Evidence Synthesis Essay

Evidence synthesis is a way of putting relevant information on a particular research question or problem together with the aim of knowledge gaps identification, select evidence based information to inform, or essential decisions in the field. Evidence synthesis in research helps to identify the connection between two or more sources, thus deriving a conclusion of the required evidence. Evidence synthesis is usually unbiased to assist decision-making or address a particular practice problem. The purpose of this paper is to present evidence synthesis of the diabetes practice problem based on three quantitative articles and three non-research evidence sources.

Introduction to the Practice Problem

The selected national practice problem is diabetes. Diabetes is a health condition that affects glucose regulation in the body. Diabetes is characterized by inadequate insulin production or problems with insulin use, thus increasing blood glucose levels. The three diabetes types include; type ,1 type 2, and gestational diabetes. Type 1 diabetes is characterized by inadequate/lack of insulin production. In type 2 diabetes, the body resists insulin or does not produce adequate insulin. Gestational diabetes is common in pregnancy, but mainly disappears after giving birth. However, gestational diabetes is a increases the risk of type 2 diabetes diagnosis in the woman’s life (CDC.gov, n.d.) Diabetes is a significant health concern and practice problem since it adversely affects the patient’s life quality, increases the risk of other health conditions such as cardiovascular diseases, and contributes to lifestyle changes. Additionally, diabetes increases healthcare costs and exerts pressure on the entire healthcare system.

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Introduction of the Evidence-Based Intervention

The evidence-based intervention selected for this project is Diabetes Self-Management Education (DSME). DSME is a tool that is used to teach diabetes patient and empower them to make self-management decisions and effectively carry out self-management activities. It improves health behaviors and outcomes for people living with diabetes. According to Hermanns et al. (2020), DSME is mainly delivered in 6-week programs whereby the patients are taught the different diabetes self-management activities and best practices. DSME has been found to improve diabetes patients’ health outcomes by positively impacting their self-care behavior and empowering them by increasing their knowledge and self-efficacy regarding diabetes (Hailu, Moen, Hjortdahl, 2019).

Analysis of the Practice Problem

Diabetes as a practice problem is one of the significant health concerns globally. Despite being preventable and controllable, it can potentially overwhelm healthcare systems and negatively affect economies and individual lives. Approximately 422 million people have diabetes globally, with a higher burden in low and middle-income nations (WHO, n.d.). More so, there is an alarming rise in newly diagnosed diabetes cases, and many more remain undiagnosed. The weight of the burden of the practice problem is mainly increased by ineffective prevention strategies, late-stage diagnosis, low screening rates, underequipped care facilities, and diabetes specialists’ scarcity (George, Stetz & Patel, 2019). Additionally, diabetes increases an individual/family’s economic burden, following increased healthcare costs, decreased productivity, and high insurance costs.

Significance, Prevalence, Mortality, and Economic Ramifications of the Practice Problem

Diabetes significance is profound and felt globally. Diabetes increases the risk of early death, and diabetes complications negatively impact the patient’s life quality. Diabetes is also related to various health issues, including amputations, heart disease, loss of sight, kidney failure, and stroke. Additionally, CDC.gov (n.d.) states that current research shows that diabetes has been found to positively affect hearing loss, dementia, and different forms of cancer, especially in older populations.

The global diabetes prevalence stands at 8.8% of the total population, with approximately 77% living in developing countries. The prevalence is anticipated to increase to 9.9% by 2045 (Standl et al., 2019). On the age distribution, people aged 40-59 are the ones who are most affected by the condition. In the US, diabetes prevalence lies at 11.3% (approximately 37.3 million) of the total population, with about 8.5 million undiagnosed people (National Diabetes Statistics Report). Furthermore, diabetes 1 in 9 deaths globally is associated with diabetes and diabetes complications. Diabetes is ranked as the seventh leading cause of mortality in the US, and is attributed to 102 188 deaths (CDC.gov, n.d.).

According to Standl et al. (2019), diabetes significantly impacts the economy and the economic productivity of affected individuals. More so, it has an enormous impact on the healthcare systems due to increased care costs used in treating and managing diabetes and its complications. Additionally, Standl et al. (2019) state that individuals with diabetes spend close to four times more than individuals without diabetes due to medication costs, lifestyle adjustments, follow-ups, and hospitalizations. Diabetes also impacts the productivity of an individual by reducing their efficiency at work, increasing absenteeism, and, therefore, low outputs. It also impacts local and national economies by the reduction of the gross domestic product (Standl et al., 2019)

Evidence Synthesis

I searched reputable data sources to locate three quantitative articles that can be used to address the diabetes practice problem. The Google search engine and google scholar database were used. The articles are peer-reviewed, published in recognized journals, and published within the last five years, thus appropriate for addressing the practice problem. The three articles are; Effects of an Outpatient Diabetes Self-Management Education on Patients with Type 2 Diabetes in China by Zheng et al. (2019), “Factors influencing Healthcare Providers’ attitude and willingness to use information technology in diabetes management” by Seboka, Yilma & Birhanu (2021), and Diabetes and the risk of hospitalization for infection: The Atherosclerosis Risk in Communities (ARIC) study by Fang et al. (2021).

