levels in people with type 2 diabetes and prediabetes conditions.

Electronic health records will be used to retrieve data related to disease incidence. Questionnaires will be important tools in this study to evaluate learners’ knowledge and behavior change after the intervention (Shirvani et al., 2021). The information contained in these instruments will be essential in carrying out the evaluation. The researcher and the implementation team will be responsible for conducting the evaluation process.

Identification of potential barriers to plan implementation, and a discussion of how these could be addressed

Implementation of a change project is often associated with different barriers that must be addressed for it to be successful. For this study, financial issues can be a barrier because the educators will need some allowance. Also, materials such as handouts must be printed which will incur some costs (Saleh et al., 2017). In addition, the care providers will need some training to inform them of what is expected from them to deliver the services.

Another barrier is time because healthcare professionals and patients will need to sacrifice their time to deliver and receive the services respectively. Opposition within the organization might be a barrier too. Financial barriers can be addressed by looking for external financial sources from donors, government agencies, and non-governmental organizations. Time issues are addressed through effective schedules that do not collide with other programs (Saleh et al., 2017). In addition, time management should be a priority. Issues to do with resistance are resolved by proper awareness creation and inclusivity in decision-making processes.

Conclusion

Diabetes mellitus is a serious community health problem across the world. Type 2 diabetes mellitus is the most common type of diabetes. Diabetes causes serious complications such as cardiovascular disease, neuropathy, hypertension, and others. This study aimed to examine the effects of community-based diabetes and healthy lifestyle education on disease knowledge and prevalence over six months. , the outcomes of this capstone project include increased knowledge of diabetes and a healthy lifestyle, reduced prevalence of type 2 diabetes, improved blood sugar, and improved participants’ self-care behaviors and self-efficacy.

 

References

Alkaabi, J. M., Al-Maskari, F., Afandi, B., Yousef, S., Shah, S. M., Heideman, W. H., & Snoek, F. J. (2021). Effects of diabetes prevention education program for overweight and obese subjects with a family history of type 2 diabetes mellitus: A pilot study from the United Arab Emirates. Oman Medical Journal, 36(3), e268. https://doi.org/10.5001/omj.2021.67

Correia, J. C., Waqas, A., Huat, T. S., Gariani, K., Jornayvaz, F. R., Golay, A., & Pataky, Z. (2022). Effectiveness of therapeutic patient education interventions in obesity and diabetes: A systematic review and meta-analysis of randomized controlled trials. Nutrients, 14(18), 3807. https://doi.org/10.3390/nu14183807

Chawla, S. P. S., Kaur, S., Bharti, A., Garg, R., Kaur, M., Soin, D., & Pal, R. (2019). Impact of health education on knowledge, attitude, practices and glycemic control in type 2 diabetes mellitus. Journal of family medicine and primary care, 8(1), 261. https://doi.org/10.4103/jfmpc.jfmpc_228_18

Dietz, C. J., Sherrill, W. W., Stancil, M., Rennert, L., Parisi, M., & McFall, D. (2022). Health Extension for Diabetes: Impact of a Community-Based Diabetes Self-Management Support Program on Older Adults’ Activation. Diabetes Spectrum. https://doi.org/10.2337/ds21-005

Gutierrez, C. (2020). Improving the care of students with diabetes in rural schools utilizing an online diabetes education program for school personnel. Rural and Remote Health, 20(1). . https://doi.org/10.22605/RRH5596

Houghton, D., Hardy, T., Stewart, C., Errington, L., Day, C. P., Trenell, M. I., & Avery, L. (2018). A systematic review assessing the effectiveness of the dietary intervention on gut microbiota in adults with type 2 diabetes. Diabetologia, 61(8), 1700-1711. 1 https://doi.org/10.1007/s00125-018-4632-0

Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3(3), 123-127. https://doi.org/10.1016/j.jik.2016.07.002

Harris, C. (2022). Effects of diabetes self-management education in the primary care setting on self-efficacy and glycosylated hemoglobin levels among adults with type 2 diabetes mellitus (Doctor Of Nursing Practice Final Manuscripts: University of San Diego). https://digital.sandiego.edu/cgi/viewcontent.cgi?article=1221&context=dnp

Kim, J., & Hur, M. H. (2021). The effects of dietary education interventions on individuals with type 2 diabetes: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 18(16), 8439. https://doi.org/10.3390/ ijerph18168439

