Date of Award

5-30-2023

Document Type

DNP Project

College

School of Nursing

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Carol Rossman

Second Advisor

Don Tynes

Abstract

Background and Problem

Type two diabetes mellitus (T2DM) is a chronic medical condition of impaired glucose metabolism that has significantly impacted the health of Americans. According to Centers for Disease Control and Prevention (CDC), T2DM is the seventh leading cause of death making up over 270,000 deaths in 2017 (CDC, 2020a). There are noted disparities among African Americans who are disproportionately affected by T2DM more than Caucasians. African Americans account for 13% of the population in the United States of which 11.7% are diagnosed with T2DM as compared to Caucasians who make up 76.3% of the population of which 7.5% have T2DM (United States Census Bureau, 2021; Haw et al., 2021). Minorities such as African Americans are least likely to achieve glycemic control and are greater than 50% more likely to suffer from the complications of T2DM than their Caucasian counterpart (Canedo et al., 2018; Cunningham et al., 2018). It is projected that without strategic interventions T2DM diabetes will affect one out of six Americans and one out of four African Americans by 2060 (Lin et al. 2020). Traditional diabetes education programs have not been effective in lowering hemoglobin A1C levels in African Americans (Lynch et al., 2019; Cunningham et al., 2018). Barriers include poor food choices, poor self-efficacy in making dietary changes, culture, and the social rewards attached to food. It is the burden of healthcare providers to develop creative ways to confront these barriers to improve dietary practices and build selfefficacy for better glycemic control.

Purpose Statement

The purpose of this project was to improve dietary self-management efficacy and blood glucose levels through the implementation of group-based lunch-and-learn educational sessions that emphasize a low-saturated fat diabetes diet consisting of whole grains, legumes, fruits, and vegetables.

Method

A convenience sample of African Americans with T2DM visiting the Benton Harbor Health Center participated in a quantitative, quasi-experimental pilot study that utilized a weekly 45-minute lunch-and-learn educational session emphasizing a low-fat, low carbohydrate diet for six weeks. Pre- and post-intervention self-efficacy and hemoglobin A1c values were measured.

Results

A paired t-test was used to evaluate whether the pre-intervention mean self efficacy for healthy diet scores and HbA1c levels improved post-intervention. The results demonstrated a statistically significant improvement in self-efficacy scores (p =.002). However, the HbA1c levels showed no improvement, but an increase post-intervention (p= 0.306).

Significance

With the increasing prevalence of T2DM and the disease burden from its complications in African Americans, practitioners must use a different approach to traditional diabetes self-management education and support (DSMES) that place emphasis on increasing dietary self-efficacy which is a predictor of behavioral change. The data from this project supports the lunch-and-learn format is an experiential method that helps the T2D to translate diabetes knowledge into real-life application through improved self-efficacy which can ultimately improve glycemic control. Achieving glycemic control leads to improved morbidity and mortality rates, lower healthcare costs and improved quality of life.

Subject Area

Diabetes; Type 2 diabetes; African Americans--Health and hygiene

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