The evaluation phase is the next step after implementing a research initiative. It involves the assessment of a project to determine its relevance and whether the goals of the project have been met. Measuring project outcomes is an effective way of gauging the success of a change process. Evaluation enhances efficiency and sustainability.
DSME initiatives aim at helping diabetic persons to gain knowledge and skills relevant in the modification of behavior and lifestyle. Diabetes literacy improves self-management and prevents disease complications. Measuring DSME outcomes helps educators in analyzing behavior change (American Association of Diabetes Educators, 2011). It also informs practitioners of the effectualness of the intervention for individuals as well for the program or practice (AADE, 2011). In this paper, I assess the effectiveness of the DSME initiative at Brady Health Center. The outcomes include HbA1c, Blood glucose level, the incidence of diabetes complications, and pre-test and post-test scores.
Pre-test and Post-test Scores
The caregivers who took part in the initiative administered pre-test and post-test quizzes at the beginning and end of each session respectively. These questionnaires were useful in determining the level of diabetes literacy for each patient, as well as the effect of the DSME forum on health knowledge. The first session of the program revealed little improvement in the post-test rates. This prompted us to make adjustments in the training tools to match the linguistic and cultural needs of the predominantly African-American population. These modifications led to better score after each session. The average change in test scores was determined on a weekly and monthly basis. At twelve months, more than two-thirds of the participants had achieved an improvement of 30% after each session for the duration of four months.
Glycated Hemoglobin (HbA1c)
The determination of HbA1c is the gold standard in evaluating how well diabetic patients are controlling their blood glucose (Hou, 2014). HbA1c measurements give a picture of the average glucose levels of an individual for about twelve weeks. Medical professional recommend that people living with diabetes should maintain a HbA1c level of below 7% (Hou, 2014). Achieving this status of glycemic control has significant effects on improving prognosis and reducing the likelihood of developing diabetes complications. High readings of HbA1c indicate poor glycemic regulation.
At the beginning of the intervention, a baseline HbA1c test was done for each participant. The measurement was repeated after every three months. A comparison of the current test result with the previous one or the baseline revealed the progress for each individual. We used an average calculation of the total change in HbA1c to determine the success of the program. A decrease of more than 1% in glycated hemoglobin level was seen in 62% of the participant at the end of the first year of project implementation. The average decrease in HbA1c for all participants was 0.92%. Clearly, the education program was helpful in empowering with self-management skills that led to better blood glucose control.
Daily Blood Sugar
Scholars have connected frequent blood sugar checks with efficient monitoring and control of diabetes. Daily measurements of glycemia allow patients and caregivers to make dietary, exercise, and medical adjustments promptly enhancing glycemic control. DSME participants were taught how to determine their sugar levels using portable glucometers. Each a patient was encouraged to take a fasting and post-prandial measurement and record it in the glucose buddy application. The patients also posted the readings on their medical charts via the patient portal. Diabetes educators together with the patient developed individual goals for glycemic control based on the daily glucose results.
Comparing the results on a weekly basis helped us assess progress for each individual and the initiative. Individualized adjustments in diet, exercise, and medicine were made according to the glucose levels (Canadian Diabetes Association, n.d). Six months into the program, over 70% of the patients were able to make dietary and exercise modifications by monitoring their blood glucose. At the end of one year, 67% of the participants had stabilized their daily glycemic measurement at 4-7 mmol/L.
The Incidence of Diabetes Complications
One of the main aims of DSME is to prevent the development of diabetes health problems by maintaining healthy glycemic levels. Diabetic individuals who manage their sugar levels well can keep problems such as hypertension, neuropathy, foot damage, blindness, and nephropathy at bay (National Health Services, 2016). Before the implementation of the DSME strategy, Brady Health Center diabetes clinic had recorded a prevalence rate of 37.8% of complications. After a year of DSME, a decrease of 10.2% in the occurrence of diabetic health issues was noted. These statistics indicate that the program met the outcome target.
Future Challenges and Opportunities
Following the DSME project, most patients have learned and mastered diabetes self-care skills as shown by the positive results. As such, these individuals are in a good position to become diabetes champions, which will boost the quarterly diabetes campaign sponsored by the health center in the community. Incorporating these heroes in the community drive will promote the public's trust in the potential of medical and self-care interventions in controlling the illness. Consequently, the number of people accessing health facility for check-up and diabetes management will increase.
There is a likelihood of patients forgetting the information they have acquired through DSME over time. It is, therefore, crucial for caregivers to find effective ways of integrating patient education into routine clinical practice. Also, pamphlets, videos, and web pages can be helpful in reminders to patients and caregivers.
References
American Association of Diabetes Educators. (2011). Outcomes Measurement: AADE Position Statement. Retrieved Jul. 29, 2016, from https://www.diabeteseducator.org/docs/default-source/legacy-docs/_resources/pdf/research/outcome_measurement_position_statement_2011.pdf?sfvrsn=2
Canadian Diabetes Association. (n.d). Self-monitoring of blood glucose. Retrieved Jul. 29, 2016, from http://www.diabetes.ca/clinical-practice-education/professional-resources/self-monitoring-of-blood-glucose
Hou, Y. Y., Li, W., Qiu, J. B., & Wang, X. H. (2014). Efficacy of blood glucose self-monitoring on glycemic control in patients with non-insulin-treated type 2 diabetes: A meta-analysis. International Journal of Nursing Sciences, 1(2), 191-195.
National Health Services. (2016). Type 2 Diabetes- Complications. Retrieved Jul. 29, 2016, from http://www.nhs.uk/conditions/Diabetes-type2/pages/complications.aspx