The sources contribute to the addressing of the diabetes national practice problem. The main aim that is salient in the three sources is to make recommendations that can be used in improving life quality for diabetes patients considering they all cover the essential aspects of diabetes. The main themes emerging from the synthesis of the three research evidence sources include diabetes self-management education, healthcare technology, and hospitalization risk for diabetes patients (Fang et al., 2021; Seboka et al., 2021; Zheng et al., 2021).

The salient points in the evidence synthesis include that diabetes complications are the primary cause of hospitalization for diabetes patients. However, diabetes complications can be prevented and reduced by empowerment through diabetes self-management education, which can be implemented through healthcare technology. The other point is that healthcare technology-assisted DSME is effective in improving diabetes self-management behavior, which in turn reduces the risk of complications and related hospitalization, thus improve the overall life quality for the patients (Jain et al., 2020).

Comparison and Overarching Objective of the Main Points from the Research Evidence Synthesis

The three research evidence sources aim at addressing the practice problem by improving patient outcomes. As mentioned earlier, diabetes self-management education, healthcare technology, and complication-related hospitalizations significantly influence patient outcomes in diabetes patients. Additionally, healthcare technology has contributed to the easy facilitation of DSME and self-management behavior, thus helping prevent complications that increase the risk of hospitalization, other related comorbidities, and mortality.

However, the main points from the research evidence have differences. First and foremost, Seboka et al. (2021) note that the perception of the care providers majorly influences the use of healthcare technology in facilitating diabetes management and diabetes self-management. On the other hand, Fang et al. (2021) only focuses on diabetes as a risk for hospitalization but fail to include parameters of exclusion of diabetes and non-diabetes-related infections that can lead to hospitalization. In addition, Zheng et al. (2021) emphasized the effectiveness of DSME in promoting diabetes self-management behaviors and practices in T2DM patients only.

The overarching objective in the three research evidence sources, as evident in the synthesis, is that DSME, facilitated by technology, can help promote self-management behavior, thus reducing complications leading to hospitalizations, hence improving patient outcomes and quality of life.

Conclusion

Diabetes is a national practice problem whose significance is felt at local, national, and global levels. Research evidence can be used to inform diabetes self-management, thus addressee the practice problem. The evidence synthesis presented above can be summarized in one statement; diabetes self-management education enhanced by healthcare technology can be used to improve diabetes self-management, preventing diabetes complications and related hospitalizations and promote desirable health outcomes, and promote better quality of life quality for diabetes patients.

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References

Centers for Disease Control and Prevention (CDC.gov). (n.d.) What is Diabetes? https://www.cdc.gov/diabetes/basics/diabetes.html

Fang, M., Ishigami, J., Echouffo-Tcheugui, J. B., Lutsey, P. L., Pankow, J. S., & Selvin, E. (2021). Diabetes and the risk of hospitalization for infection: the Atherosclerosis Risk in Communities (ARIC) study. Diabetologia, 64(11), 2458-2465. https://doi.org/10.1037/hea0000710

George, S., Stetz, L. & Patel, M. (2019) Diabetes: The Worlds Weightiest Problem. [White Paper] Aetna. https://www.aetnainternational.com/en/about-us/explore/future-health/diabetes-world-weightiest-problem.html

Hailu, F. B., Moen, A., & Hjortdahl, P. (2019). Diabetes self-management education (DSME)–Effect on knowledge, self-care behavior, and self-efficacy among type 2 diabetes patients in Ethiopia: A controlled clinical trial. Diabetes, Metabolic Syndrome, and Obesity: Targets And Therapy, 2489-2499. https://doi.org/10.2147/DMSO.S223123

Hermanns, N., Ehrmann, D., Finke‐Groene, K., & Kulzer, B. (2020). Trends in diabetes self‐management education: where are we coming from and where are we going? A narrative review. Diabetic Medicine, 37(3), 436-447. https://doi.org/10.1111/dme.14256

