To what extent have government strategies been effective in tackling type two diabetes among adults in England from 2014 to present
Research question
The research questions that the proposed study seeks to address are:
- What are the primary identifiable factors across the most efficacious strategies that constitute a successful intervention that addresses type 2 diabetes?
- What are the trends in type 2 diabetes and its health implications for the adult population in England?
- To what extent has the government intervention strategies impacted the prevalence of type 2 diabetes in England for the past six years?.
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Introduction
Type 2 diabetes is an issue affecting individuals across the world from all walks of life and all ages. This research proposal aims to contribute to the understanding of the effectiveness of the government intervention strategies in addressing type 2 diabetes, T2D, that mainly affects adults in England. The proposal addresses the general background of T2D prevalence in England and the UK and analyses the rationale for the choice of this area of research. The target group demographics, the epidemiological information, and the statistics pertaining to the T2D situation in England. Also, it will provide evidence of England’s local strategies and policies aimed at attacking type 2 diabetes. The description and justification of the research methodology, measures involved in the intervention development, and ethical considerations are highlighted within this proposal. Furthermore, the expected outcomes, the research outline, and the timeframe will be presented in this proposal. These particular aspects are vital in the completion of the dissertation aimed at exploring the efficacy of government strategies in tackling T2D in England Gundu, 2018).
Background and rationale for the study
Zhong, Juhaeri, and Mayer-Davis (2018) report that the prevalence of diabetes in England is significantly rising. A total of 2.7 million adult people was diagnosed with diabetes in 2013, which was an increase of 137,000 individuals since 2012. According to Strain et al. (2018), almost 25% of the adult population with T2D diabetes are unaware of their condition, and thus the number of cases diagnosed understates the actual prevalence of this epidemic. Taking into account the number of undiagnosed individuals, England has about 3.2 million adult people with T2D (Edward and Ousey, 2015). The prevalence of this epidemic is high in regions that are socio-economically deprived. There is a strong relationship between obesity and T2D, and therefore the increasing prevalence of obesity in England and the entire UK continues to accelerate the prevalence of diabetes Gundu, 2018). The total number of adult populations with diabetes is expected to increase to 4.6 million people by 2030. Compared to Scotland, Wales, and Nothern Ireland, England has the highest type 2 diabetes prevalence rate of 5.4%, and overall, T2D is estimated at 90% of the diabetes cases in the UK. Out of 17 adults in the UK, one person has diabetes mellitus, whether screened and diagnosed with this condition or not (Gundu, 2018).
England is currently adopting the National Health science Diabetes Prevention Programme, NHS-DPP, as an evidence-based behavioral intervention to adults at the high risk of T2D to delay or prevent the onset of T2D (Penn et al., 2018). The effectiveness of lifestyle interventions in preventing the onset of this condition was first examined in the randomized clinical trials in the USA and Finland with a significant level of risk reduction. The NHS reduces the risk via maintaining or achieving a healthy weight, a healthy balanced diet, and recommended levels of activity. Prior to the implementation of NHS-DPP, the government has implemented the National Diabetes Prevention Programme and National Prevention Research Initiatives. According to Chatterjee, Khunti, and Davies, (2017), this particular strategy offers personalized support in helping people to minimize the risk of T2D by eating healthy, getting active, and losing weight. Besides, research is being conducted to establish ways that keep the risk for T2D as low as possible for every person through identifying methods that can be used to provide more help to the adult population.
The cases of physical inactivity and obesity are in a continuous rise across the United Kingdom, mainly affecting elderly who are overweight. The increase in diagnoses of T2D, as well as the related co-morbidities, puts a burden on the country. According to Xiao and O’neill (2017), it is estimated that NHS in the UK spends about 10 billion pounds annually on diabetes, and a significant percentage of these are as a result of the preventable complication emerging from diabetes. Despite the implementation of largescale programs aimed at the prevention of diabetes, translating these interventions that are often costly into routine practice is still a challenge (Zhong, Juhaeri, and Mayer-Davis, 2018). A series of systematic reviews have been performed in these intervention programs, yet scarce information has been availed concerning the degree of their effectiveness in England. However, for the effective implementation of national diabetes prevention services in England, there is a need for a wider review of the ongoing as well as the previous prevention programs in order to establish their effectiveness as well as the variations between these government strategies. In addition, it is vital to identify specific elements of lifestyle interventions that affect the effectiveness to enable the implementation of the most cost-effective and efficient diabetes strategies to tackle the prevalence of type 2 diabetes.
Aims and objectives
Research aim
- To investigate how effective the government strategies have been on tackling type 2 diabetes from year to year
Research objectives
- To investigate the prevalence of type 2 diabetes in England
- To investigate the factors associated with type 2 diabetes
- To investigate the health implications of type 2 diabetes
Methodology
As has been demonstrated in the previous sections, type 2 diabetes is a growing issue on the local, national, and global scale but seems to disproportionately impact the adult populations. The overall rate of T2D is higher in the UK, and this rate is ever-increasing in England due to the increase in obesity. This section focuses on the research design and the rationale for its choice. It explores the methodology as well as an extensive analysis of the strengths as well as the possible threats to its validity.
