Nursing

Author, year; Credentials Article #1

Mirahmadizadeh, A. Delam, H. Seif, M. et al. (2019). All authors had a doctorate degree with one holding a masters. Published in the International Journal of Molecular Sciences.

Article Focus/Title

Factors Affecting Insulin Compliance in Patients with Type 2 Diabetes in South Iran, 2017: We Are Faced with Insulin Phobia

Research Design/Intervention

Cross-sectional study : No intervention

Level of Evidence and model used to grade evidence

Level IV :Johns Hopkins

Sample/# of subjects, how recruited

Adults aged 30 years or greater who attended one of twelve diabetic clinics in Shiraz, Iran were evaluated once written consent was obtained. Sample N= 457 patients among 8376 diabetic patients in total. The sample was obtained via convenience sampling. There was 95% confidence interval, error of 0.05 and design effect of 1.7.

Evaluation Tool (CASP or others- identify tool used)

JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies, Score 8/8

Data Collection procedure

Collected via a questionnaire that was administered by a trained nurse who completed face-to-face interviews, obtained the responses from the participants, and then completed a verify and read-back with the patients to confirm accuracy of responses.

Type of Instrument, reliability and validity of instrument

Questionnaire broken into two parts. Part one encompassed demographic information. Part two included 28 questions that assessed the patients’ reasons for noncompliance to treatment. This second component held two dimensions that focused on noncompliance related to use of insulin as well as noncompliance related to socioeconomic factors.

Reliability and Validity of study, limitations

Validity determined through a review of diabetic experts, epidemiologists, and five professors at multiple stages throughout the collection process. All experts approved the questionnaire. Reliability and internal consistency of the questionnaire was evaluated through test-retest as well as Chronbach’s alpha. The reliability was determined to be 0.91 and the Chronbach alpha was calculated to be 0.92. Study approval from the Ethics Committee of Shiraz. Written informed consent obtained. Statistical data listed in percentages and standard deviations. Appropriate statistical and standardized methods.

Data Analysis – identify LOM, Statistics, findings

T-test was implemented to analyze data. A logistic regression model was utilized to evaluate the relationship between the demographic variables and the clinical variables. Analysis of this model was completed through the Wald method. In addition, the statistical software used to analyze the data was the SPSS version 19. Statistical significance level was 0.05.

Results

N+308 (67.4% of participants) were women. Mean age= 55.16 +/- 5.79 years mean A1C level was 8.92%. 60.2% of participants were noncompliant with insulin administration. Factors such as age, gender, marital status, educational level, residence, insurance, diet, and physical activity were all variables associated with noncompliance as evidenced by statistical significance P<0.001. The duration that the participants had with diabetes was also associated with compliance with a P value of 0.025.

Discussion/

Significance/

Limitations

Findings demonstrate multiple variables and the association with decreased compliance to diabetic treatment. Additionally, the findings support the need for increased educational and financial support for diabetic patients.

Limitations: data was only obtained from public diabetic centers. There was no inclusion of private practices. Convenience sampling implemented. Limits generalizability. The cross-sectional design of the study as limits causation of results.

Helpful/Reliable/Compared to other art

Helpful. Statistically significant results. Appropriate analysis and interpretation of results. Clear findings. Addressed limitations and gaps in research for future studies. This study was Other literature makes note of noncompliance to diabetic treatment. In this present study, <40% of the participants were willing to complete insulin therapy. A study in existing literature was mentioned to state that 48% of the population was willing to start insulin therapy. Discrepancies in result could be in relation to sociocultural and financial differences among the different nations. Other studies reported determine compliances to insulin treatment and other modalities comes from experience. These findings were also similar in the present study. Fear, concerns, and adverse effects were lessened in participants who had initiated and implemented insulin therapy in the past.

Author, year; Credentials, Article #2

Sahin, G. Rizalar, S. (2018). Both authors held a doctorate level degree. Published in International Journal of Caring Sciences.

