The following questions pertain to:
George, S., & Thomas, S. (2010). Lived experience of diabetes among older, rural people. Journal of Advanced Nursing, 66(5), 1092-1100.
What is the purpose of this research?
What is the research question (or questions)? This may be implicit or explicit.
The research question was not specified. A likely research question can be stated as “What are the lived experiences and views of insulin-dependent diabetic rural older adults on diabetes self-management?
Did the authors describe the research design of this study? If so, give a description.
Describe the population (sample) for this study.
The sample was 10 female English-speaking, rural-based, insulin-dependent diabetic older adults between the ages of 65 and 85 years aged between 65 and 85. Majority, or 8 participants, was African American and the remaining was White.
Was the sample adequate for the research design that was selected?
Qualitative phenomenological research is not concerned with the representativeness of the sample size but with the representativeness of the narrative experiences documented. As such, the sample is often small often consisting of 6 to 12 participants as was noted by the authors. The sample is considered adequate because saturation was achieved. Saturation means that at one point during data collection, the authors have ceased to find anything new. This signifies that the prior interviews already captured the experiences and views of the participants in regard to the phenomenon and further interviews would be pointless.
Describe the data collection procedure.
Participants were interviewed face-to-face in their homes during days and times that were most convenient to them. The interviews employed an open-ended question on what it was like to be living with diabetes. The older adult was then free to narrate his or her story on the topic with the interviewers using prompt questions to fully explore the aspects of the experience. There was no limitation on the interview duration. All the interviews were recorded and later transcribed word-for-word. A brief survey was also conducted to obtain data on self-management issues such as the frequency of blood sugar testing.
How were the data analyzed after collection?
There was prolonged engagement as the transcripts were re-read and checked for accuracy against the recordings before being re-read again to elicit insights. A multidisciplinary group of qualitative researchers reviewed the transcripts to generate meaning units out of the phrases and words in the texts. Themes capturing the essence of participant experiences subsequently emerged as the relationships among meaning units were established. The participants’ answers to the survey questions were tallied to show what their answers were.
Discuss the limitations found in the study.
Generalizability is a limitation of the study. While the population is rural-based insulin-dependent diabetic older adults, the sample was all female and predominantly African American. Participants were also English-speaking which limits generalization to diabetic older adults who are fluent in other languages.
Discuss the authors' conclusions. Do you feel these conclusions are based on the data that they collected?
In brief, the authors concluded that rural-based insulin-dependent diabetic older adults found illness self-management to be especially challenging. This was manifested in diabetes being generally poorly controlled. The difficulties of chronic illness typically led to questions relating to their own existence. These conclusions are based on the data collected given the thick descriptions of the themes that emerged with direct quotes chosen to illustrate them. The answers to the survey questions also support the conclusions.
How does this advance knowledge in the field?
The themes provide insights to diabetes self-management educators on how they can best tailor the content and delivery of education so that they are applicable, relevant, and helpful to rural-based insulin-dependent diabetic older adults.
The following questions pertain to:
Hunt, C., Sanderson, B., Ellison, K., (2014). Support for diabetes using technology: A pilot study to improve self-management. MedSurg Nursing, 23(4), 231-237.
What is the purpose of this research?
What is the research question (or questions)? This may be implicit or explicit.
Again, a research question was not specified. A possible question can be stated as “Does the use of Apple iPad diabetic self-management applications in a workplace diabetes self-management program lead to enhanced self-management behaviors, self-efficacy, and type 2 diabetes outcomes?”
Did the authors describe the research design of this study? If so, give a description.
The study method was stated to be a two-group crossover and repeated-measures design which is a type of randomized controlled trial (RCT) design. There was random allocation to two arms – the Apple iPad arm and the control group tasked to document self-management behaviors in a personal journal. Baseline measurements of the dependent variables were made and again at 3 months post-intervention. The control group then received the experimental intervention while the original Apple iPad group received the control intervention in a crossover fashion for another 3 months before the variables were measured again. In addition, qualitative feedback on the Apple iPad self-management application was elicited from participants. As such, the study is of a mixed-method design employing quantitative experimental and qualitative methods.
Describe the population (sample) for this study.
The study focused on English-speaking adults with type 2 diabetes mellitus attending an employee diabetes self-management program.
Was the sample adequate for the research design that was selected?
The sample size is 17 which is small but is appropriate since the study was a pilot. If the study was a full RCT, a power analysis would need to be conducted to ascertain the sample size that would be adequate to provide the study power to detect true changes in the variable measurements.
Describe the data collection procedure.
Questionnaires were employed to measure self-efficacy and self-management behaviors at baseline and at mid- and post-intervention. Glycosylated hemoglobin (HbA1c) measurements were obtained through blood tests. The participants also documented specific self-management behaviors on the Apple iPad for the intervention group or on paper journals for the control group. The entries were relayed regularly to the researchers.
How were the data analyzed?
Descriptive statistics were used to analyze patient demographics and the changes in glycosylated hemoglobin values. Analysis of variance (ANOVA) was used to analyze between-group differences in self-efficacy and self-management. Changes in behaviors at various points in time were analyzed through a repeated measures analysis. Qualitative feedback was summarized.
Discuss the limitations found in the study?
As the study was a pilot, a major limitation also relates to generalizability as the sample size was small. In addition, study participants had acceptable baseline glycosylated hemoglobin and self-efficacy because they were already part of a self-management program in the workplace. As such, the findings may have a limited generalizability to the population of adults with type 2 diabetes who do not have access to such as program.
Discuss the authors' conclusions. Do you feel these conclusions are based on the data that they collected?
How does this advance knowledge in the field.
Apple iPad technology can be maximized as tools in fostering type 2 diabetes self-management in adults.
