Date of Award
Projects: SPU Access Only
Doctor of Nursing Practice (DNP)
Background: Underserved ethnic groups are twice as likely to develop chronic medical conditions and have lower overall health compared to non-Hispanic whites (Claydon, Austin, & Smith, 2016; Park, Nam & Whittemore, 2016). Social determinants of culture and personal barriers have shown to play a prominent role in health disparities in ethnic groups. Medical misinformation from long-held cultural practices perpetuate the recurrence of preventable illnesses when they are not examined. Minorities have a higher risk of developing chronic diseases, including heart disease, stroke, and diabetes compared to whites (Zullig, Granger, Vilme, Oakes, & Bosworth, 2019). Currently, there are over 500,000 people living with diabetes in Washington state; state-wide prevalence has doubled in the last 20 years, with higher rates in those with low-income levels (Washington Health Care Alliance, 2016). Due to their increased prevalence, racial and ethnic minorities who suffer from long-term illnesses spend twice as much out-of-pocket for medical treatments (Zullig et al., 2019). Increased out-of-pocket spending is a barrier to care and perpetuates the cycle of medical noncompliance, use of emergency services, and health disparity.
Problem and Purpose Statement: A problem exists in implementing health education that is culturally tailored to encourage community members to utilize newly-acquired evidence-based knowledge. To address the lack of resources for those living in an ethnically diverse urban population, developing a health education curriculum that is mindful of the community’s culture and health literacy, and anchored on evidence-derived interventions is imperative to equip community members with skills to manage their health. The purpose of this DNP project was to implement evidence-based health education at a faith-based organization to individuals and families living in an underserved urban community in Washington state to effectively manage diabetes at home.
Methods: The project location was intended to take place at a faith-based organization that provide resources to individuals and families living in a culturally-diverse, underserved urban community in Washington state where poverty is prevalent. Due to the coronavirus pandemic, an online video recording replaced in-person gatherings to allow participants to watch and respond to surveys remotely in their own time. The data collection method included completion of pre- and post- diabetes knowledge and health management Likert-scale tests to assess diabetes health knowledge, confidence, and planned behavior through SurveyMonkey. The program originally was to be modified based on feedback from knowledge test, Likert-scales, and comment cards the day after class. During revision of in-person to online learning, the comment card with Likert-scale was omitted to limit participants’ burden of completing multiple online evaluation tools. Participants were provided an email to communicate feedback and suggestions, which were assessed bi-weekly from May-July 1st, 2020.
Results/Outcomes: For both pre- and post-response times for diabetes knowledge, self-confidence, and planned behavior, post-responses had a remarkedly shorter duration, with the Likert-scale post-questionnaire having an average completion time of twenty-seven seconds. These findings suggest lack of time spent answering questions in the post assessments which may have contributed to participants’ ability to arrive at thoughtful responses. The individual results suggest improvement in participants’ confidence level, but any conclusions are indeterminant when considering the short duration time participants spent answering questions as well as the small sample size in this project. Even more, since results were obtained online through SurveyMonkey, it is challenging to discern other personal or environmental factors that could have affected learning and subsequently, test and questionnaire answers.
Sustainability: The sustainment plan was to train undergraduate nursing students who has an established relationship with the project site. Nonetheless, in-person training of undergraduate students to lead future diabetes classes was not conducted due to the project site’s temporary discontinuation to host students. However, the local university liaison was given the online diabetes health video along with an electronic record of the presentation brochure and script (See Appendix H). The materials encompassed clear, detailed instructions and successful methods to obtain feedback from staff and volunteers through utilizing semi-structured interviews and comment cards (See Appendix G). Once in-person interaction resumes, the nursing students’ role is to continue community outreach through health education as well as recruit staff and new volunteers to partake in future health classes. The DNP student will be available as a resource through email to the university liaison and students until June 2021.
Implications for Practice: Although face-to-face learning is the preferred method, the impact of the coronavirus pandemic made this option unfeasible. While a pre-recorded video lecture has many advantages, such as extending the spatial and temporal barriers and flexibility for community members, this project demonstrated this approach yielded low participant responses. An alternative tool would be to offer multiple live video class sessions to include staff and volunteers, which can promote accountability that corresponds with the organization’s and this project’s current wellness promotion efforts. Even more, this implication for future online live class sessions could reduce external variables that inhibits learning, foster a meaningful environment to attain diabetes health management skills, provide opportunities for guidance when questions arise, and encourage feedback and meaningful data analysis to improve health.
Sustaining a wellness education project through collaboration between a faith-based organization and health providers to incorporate the community’s culture, medical literacy status, and health needs diminishes the care gap between the underserved and health organizations. Results were insignificant in this study, however collaborating with the pilot undeserved urban community revealed the unremitting value of in-person interactions to understand a population’s cultural and health needs, leading to meaningful health changes. Close partnership with the project’s organization, staff, volunteers, and community are significant factors in delivering evidence-based diabetes management education to clarify medical misinformation and increases confidence and planned behavior that can lead to the reduction of diabetes-related complications.
Mac, Jennifer V., "Diabetes Health Management Education for an Underserved Urban Population" (2021). Doctor of Nursing Practice (DNP) Scholarly Projects. 16.