This research will be designed with the aim of understanding what was significant to the government strategies to enable individuals who are diagnosed with T2D to successfully self-manage their health condition through the adoption of the most effective interventions. In this regard, the methodological approach taken should be appropriate to answering the research questions identifies within the constraints of this study, including the financial costs and available time. The qualitative research strategy for health research services tackles the “why,” “what,” and “how” questions and not necessarily the “how many” type of questions that are exhibited within the quantitative approaches to research (Leung, 2015.). Identifying and exploring the efficacy as well as the barriers exhibited in the implementation of different T2D management strategies falls better within the initial three categories compared to the questions that are appropriately answered through the quantitative methods. This research will, therefore, employ the qualitative methodology, and the data will be obtained using semi-structured interviews to offer insights into the way participants comprehend and interpret the intervention strategies. Also, they will aid in establishing the bottlenecks that are not part of the medically oriented parameters. The use of the interview method will enable the examination of how respondents select T2D management interventions, how these strategies correlate with their daily routines, the outcome of inefficient strategies, and why particular strategies are not efficient.
This study takes an exploratory nature, and therefore qualitative methods will suit this approach to researching the primary research question and establish the inefficiencies in the intervention strategies rather than selecting data from a broad survey that is not tailored towards tackling a particular research question. This particular research strategy correlates with the criteria laid down by Green and Thorogood, and therefore the quantitative approach will fail to address the “why” and “what” nature of questions, which are key in addressing the primary research questions.
Strengths of the qualitative approach
The qualitative approach enables the collection of more elaborate data regarding the utilization of T2D intervention strategies by the government of England. Also, it will enable an in-depth understanding of how individuals comprehend their social context, which is crucial in answering the primary research question for this research, which is the identification of the core factors that identified with the effective strategies for management of T2D in England. Conducting this exploratory study quantitatively would subject it to issues related to multiple significance testing, such as testing for multiple variables and thus opening room for false positives. According to Chapman, Hadfield, and Chapman (2015), the use of the quantitative method demands prior insight to design the survey. Despite the successful application of the survey for other researches, the use of this method is likely to result in missing out on crucial barriers. Therefore, quantitative research would best be suited for performing a follow-up survey study as an approach for testing the findings of qualitative research and be generalizable because of the larger sample used. The data collected using this method is rich in nature and thus permitting exploration of multiple ranges and more complex ideals relating to the implementation of the T2D intervention strategies.
Literature search strategy
The search strategy for this research will utilize a more inclusive approach. A free text approach will be employed because the subject matter is relatively broad, and therefore specific subject headings may not capture the topic under review more comprehensively. The search was limited only to research that contained diabetes in their abstracts and titles to limit the search due to the tendency of free note approach to generate massive hits and capturing articles that have free text words despite them not being related to the topic. This section will entail an electronic search of the published literature in renowned databases for relevant articles. It will utilize the following databases, including MEDLINE, CINAHL, EMBASE, SCOPUS, Global Health, and EBMALL. Both ProQuest and Theses Global will be used to identify the published dissertation.
Inclusion criteria
The participants will be aged above 18 years-old with type 2 diabetes. They should be citizens and residents of England. Studies published in English between 2014 2020 will be selected. The papers must strictly be focusing on type 2 diabetes issues within England.
Exclusion criteria
Studies with participants that exhibit gestational diabetes, who gets pregnant with type 2 diabetes, develop diabetes secondary to medication, and unable to speak English will be excluded. Studies where participants have mental disabilities and are unable to read will be excluded. Research articles will be excluded if they are single studies instead of reviews, reviews of factors that impact only type 1 diabetes, and reviews of strategies aimed at improving the self-management. Research papers outside England and published in other languages other than English will be excluded.
Ethical considerations
Project Outline
Research Timetable
Bibliography
Zhong, V.W., Juhaeri, J., and Mayer-Davis, E.J., 2018. Trends in hospital admission for diabetic ketoacidosis in adults with type 1 and type 2 diabetes in England, 1998–2013: a retrospective cohort study. Diabetes Care, 41(9), pp.1870-1877.
Strain, W.D., Hope, S.V., Green, A., Kar, P., Valabhji, J. and Sinclair, A.J., 2018. Type 2 diabetes mellitus in older people: a brief statement of key principles of modern day management, including the assessment of frailty. A national collaborative stakeholder initiative. Diabetic Medicine, 35(7), pp.838-845.
Edward, K.L., and Ousey, K., 2015. Exploring resilience for people with type 2 diabetes who have a wound. Wounds UK,11(2), pp.28-31.
Gundu, H.R.R., 2018. Excess weight, obesity, diabetes (type-2), and clinical complications. Arch. Diabetes Obes., 1, pp.1-2.
Penn, L., Rodrigues, A., Haste, A., Marques, M.M., Budig, K., Sainsbury, K., Bell, R., Araújo-Soares, V., White, M., Summerbell, C. and Goyder, E., 2018. NHS Diabetes Prevention Programme in England: formative evaluation of theprogramme in early phase implementation. BMJ open, 8(2), p.e019467.
Chatterjee, S., Khunti, K. and Davies, M.J., 2017. Type 2 diabetes. The Lancet, 389(10085), pp.2239-2251.
Xiao, M. and O’neill, C., 2017. Detection and management of diabetes in England: results from the Health Survey for England.Diabetes Therapy, 8(5), pp.1163-1174.
Chapman, A.L., Hadfield, M. and Chapman, C.J., 2015. Qualitative research in healthcare: an introduction to grounded theory using thematic analysis. Journal of the Royal College of Physicians of Edinburgh, 45(3), pp.201-205.
Leung, L., 2015. Validity, reliability, and generalizability in qualitative research. Journal of family medicine and primary care, 4(3), p.324.