Jain, S. R., Sui, Y., Ng, C. H., Chen, Z. X., Goh, L. H., & Shorey, S. (2020). Patients’ and healthcare professionals’ perspectives towards technology-assisted diabetes self-management education. A qualitative systematic review. PloS One, 15(8), e0237647. https://doi.org/10.1371/journal.pone.0237647

National Diabetes Statistics Report website. https://www.cdc.gov/diabetes/data/statistics-report/index.html

Seboka, B. T., Yilma, T. M., & Birhanu, A. Y. (2021). Factors influencing healthcare providers’ attitude and willingness to use information technology in diabetes management. BMC Medical Informatics And Decision Making, 21(1), 1-10. https://doi.org/10.1186/s12911-021-01398-w

Standl, E., Khunti, K., Hansen, T. B., & Schnell, O. (2019). The global epidemics of diabetes in the 21st century: Current situation and perspectives. European Journal of Preventive Cardiology, 26(2_suppl), 7-14. https://doi.org/10.1177/2047487319881021

World Health Organization. (n.d.). Diabetes. https://www.who.int/health-topics/diabetes#tab=tab_1

Zheng, F., Liu, S., Liu, Y., & Deng, L. (2019). Effects of an outpatient diabetes self-management education on patients with type 2 diabetes in China: a randomized controlled trial. Journal of Diabetes Research, 2019. https://doi.org/10.1155/2019/1073131

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Appendix A: Johns Hopkins Nursing Evidence-Based Practice Individual Evidence Summary Tool

Practice Question: Does diabetes self-management education help reduce the risk of infection, complication and hospitalization, and improve the quality of life and health outcomes for diabetes patients?

Date: 27^th January 2023

Article Number	Author and Date	Evidence Type	Sample, Sample Size, Setting	Findings That Help Answer the EBP Question	Observable Measures	Limitations	Evidence Level, Quality
64 (11)	Fang, M., Ishigami, J., Echouffo-Tcheugui, J. B., Lutsey, P. L., Pankow, J. S., & Selvin, E. 2021	Experimental research	12379 participants of the Atherosclerosis Risk in Communities (ARIC) study were used in the study	The findings of this study are that diabetes is associated with a higher risk for infection and hospitalization. These infections may result from diabetes complications or other related comorbidities.	The article’s main aim was to determine the association between diabetes and the risk of infections leading to hospitalization. It was observed that people with diabetes are more likely to be hospitalized due to infections than people without diabetes.	The definition of hospitalization for infection was not validated The association between glycemic control and infections complication was not measured There was a physician’s bias toward referring diabetes patients to the hospital due to infections	Fang et al. (2021) was appraised at Level 3 evidence with grade A quality. The study has generalizable results and the sample size is sufficient for the study design.
21(1)	Seboka, B. T., Yilma, T. M., & Birhanu, A. Y. 2021	Cross-sectional study	The sample contains 406 participants, with 283 nurses and 123 physicians in two teaching and referral hospitals where remote monitoring of patients had not been implemented.	The findings that can address the practice problem are: care providers are willing and ready to use healthcare information technology to facilitate diabetes management.	Among the observable measures in this study is the use of structured questionnaires to collect data and descriptive statistics in analysis. Tables and figures are also used to display the results for the attitude and willingness of care providers to use information technology in diabetes management.	The study had two major limitations; one, only a quantitative approach was used. Thus, the findings may lack enough strength. Second, the study was conducted; thus, the generalizability of findings may be difficult.	Seboka et al. (2021) was appraised at level 3 evidence and Grade A quality. The results are reasonable and consistent. The study is based on a comprehensive literature review.
11(1)	Whittemore, R., Vilar-Compte, M., De La Cerda, S., Marron, D., Conover, R., Delvy, R., Lozano, A. M. & Pérez-Escamilla, R. 2019	Qualitative Descriptive study	The sample included 20 adults with type 2 diabetes and 19 care providers from Mexico and different clinics around. ❑	The findings contributing to addressing the evidence-based practice question include that personal challenges mentioned by the patients include inadequate social support, difficulties in lifestyle modification, and mental health issues. The system challenges identified by care providers include patient engagement barriers, perceived care quality and inadequate resources.	The study’s aim was to identify the challenges in diabetes self-management as perceived by type 2 diabetes patients and care providers. Tables and figures are used to display the different challenges in diabetes self-management as perceived by patients and care providers.	One of the major limitations of this study is that the study setting was confined to one geographical setting. Although Mexico is a mirror for other low-income settings, the findings may not represent all vulnerable populations.	Whittemore et al. (2019) was appraised at level 3 evidence. It presents a qualitative study with grade-A quality evidence. It has generalizable results and a consistent conclusion. however, the sample size and characteristics are not representative of vulnerable populations.
1073131	Zheng, F., Liu, S., Liu, Y., & Deng, L. 2019	Randomized Controlled Trial (RCT)	Sixty patients with type 2 diabetes. 30 were allocated to a control group, and 30 to an intervention group	The findings of this study are that diabetes self-management education effectively improves the level of self-reported self-management, psychological distress, and glycemic control in patients with type 2 diabetes.	To determine the effects of an outpatient diabetes self-management education program, two regular and health education programs were provided. The observable measures were the diabetes self-care activities measured and recorded before and after the intervention.	Despite mentioning the effects of diabetes self-management interventions, the article does not include the effectiveness of these effects in improving patient outcomes. The use of only two education sessions may have provided limited evidence.	Zheng et al. (2019) appraised at Level 1 evidence with grade A quality. The study was unbiased, and the risk of systematic errors was minimal. The sample size is sufficient for the study design.