Metonnou, C. G., Azandjeme, C. S., Sossa, C. J., Issiako, B. N., Paraïso, M. N., & Agueh, V. (2022). Effects of a Community-Based Intervention on the Lifestyle and Health of People at Risk of Type 2 Diabetes in Benin. Food and Nutrition Sciences, 13(10), 842-860. https://doi.org/10.4236/fns.2022.1310061

Moreno, E. G., Mateo-Abad, M., de Retana García, L. O., Vrotsou, K., del Campo Pena, E., Perez, Á. S., & Osakidetza Active Patient Research Group. (2019). Efficacy of a self-management education programme on patients with type 2 diabetes in primary care: a randomised controlled trial. Primary Care Diabetes, 13(2), 122-133. https://doi.org/10.1016/j.pcd.2018.10.001

Rafie, C., Hosig, K., Wenzel, S. G., Borowski, S., Jiles, K. A., & Schlenker, E. (2021). Implementation and outcomes of the Balanced Living with Diabetes program conducted by Cooperative Extension in rural communities in Virginia. Rural and Remote Health, 21(3). https://doi.org /10.22605/RRH6620

Saleh, F., Afnan, F., Ara, F., Mumu, S. J., & Khan, A. A. (2017). Diabetes education, knowledge improvement, attitudes, and self-care activities among patients with Type 2 Diabetes in Bangladesh. Jundishapur Journal of Health Sciences, 9(1). https://doi.org/10.17795/jjhs-36058

Shirvani, T., Javadivala, Z., Azimi, S., Shaghaghi, A., Fathifar, Z., Devender Bhalla, H. D. R., & Nadrian, H. (2021). Community-based educational interventions for the prevention of type II diabetes: a global systematic review and meta-analysis. Systematic reviews, 10(1), 1-12. https://doi.org/10.1186/s13643-021-01619-3

T-Malek, T. M. M. B., & Ahmad, A. B. (2022). The Effect of Web-Based Education Programs on Self-Efficacy and Self-Care Behavior in Quality of Life Among Diabetic Type 2 Patients in Public Hospital. Research Square, 2022. https://doi.org/10.21203/rs.3.rs-1381251/v1TENGKU

 