Article Focus/Title

Relationship between Nutritional Status, Treatment and Care Attitude in Diabetic Individuals

Research Design/Intervention

Descriptive and cross-sectional study- no intervention used

Level of Evidence and model used to grade evidence

Level IV:Johns Hopkins

Sample/# of subjects

Volunteer individuals with type 2 diabetes N=100 who applied to the Samsun Education Research Hospital. Participants must have had diabetes for at least one year.

Evaluation Tool (CASP or others- identify tool used)

JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies, Score 6/8

Data Collection procedure

Questionnaire prepared by researcher and Diabetes Attitude Scale developed by National Diabetes Commission. No other information included regarding collection process.

Type of Instrument reliability and validity of instruments

Questionnaire survey and Diabetes Attitude Scale. 33 questions identifying the sociodemographic characteristics, nutritional status and diabetes characteristics of participants were collected via a survey form. A Diabetes Attitude Scale was also included. This Likert-type scoring system ranged from 1-5 with a score >3 equivalent to a positive attitude and a score of <3 equivalent to a negative attitude.

Reliability and Validity of study, limitations

Validity and reliability were performed by Ozcan. Obtained ethics committee approval. Consent obtained from volunteer individuals. All results listed as percentages or standard deviations. Information and statistical methods appropriate.

Data Analysis: id statistics, LOM, findings

Analysis completed in SPSS. Descriptive statistics were shown as mean +/- standard deviation for variables that demonstrated normal distribution. One -way ANOVA for distribution of normal groups. P value results < 0.05 were deemed statistically significant.

Results

Mean age of participants was 59.54 +/- 12.04 years. Participants deemed “slightly obese” was 21% and those considered “obese” was 64%. Participants who follow the prescribed dietary lifestyle was 9% and 49% demonstrated partial adherence. The Diabetic Attitude

Scale (DAS) score was not significantly affected by the demographic variables of gender, marital status, BMI, education, occupation, and diet compliance. Statistical significance (P=0.000) was reported between compliance and income levels of the participants. Statitical significance was also noted between the attitude scale and physical exercise with a P value of 0.032.

Discussion/

Significance/

Limitations

Many socioeconomic factors, except for income, were significant to the DAS Score. Physical exercise and DAS score showed statistical significance. No significant difference was discovered between duration of the disease, fasting glucose level, A1C, and the type of treatment implemented. Diet compliance is low, and education is inadequate regarding treatment. Limitations: small sample size, no mention of sampling technique, poor description of data collection process and analyzation.

Helpful/Reliable/Compared to other art

Helpful but cautions warranted. Sampling method, effect size and power analysis are not mentioned. Small sample size. However, statistically significant results, appropriate use of tables and interpretation of results. Clear findings provided. Other literature shows similar results that concluded that education and income levels regarding diabetes, treatment, and importance of compliance are generally low.

Author, year; Credentials, Article #3

Furthauer, J. Flamm, M. and Sonnichsen, A. (2013). All authors have some relation to an Institute of General Practice. Published through Biomed Central.

Article Focus/Title

Patient and Physician Related Factors of Adherence to Evidence Based Guidelines in Diabetes Mellitus Type 2, Cardiovascular Disease and Prevention: A Cross- Sectional Study

Research Design/Intervention- describe intervention

Cross-sectional study no intervention done

Level of Evidence

Level IV

Sample/# of subjects, how recruited.

N=58 general practitioners (GP) were included in the study. Initially 124 were randomly selected, but only 58 responded. They were under the agreement to work 58 straight consecutive days from January to April 2011. All consecutive patients were included from that day as long as the inclusion criteria were met. N=501 patients were included in the study. 526 patients were eligible to participate but only 95.3% gave consent to be included. The patient sample represents a random consecutive selection.

Evaluation Tool (CASP or other tool used)

JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies, Score 7.5/8

Data Collection procedure

A structured case report form (CRF) was completed on each patient to collect demographic data regarding chronic diseases, medication and past medical history. Nine quality indicators were implemented after the CRF to determine the guideline-adherence of treatment for the chronic target diseases. Interviews of the patients and GPs occurred independently of one another, again using the structured CRF.

