Research Design and Sampling Chapter

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pilot study. The participants will be self-selected from among existing patients of a free clinic who meet specific criteria. The participants will be invited to attend a diabetes self-management course that is offered free of charge a local clinic. Once the self-selected individuals arrived at the clinic, there are additional selection criteria. The participants will be selected for having hemoglobin A1Cs greater than 10.0, for having Type 2 diabetes, and all of the participants were already patients at the free clinic. The information gathered will be used for a retrospective chart review to compare hemoglobin A1Cs against those that did not participate in the classes.

The initial hemoglobin A1C was drawn at the patient's visit and instigated the referral of the patient to the program. The hemoglobin A1Cs will be redrawn at the patient's next visit, which is typically every 3 months for uncontrolled diabetes. A group that has its first drawn in August will have its next drawn in November. The group from September will have its second drawn in December and the October group will be redrawn in January. The chart review will begin in January when all groups have been redrawn.

Each class covered a different component of self-management of Type 2 diabetes. The first class focuses on identifying long-term goals and strategies relating to the diabetes management. Each participant will be asked to create a SMART objective (specific, measurable, achievable, results-focused, and time-bound). Materials for this class will focus on how the individual can adopt a strategy to change his/her behaviors, which will be key to managing the diabetes over the long run. The participants are expected, upon conclusion of this class, to understand the process of creating a long-term plan, and to have created a long-term plan along with the SMART objectives of that plan.

The second class focuses on stress reduction and coping. Stress is associated with negative outcomes for Type 2 diabetes patients, which means that the ability to manage one's stress is a key success factor in maintaining the discipline to stick to the strategy to self-manage the diabetes. Coping tools allow people to take a break from stress long enough to get some perspective on life, or their situation. The ability to focus on finding peace, on focusing on the positive, and redirecting stress energy are all elements of the second class.

The third class features an outline of the effects of physical exercise on glucose levels, as well as a lesson on how to monitor glucose levels, and adjust the diet for increased physical activity. This is an integral part of self-management of Type 2 diabetes, and this lesson is intended to spur an increase in physical activity among the patients, and allow them to make the appropriate adjustments to their diet to accommodate for this additional physical activity.

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The monitoring lesson will teach the participants to monitor for hypoglycemia and make the appropriate adjustments to food intake.

The research design will be in the form of a survey. The participants in the study will be asked to fill out four different forms. These will be a an initial assessment form that will contain demographic information, information about exercise, medications and nutritional management. Further information collected on this form will be about coping and stress management, dealing with chronic and acute issues related to diabetes, and behavior change strategies. Another form will outline the participant's SMART objectives.

A third form will focus on the education plan for the participant. The assessor will determine for each patient what his/her level of education is, and this will help with the lesson plan for that individual, to ensure that he/she receives the specific knowledge and information in which he/she is deficient. A fourth form will be a behavior change and goal-setting form. This form is where each participant will self-report on his/her goals, and the progress that he/she is making towards meeting the goals. The strategies for change will be elaborated on this form, along with notes as to whether the change strategy has been successful or not.

Sampling Method

The population for the participants will be those patients who are already in the free clinic. These patients will meet specific criteria regarding their illness, including A1Cs greater than 10.0 and having Type 2 diabetes. The patients will be referred by the clinic into the survey, and will have to volunteer to participant. This means that the patients are not chosen at random. The nature of the clinic's population is that it is not perfectly representative of the general population as a whole. The patients will be referred by a practitioner after having been screened for their fit with this program. The patients participating in the education program for self-management need to be suitable for such a program; this is an ethical requirement. Thus, the medical provider is the arbiter of suitability for the program, and the patient still has to agree to participate, with full informed consent.

Data Collection Procedure/Instruments

The study is to gauge the efficacy of the program for self-management education. Surveys of participants will be used as the primary data collection procedure. The medical provider first fills out the initial assessment, which is used in part to gauge what changes the program participants have made over the course of the program. The participant will then….....

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