Appendix

Literature Evaluation Table

Criteria	Article 1	Article 2	Article 3	Article 4
Author, Journal (Peer-Reviewed), and  Permalink or Working Link to Access Article	Gutierrez, C. Rural and Remote Health. https://www.proquest.com/docview/2675655601?pq-origsite=gscholar&fromopenview=true	Harris, C. Doctor Of Nursing Practice Final Manuscripts: University of San Diego. https://digital.sandiego.edu/cgi/viewcontent.cgi?article=1221&context=dnp	Rafie et al. (2021). Rural and Remote Health. https://www.proquest.com/docview/2675665966?pq-origsite=gscholar&fromopenview=true	T-Malek & Ahmad, (2022). Research Square. https://assets.researchsquare.com/files/rs-1381251/v1_covered.pdf?c=1645479903
Article Title and Year Published	Improving the care of students with diabetes in rural schools utilizing an online diabetes education program for school personnel. (2020).	Effects of diabetes self-management education in the primary care setting on self-efficacy and glycosylated hemoglobin levels among adults with type 2 diabetes mellitus. (2022).	Implementation and outcomes of the Balanced Living with Diabetes program conducted by Cooperative Extension in rural communities in Virginia. (2021).	The Effect of Web-Based Education Programs on Self-Efficacy and Self-Care Behavior in Quality of Life Among Diabetic Type 2 Patients in Public Hospital. (2022).
Research Questions (Qualitative)/Hypothesis (Quantitative)	No hypothesis was mentioned. However, a possible hypothesis is that online diabetes education programs in schools can enhance the diabetes management of students with the disease.	No hypothesis. A possible hypothesis is that diabetes self-management education for patients with type 2 diabetes can improve patients’ self-efficacy and glycemic control.	The possible hypothesis is that BLD will improve blood glucose control, self-management, and lifestyle behaviors.	Web-based educational programs will improve diabetic self-efficacy management (DSEM) and diabetic self-care behavior management (DSCM).
Purposes/Aim of Study	To assess the effect of the online diabetes education program on diabetes care at school.	To provide diabetes self-management education within a family practice clinic to improve patients’ self-efficacy and glycemic control.	This study evaluated the implementation and outcomes of a lifestyle management program, Balanced Living with Diabetes (BLD) conducted by community-based educators.	To identify the effects of web-based educational programs on diabetic self-efficacy management (DSEM) and diabetic self-care behavior management (DSCM) in quality of life (QoL) among type 2 diabetes patients in public hospitals.
Design (Type of Quantitative, or Type of Qualitative)	This was a qualitative-quasi-experimental study using a pre-and-posttest design.	This was a quantitative study using a quasi-experimental design.	This was a quantitative longitudinal study done between 2015 and 2017.	This was a quantitative quasi-experimental design of pre-test and post-test.
Setting/Sample	This study was done in Thirty-six school districts within South Central Texas. Participants include non-medical staff and medical staff.	This study was conducted in a primary care setting with a high number of type 2 diabetes diagnoses. Convenience sampling was used.	This study was conducted in 16 rural counties in the State of Virginia. A purposive sampling method was used.	This study was conducted at an orthopedic treatment clinic at Hospital Sultanah Nur Zahirah (HSNZ) Kuala Terengganu.
Methods: Intervention/Instruments	A 12-module online diabetes education program for school personnel. 30-question knowledge pretest and post-test were used to measure knowledge and self-efficacy.	Education was guided using the AADE7 self-care behaviors. Handouts for these topics and website information were provided. One week of telephone follow-up was provided.	The BLD program is a group-based lifestyle intervention program for adults with type 2 diabetes. The BLD program consists of four consecutive weekly classes involving interaction with a nutritionist or certified diabetes educator. Questionnaires were also used.	Web-based education involved the management of a diabetic diet, medication management, exercise, physical assessment, mental management, and adherence to the treatment plan of a specialist. Instruments included questionnaires,
Analysis	Quantitative data were analyzed using the Statistical Package for the Social Sciences v17.0. T-test and g Pearson’s correlation coefficient were used.	Descriptive statistics were used. Graphs were used to present the results.	Descriptive statistics were used. e Statistical Package for the Social Sciences v25 was used. A T-test was also used.	Data were analyzed using SPSS-version 25 software, descriptive statistics, ANOVA, and t-test.
Key Findings	There was a significant increase in knowledge and confidence scores of the participants from pre- to post-test.	50% of the participants had an improvement in self-efficacy and 60% of participants had a reduction in hemoglobin A1c values.	Studies showed a significant increase in diabetes and food knowledge and diabetes management self-efficacy. In addition, A1C decreased significantly.	Web-based health education improved the management of a diabetic diet, medication management, exercise, physical assessment, mental management, and adherence to the treatment plan of a specialist.
Recommendations	Online programs with up-to-date information on diabetes care can enhance the ability of school personnel to care for students with diabetes.	Diabetes Self-Management Education should be implemented in care settings to improve patients’ Self Efficacy and Glycosylated Hemoglobin Levels.	The Cooperative Extension System (CES) is an effective network for the implementation of community-based diabetes lifestyle-management programs.	Web-based health education should be implemented to improve the management of a diabetic diet, medication management, exercise, physical assessment, mental management, and adherence to the treatment plan of a specialist.
Explanation of How the Article Supports EBP/Capstone Project	This study relates to the capstone project because it supports community-based diabetes education to prevent and manage disease symptoms.	This article supports diabetes and healthy lifestyle education to improve the health of patients with type 2 diabetes.	This article proves that community-based educational interventions can improve diabetes and food knowledge and diabetes management self-efficacy. They are also effective for blood sugar control.	This article supports the implementation of diabetic and healthy lifestyle education for the prevention and management of diabetes.

 

