NURSING: EVIDENCED-BASED PRACTICE PROJECT

This paper provides a comprehensive literature review to support evidence-based interventions that addresses the following PICOT question as the basis of proposed evidence-based practice project. For Hispanic adults residing in Arizona (P), how does introducing exercise protocol and cultural health nutrition (I) compare with utilization of universal protocols (C) in minimizing pervasiveness of Type 2 Diabetes (O) in 10 months (T).

Type 2 diabetes incidence among Hispanics in Arizona is impacted by several factors that are not common in other groups. Some aspects that must be accounted for when designing interventions include the social-economic status of the identified population, genes, tradition and culture, public attitudes and perceptions, and access to healthcare and other supportive services (Morales et al., 2020). Hispanics are well-grounded in culture; therefore, a culturally-relevant intervention is likely to deliver better outcomes. The universal protocols established to reduce the prevalence of T2D are less-effective among Hispanic youths and adults in Arizona. Comparing the adequacy of physical exercise and cultural health nutrition to the use of universal health protocols is essential to determine the most appropriate intervention for the identified population.

Methods

A lot of research has been conducted to investigate factors that impact T2D prevalence among Hispanics in various regions. Therefore, the existing research is a reliable source of information to answer the formulated clinical question and determine the most appropriate intervention. A theoretical, qualitative review of literature is useful to synthesize and compare evidence from various sources systematically. The main goal is to fill the existing knowledge gaps and create new information to be used as evidence supporting particular interventions. The current study adopts an exploratory approach to generate new information based on the insights obtained from existing research. Some keywords used in the literature search process include Latino culture, type II diabetes, physical exercise, and T2D among Hispanics. Peer-reviewed research articles are identified and retrieved from reliable platforms like the GCU library database and Scholar Google. The inclusion criterion used to identify materials for the current study emphasizes accuracy and currency in that articles published over five years ago are excluded.

Literature Review

According to Smith-Miller et al. (2017), Hispanics face many challenges that affect the management of T2D effectively. The researchers conducted a mixed-methods study to investigate the factors that hinder T2D self-management among Hispanic immigrants. Semi-structured interviews were used to collect data from a sample population of 30 people. Hispanics are equally concerned about T2D like other groups in society. The study unearthed multiple barriers that affect successful T2D management in the identified population. A few of the population's challenges include poor interaction and communication with healthcare providers, cultural stigmatization, economic constraints, the lack of legal documents, and the complexity of the disease. Many Hispanics in Arizona are relatively disadvantaged and can barely afford gym subscriptions. Poor mastery of the English language and the lack of legal documents limits access to reliable healthcare services.

A patient-centered intervention that is based on patient education is essential to promote T2D self-management. According to Brunk et al. (2017), Hispanics are less knowledgeable about foods with low glycemic, the importance of monitoring personal glucose levels, and the importance of physical activities to reduce glucose concentration in the body. A descriptive qualitative study in which participants were organized into focus groups was conducted. The authors also highlight that many of the intervention programs created for T2D management are not culturally-appealing to the identified population. For instance, many Hispanics consider gym enrollment as a luxury that they cannot afford. Therefore, culturally-appropriate interventions are essential to encourage physical exercising and self-management of T2D among Hispanics. Culture is a crucial element that promoted positive healthcare outcomes. In a different study, Joo and Liu (2019) found that “culturally appropriate healthy lifestyle behaviors, emotional support, and family engagement” facilitate effective T2D management in low-income populations. The researchers conducted a qualitative literature synthesis of recent research articles to identify the role of culture healthcare.

A recent study by Williams et al. (2017) indicates that existing diabetes intervention programs are ineffective among Latino youths. The researchers conducted a randomized controlled trial that led them to conclude that a culturally-grounded, community-based intervention is more suitable to reduce T2D prevalence among Latino youths and adults. The conclusion is consistent with the results of a different qualitative study conducted by Fortmann et al. (2019). They discovered that Hispanics have a "66% greater risk of developing T2D" than Non-Hispanic whites in America. The two articles emphasize the development of a culturally-tailored T2D management program for Hispanics to improve health outcomes.

In summary, the reviewed articles provide meaningful insights into the public health problem investigated in the current study. Type II diabetes is a significant healthcare problem for the Hispanic community. The articles seem to complement each other in that their results and findings are consistent. Most importantly, the articles emphasize a cultural-approach to introduce appropriate intervention for the identified population. However, some differences are also noted among the articles. For instance, Smith-Miller et al. (2017) suggest that Hispanics' socioeconomic status is the main factor that impacts their healthy lifestyle behaviors. On the contrary, Williams et al. (2017) and Fortmann et al. (2019) point out that genes have the most significant impact on the development of T2D among Hispanics. However, a standard limitation is that none of the articles provides a reliable solution or a framework for the development of a culturally-appropriate intervention program.

Areas of Further Studies

Evidently, and based on the information presented in the articles, Hispanics' type 2 diabetes prevalence is relatively high. Healthy lifestyle behaviors influenced by culture are the most likely reasons for this high incidence. Existing research also indicates that genes contribute to the development of diabetic conditions. Latino youths exhibit a high rate of insulin resistance and struggle with obesity (Williams et al. 2017). Although this information is available, researchers have barely investigated the methods to reduce or prevent diabetes among Hispanics in America. The health problem is highly prevalent in the U.S., mostly within Arizona, yet it does not disproportionately impact Hispanics in other regions. Therefore, future studies should focus on identifying geographical factors that influence T2D prevalence among Hispanics.

References

Brunk, D. R., Taylor, A. G., Clark, M. L., Williams, I. C., & Cox, D. J. (2017). A culturally appropriate self-management program for Hispanic adults with type 2 diabetes and low health literacy skills. Journal of Transcultural Nursing, 28(2), 187-194. doi:10.1177/1043659615613418

Centers for Disease Control and Prevention CDC, (2019). Retrieved from https://www.cdc.gov/diabetes/basics/type2.html

Fortmann, A. L., Savin, K. L., Clark, T. L., Philis-Tsimikas, A., & Gallo, L. C. (2019). Innovative diabetes interventions in the U.S. Hispanic population. Diabetes Spectrum, 32(4), 295-301. doi:10.2337/ds19-0006