Type of Instrument, reliability and validity of instruments used

Interview, quality (QI) and structured case report form (CRF)

Reliability and Validity of study, limitations

Informed consent was obtained from both participant party members. The study was compliant with the Declaration of Helsinki and with the Austrian data protection legislation. Ethics approval was obtained from the ethics committee and federal state of Salzburg. Randomization utilized in sampling. Appropriate statistical methods implemented.

Data Analysis - identify statistics, LOM, findings

All data obtained from the CRFs was recorded and transferred to IBM SPSS Statistics v. 19.0 for analysis. Response rate documented in percentages.

Results

46.8% of GP responded to participate in the study. In these 58 GP surgeries, 95.3% of patients gave consent to be included corresponding to a mean of 8.6+/-5.3 standard deviation patients per surgery. 1224 total QIs were analyzed, 174 of which had type II diabetes. The remaining included other chronic disease evaluated in the study. 64.4% of patients are unsure why they are taking a particular drug as treatment for their chronic conditions, 20.0% state they do not need treatment, 3.4% state they do not want treatment, 5.4% report an adverse drug event to the treatment, and 6.8% falsely report discontinuation of treatment. From the GP perspective, nonadherence is related to contraindications, falsely discontinued, noncompliance, adverse drug even, avoidance of polypharmacy and falsely not indicated. 72.2% of all nonadherence to chronic treatment is as a result of the GPs not initiating/thoroughly explaining the therapy. A large knowledge gap between physicians and patients regarding treatment regimens and expectations was determined.

Discussion/Significance/ Limitations

More than half of participants are unaware why they are prescribed particular drugs making physicians responsible for nonadherence to treatment for diabetes and other chronic conditions alike. It was noted that physicians ignore guideline recommendations for treatment most frequent because they falsely assumed a particular prescription or treatment was not necessary or indicated. Education plays an essential role to treatment compliance. Lack of knowledge, communication and, awareness about proper treatment guidelines and expectations of the patient were noted in this study and indicative for implementation of better health education practices. Limitations: reported small sample size, 50% response rate of GPs, single visitation day for each GP and only interviewing patients on that particular day. Possible biases to result from this. Narrow set of only nine quality indicators implemented in the study to judge adherence to treatments.

Helpful/Reliable/Compared to other art

Helpful. Randomization in sample selection, valid and reliable. Results were clear and interpreted appropriated. Proper use of tables throughout the study. Rigorous analysis of data. Adds to evidence base and provided enhancement on need for further education. When compared to other literature, findings are consistent and enhances the evidence.

Author, year; Credentials, Article #4

Andradre-Dias, J. Rodriguez, R. Sales, Z. et al. (2016). All authors are nurses, many of which have obtained a PhD or are a PhD student.

Article Focus/Title

Diabetes Mellitus Clients’ Conceptions About the Treatment

Research Design/Intervention (describe intervention)

Descriptive and exploratory study with a qualitative approach – no intervention

Level of Evidence and model used to grade evidence

Level IV Johns Hopkins

Sample/# of subjects. How recruited?

Registered users in diabetes service, N=11. Obtained through convenience sampling of a project presentation held in a basic health unit.

Evaluation Tool (CASP or other tools used)

CASP Qualitative checklist, Score 7/10

Data Collection procedure

Information was obtained through a semi-structured interview and voice recorder. No mention of who collected the data or how despite brief information of tool used.

Type of Instrument, reliability and validity of instrument

Semi-structured interview. Voice recorder also utilized.

Reliability and Validity of study, limitations

Research approved by Research Ethics Committee, participants informed and aware of these, objectives, rationale, risks and benefits. All participants signed consent form. Standard and synonymous method of data collection. Appropriate literature review provided.

Data Analysis – identify statistics, LOM, findings

Data was obtained from the eleven interviews with a deeper reading occurring later. This information was coded and grouped semantically after collection from the interviews. This allowed for the identification of five categories: correct use of hypoglycemic drugs, adoption of proper diet, physical activities, use of phytotherapy and adoption of preventative attitude.