Criteria	Article 5	Article 6	Article 7	Article 8
Author, Journal (Peer-Reviewed), and  Permalink or Working Link to Access Article	Romero-Castillo et al. International Journal of Environmental Research and Public Health. https://www.ncbi.nlm.nih. gov/pmc/articles/PMC9 100266/pdf/ijerph-19-05079.pdf	Moreno et al. Primary Care Diabetes. https://www.researchgate. net/publication/328767723_ Efficacy_of_a_self-management _education_programme _on_patients_with_type_2_ diabetes_in_primary_care_ A_randomised_controlled_trial	Metonnou et al. (2022). Food and Nutrition Sciences. https://www.scirp.org/pdf/fns_ 2022101911181915.pdf	Alkaabi et al. Oman Medical Journal. https://omjournal.org/PDF/OS-OMJ-D-20-00051%20(06C).pdf
Article Title and Year Published	Effects of Nursing Diabetes Self-Management Education on Glycemic Control and Self-Care in Type 1 Diabetes: Study Protocol. (2022).	Efficacy of a self-management education program on patients with type 2 diabetes in primary care: A randomized controlled trial. (2019).	Effects of a Community-Based Intervention on the Lifestyle and Health of People at Risk of Type 2 Diabetes in Benin. (2022).	Effects of diabetes prevention education program for overweight and obese subjects with a family history of type 2 diabetes mellitus: A pilot study from the United Arab Emirates. (2021).
Research Questions (Qualitative)/Hypothesis (Quantitative)	Spanish Diabetes Self-Management Program (SDSMP) is more effective for type 2 diabetes care.	The community-based diabetes self-management support (DSMS) will improve Patient Activation Measure (PAM) scores.	Community-based education on lifestyle changes will improve metabolic indicators and intensity of leisure activity and dietary score in type 2 diabetes patients.	Community-based (family-oriented) diabetes education is effective in the prevention of type 2 diabetes mellitus.
Purposes/Aim of Study	To assess the efficacy of the Spanish Diabetes Self-Management Program (SDSMP) versus usual care in adults with type 2 diabetes mellitus (T2DM) residing in a Spanish region.	To determine whether completion of a community-based diabetes self-management support (DSMS) program delivered through a university Cooperative Extension network increased Patient Activation Measure (PAM) scores and to examine predictors of improvement in PAM scores in individuals participating in the DSMS.	To measure the effects of lifestyle intervention in subjects at risk of T2D in a West African country.	To test the feasibility and effects of a diabetes mellitus prevention education program designed for overweight and obese Emirati people with at least one parent with T2DM.
Design (Type of Quantitative, or Type of Qualitative)	This was a quantitative study involving a two-arm randomized controlled trial design.	This was a quantitative study involving a longitudinal, mixed-methods design.	This was a quasi-experimental pre-and-post-study design, with a control and a treatment group.	This was a quantitative pilot study using a pre-post design without a control arm.
Setting/Sample	This study was conducted in the Basque Country, Spain. Random sampling was used.	The study was conducted in upstate South Carolina. Recruitment of participants occurred at community-based locations, including libraries, churches, and activity centers. Purposive sampling was used.	The study took place in the municipality of Tchaourou located in the northeast of Benin, a West African country. Participants were residents between the ages of 15 to 60 at risk of type 2 diabetes. The probability sampling method was used in this study.	This study was conducted at the Diabetes Center at Tawam Hospital in Al Ain, UAE. 44 participants were recruited. A convenience sampling method was used.
Methods: Intervention/Instruments	The intervention consisted of a 2.5-h workshop, once a week for 6 consecutive weeks. HbA1c values were measured by turbidimetric inhibition immunoassay or high-performance liquid chromatography. Questionnaires were also used.	Health Extension for Diabetes (HED) is an established diabetes self-management education and support program. instruments used include the PAM instrument and the Self-Efficacy for Diabetes (SED) scale.	Peer educators or nutritionists led 30-min sessions of moderate physical activity each day. Questionnaires were used to collect information.	Interventions included three individualized or family-engaged counseling sessions based on the DiAlert protocol. They also used a questionnaire to assess the beliefs and risk perceptions, commitment, and nutritional choices of the participants.
Analysis	Descriptive statistics, chi-square test, Student’s t-test, and non-parametric Wilcoxon test were all used.	Analysis was conducted using a descriptive statistic, a Wilcoxon sign-rank test, and an x 2 test.	Descriptive statistical analysis and t-tests were used in this study. The software IBM SPSS Statistics 20 was also used.	Analysis was done using the g SPSS Statistics 21.0. Descriptive statistics were used.
Key Findings	Significant improvements were seen in self-efficacy, and disease control.	Community-based DSMS interventions were effective in generating positive change in individuals’ activation. HED provides a feasible and accessible DSMS option.	Blood glucose has significantly decreased. Participants had improved their ability to practice a healthy lifestyle.	The result showed significant improvements in glycated hemoglobin levels. Participants also demonstrated improvement in physical activity and dietary choices.
Recommendations	Educational strategies are effective in improving self-efficacy, and disease control in type 2 diabetes patients.	It is recommended that people living with diabetes attend a DSMS program such as HED to increase their ability to effectively self-manage various components of their chronic condition.	Community-based education on lifestyle changes is encouraged to improve metabolic indicators and intensity of leisure activity and dietary scores in type 2 diabetes patients.	Community-based (family-oriented) diabetes education should be embraced to prevent or delay the onset of type 2 diabetes.
Explanation of How the Article Supports EBP/Capstone	This study shows that educational interventions are effective in improving self-efficacy, and disease control in type 2 diabetes patients.	Community-based educational interventions are effective in managing type 2 diabetes.	This article supports community-based education and lifestyle changes to prevent type 2 diabetes.	This study supports family-oriented community-based education to prevent type 2 diabetes.