Attach a reference list with full citations of articles reviewed for this Practice question.

Reference List

Whittemore, R., Vilar-Compte, M., De La Cerda, S., Marron, D., Conover, R., Delvy, R., Lozano, A. M. & Pérez-Escamilla, R. (2019). Challenges to diabetes self-management for adults with type 2 diabetes in low-resource settings in Mexico City: a qualitative descriptive study. International Journal For Equity In Health, 18(1), 1-10. https://doi.org/10.1186/s12939-019-1035-x

Assignment
Purpose
The purpose of this assignment is to develop a synthesis of evidence using three quantitative research articles and three non-research evidence sources. The development of the Johns Hopkins Individual Evidence Summary Tool builds a body of research evidence about a practice problem and evidence-based intervention for implementation in a practice change project. Continually adding research studies to the Johns Hopkins Individual Evidence Summary Tool builds the foundation for the synthesis of research evidence for a practice change.

Please note that this is the first part of a 2-part assignment. You will receive feedback from your course faculty on this assignment and will be required to use the feedback to revise this paper. In Week 6, you will add to this paper and submit as the Week 6 Assignment.

Instructions
Follow these guidelines when completing the assignment. Contact your course faculty if you have any questions.

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Review the directions for completing each column of the Johns Hopkins Individual Evidence Summary Tool (located in the Week 2 lesson).
Use the two quantitative research studies from NR715 that are already on your expanding Johns Hopkins Individual Summary Tool. Add the quantitative research study appraised in Week 1 of this course to your Johns Hopkins Individual Evidence Summary Tool.
All articles must be recent research articles less than 5 years old, be related to your selected National Practice Problem, and include an evidence-based intervention.
If any of your quantitative research studies do not meet these requirements, you need to find replacement quantitative research studies and update the Johns Hopkins Evidence Summary Tool after you appraise, level the evidence, and grade the quality of the replacement study.
Locate three non-research evidence sources to support the articulation of the practice problem.
Use a synthesis style of writing in every section (1, 2, 3, & 4) of the paper when incorporating research evidence and non-research evidence.
Use the most current version of Microsoft Word that is the format for all Chamberlain University College of Nursing. You can tell the document is saved as the current version because it will end in “docx.”
All Chamberlain University policies related to plagiarism must be observed.
Review the rubric for the grading criteria.
The assignment includes the following components:

Introduction
Use a synthesis of research evidence and non-research evidence when writing this section of the paper.
Write a one-sentence purpose statement.
Introduce the practice problem.
Introduce the evidence-based intervention using research evidence.
Analysis of the Practice Problem (1-2 paragraphs)
Use a synthesis of research evidence and non-research evidence when writing this section of the paper.
Present the following at the national and local levels:
Significance
Prevalence
Mortality
Economic ramifications of the practice problem
Evidence Synthesis (minimum of 3 quantitative research articles)
Use a synthesis of research evidence when writing this section of the paper.
Identify the main themes and salient points that emerge from a synthesis of research evidence.
Compare and contrast the main points from a synthesis of research evidence.
Present an objective overarching synthesis of the research intervention.
Conclusion
Use a synthesis of research evidence and non-research evidence when writing this section of the paper.
Write one concise paragraph providing a clear and logical summation of the paper.
References
Include a list of all references in APA format.
Appendix A: Attach the completed Johns Hopkins Individual Evidence Summary Tool as Appendix A. Complete all sections of the Johns Hopkins Individual Evidence Summary Tool for each research study. Include the following:
Include a minimum of three quantitative research studies.
Complete all sections completely and identify the quality and the levels of evidence.
Writing Requirements (APA format)
Length: 4-6 pages (not including title page, reference page, or appendix)
1-inch margins
Double-spacedâ€¯pages
12-point Times New Roman or 11-point Arial font
Headings & subheadings
In-text citations
Title page
Reference page
Standard English usage and mechanics
Course Outcomes
This assignment enables the student to meet the following course outcomes:

Analyze research and non-research data for the purposes of critical appraisal and judgment of evidence for translation into practice. (POs 1, 3, 5, 7, 9)
Synthesize research study evidence and non-research evidence relevant to practice problems and a practice question. (POs 1, 3, 5, 9)

Due Date
By 11:59 p.m. MT on Sunday
Late Assignment Policy applies
Rubric

Week 4 Assignment Grading Rubric

CriteriaRatingsPtsThis criterion is linked to a Learning Outcome

Introduction

Requirements:

1. Use a synthesis of research evidence and non-research evidence when writing this section of the paper.

2. Write a one-sentence purpose statement.

3. Introduce the practice problem.

4. Introduce the evidence-based intervention using research evidence.

20 pts

Includes all requirements and provides an excellent introduction

18 pts

Includes all requirements and provides a sufficient introduction

16 pts

Includes fewer than all requirements and/or provides a partial introduction

0 pts

Includes fewer than all requirements and/or provides an undeveloped introduction

20 pts

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This criterion is linked to a Learning Outcome

Analysis of the Practice Problem

Requirements:

1. Use a synthesis of research evidence and non-research evidence when writing this section of the paper.

2. Present the following at the national and local levels:

a. Significance

b. Prevalence

c. Mortality

d. Economic ramifications of the practice problem

30 pts

Includes all requirements and an provides an in-depth analysis of the practice problem

27 pts

Includes all requirements and provides a sufficient analysis of the practice problem

24 pts

Includes fewer than all requirements and/or provides a partial analysis of the practice problem

0 pts

Includes fewer than all requirements and/or provides an undeveloped analysis of the practice problem

30 pts

This criterion is linked to a Learning Outcome

Evidence Synthesis

Requirements:

1. Use a synthesis of research evidence when writing this section of the paper.

2. Identify the main themes and salient points that emerge from a synthesis of research evidence.

3. Compare and contrast the main points from a synthesis of research evidence.

4. Present an objective overarching synthesis of research evidence about the intervention.

60 pts

Includes all requirements and provides an in-depth evidence synthesis

54 pts

Includes all requirements and provides a sufficient evidence synthesis

48 pts

Includes fewer than all requirements and/or provides a partial evidence synthesis

0 pts

Includes fewer than all requirements and/or provides an undeveloped evidence synthesis

60 pts

This criterion is linked to a Learning Outcome

Conclusion

Requirements:

1. Use a synthesis of research evidence and non-research evidence when writing this section of the paper.

2. Write one concise paragraph providing a clear and logical summation of the paper.

10 pts

Includes all requirements and provides an in-depth conclusion.

9 pts

Includes all requirements and provides a sufficient conclusion

8 pts

Includes fewer than all requirements and/or provides a partial conclusion

0 pts

Provides an undeveloped conclusion

10 pts

This criterion is linked to a Learning Outcome

APA Style and Standards

Requirements:

1. Use appropriate Level I headers.

2. References and in-text citations are in current APA style.

3. Paper length is 4-6 pages excluding title, reference pages, and appendix.

20 pts

Includes all requirements and presents excellent APA style and standards

18 pts

Includes all requirements and provides a very good APA style and standards

16 pts

Includes fewer than all requirements and/or provides a basic APA style and standards

0 pts

Includes fewer than all requirements of APA style and standards and/or provides poor style and standards

20 pts

This criterion is linked to a Learning Outcome

Clarity of Writing

Requirements:

1. Standard English usage and mechanics

2. No spelling or typographical errors

3. Organized presentation of ideas

20 pts

Includes all requirements and demonstrates excellent clarity of writing

18 pts

Includes all requirements and demonstrates very good clarity of writing

16 pts

Includes fewer than all requirements and/or demonstrates basic clarity of writing

0 pts

Includes fewer than all requirements and/or demonstrates poor clarity of writing

20 pts

This criterion is linked to a Learning Outcome

Appendix A

Requirements:

1. Include three quantitative research studies.

2. Complete all sections completely and identify the quality and the levels of evidence.

3. Attach the completed Johns Hopkins Individual Evidence Summary Tool as Appendix A.

40 pts

Includes all requirements and provides an in-depth summary table

36 pts

Includes all requirements and provides a sufficient summary table

32 pts

Includes fewer than all requirements and/or provides a partial summary table

0 pts

Includes fewer than all requirements and/or an undeveloped completed summary table

40 pts

Total Points: 200

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Evidence Synthesis Essay