Results

Participants are aware of DM treatment, but lack substantiative knowledge and lack applicable treatment to their daily routines often leading to nonadherence. It was determined that there is a greater need for health education on the subject in order to overcome knowledge deficiencies related to proper DM treatment. Five categorical themes derived.

Discussion/Significance/ Limitations

Lack of essential knowledge needed for patients to be compliant. Limitations: difficult to generalize as sample is small, no mention of effect size. Poor mention of data collection process and analyzation of results.

Helpful/Reliable/Compared to other art

Helpful, but cautious. This study was a small sample size. Missing information regarding thorough data collection and analysis process of said data. However, thorough and clear representation of discussion section and five categorical themes identified. Interpretation of these results are appropriate. Sahin, G and Rizalar, S. (2018) support the notion that compliance to the five categorical themes are essential to diabetic management and improved quality of life.

Author, year; Credentials, Article #5

Gimenes Faria, H. T., Luchetti Rodrigues, F. F., Zanetti, M. L., et al. (2013). All authors are associated with two different universities in Brazil. It is unknown of further credentialing or roles at said universities.

Article Focus/Title

Factors Associated with Adherence to Treatment of Patients with Diabetes Mellitus

Research Design/Intervention (describe intervention)

Cross-sectional Study

Level of Evidence and model used to grade evidence

Level IV

Sample/# of subjects, how recruited

N=357 out of a population of 1,406 individuals with type 2 diabetes mellitus from 17 primary care institutions in brazil. All participants were greater than 18 years of age, used oral antidiabetic therapies, had cognitive and hearing capacities and were a patient in the institution of study.

Evaluation Tool (CASP or others -identify tool used)

JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies, Score 6/8

Data Collection procedure

Data was collected between February and December 2010 by trained researchers. Data collection was broken into several stages. Structured interviews were obtained in the participant homes and then a second stage was completed within the 17 health institutions.

Type of Instrument, reliability and validity of instruments

Four questionnaires. The first questionnaire evaluated demographic/clinical/and metabolic variables. The second was titled Measurements of Treatment Adherence (MTA) which assessed patient behaviors related to treatment drug use. A food consumption frequency questionnaire and an international physical activity questionnaire.

Reliability and Validity of study, limitations

Study was compliant with national and international standards of ethics. Consent and inclusion criteria were implemented prior to data collection. Standard data collection used as well as appropriate statistical methods.

Data Analysis – identify statistics, LOM, findings

Descriptive statistics were used to analyze data. This form of analysis assisted in the determination of the prevalence of adherence to treatment and the characterization of the first questionnaire implemented. The MTA was analyzed on a 6-point ordinal scale. Scores greater than or equal to 5 were indicative of adherent patients and scores less than 5 resembled nonadherent patients. Patients who were adherent based off of the food consumption questionnaire attended 3/6 nutritional recommendations. To analyze the final questionnaire regarding physical activity, those considered adherent were participants who were classified as moderately to very active. Nonadherent patients were classified as sedentary and inactive. Fisher’s exact test was implemented to analyze adherence with the demographic variables. Crude Odd’s ratio was calculated with a confidence interval of 95%. Statistical analysis was performed with SAS 9.0 statistical software. Values of P <0.05 are considered statistically significant.

Results

Mean age was 62.4 years +/- 11.8; 66.7% of the sample were female. 84.4% of the sample showed adherence to medication therapy, 58.6% to physical exercise and 3.1% to diet. Only 6 patients showed adherence to all three components. No association noted between adherence to treatment and gender, age, education, family income or time since diagnosis. A1C and physical exercise were statistically significant and showed association with adherence as evidenced by a p value of 0.036 and p=0.006 respectively.

Discussion/Significance/ Limitations

Findings showed no association between demographic variable and adherence to treatment. Exercise and A1C show showed statistically significant results in association with aadherence. Support groups and knowledge are important to achieving adherence to diabetic treatment. Limitations: cross-sectional design which prevents cause/effect relationships.

Helpful/Reliable/Compared to other art

Helpful. Appropriate data analysis with statistically significant results. Clear representation of findings. Rigor and validity established. Findings are consistent with other literature results which indicates that demographics are weak predictors of treatment adherence.