EBP Proposal for Addressing Type 2 Diabetes Among School-Aged Children

Weekly Wellness Program Implementation Plan

Research Question:

Do school-aged children with type 2 diabetes who participate in a weekly wellness program compared to a wellness education have reduced monthly hyperglycemia episodes over six months?

The Setting and Access to Potential Subject

The proposed weekly wellness initiative for reducing hyperglycemia episodes among school-aged plans originated from stakeholders’ commitment to improving the existing interventions. The wellness education on diabetes type 2 proved ineffective in reducing hyperglycemia episodes among children. Therefore, healthcare stakeholders, including physicians, dietitians, advanced practice nurses, general nurses, social workers, and parents, approved strategic weekly wellness programs, encompassing monitored diets, physical activities, and weight management as ideal in improving health for school-aged children with type 2 diabetes. After a lengthy peer-review exercise and in-depth analysis of benefits by the institutional review board, it approved weekly wellness programs as a quality improvement strategy. Since all healthcare actors and participants collectively approved this strategy, consent forms were unnecessary. The desire for the institution to sponsor a wellness program originates from providing evidence-based care for patients, especially children will type two diabetes.

The institute deals with thousands of children who have diabetes as symptomatic and asymptomatic annually. The average risk factors for type 2 diabetes include physical inactivity, obesity, genetic issues, race and ethnicity, and family history (Bellou et al., 2018). Out of the total annual number of children treated for type 2 diabetes by the institute, about 60% have weight management and obesity issues. The institute applies the recommended BMI≥25kg/m² to test obesity a risk factor for type 2 diabetes and fasting plasma glucose (FPG) 100mg/dL (5.6 mmol/L) to 125 mg/dL (6.9 mmol/L) impaired fasting glucose to qualify children as prediabetic or diabetic (American Diabetes Association, 2018). Alongside testing risk factors for diabetes among children, the institution provides medication adjustments during clinical visits by patients. Therefore, selecting the subject relied on the data extracted from institutional electronic systems, indicating the prevalence of type 2 diabetes among school-aged children.

Timeframe for the Implementation Process

The implementation process for wellness programs will take 12 months, where the organization will utilize the first three months to mobilize resources, consolidate inputs by different stakeholders, and align the culture according to the program needs. Also, the first three months will be crucial in preparing a budgetary proposal and seeking approval from the board of directors. Apart from consolidating resources, aligning organizational culture, and approving a budget plan for the initiative, the organization will employ a more effective workforce, including physical activity instructors, dietitians, and community-based health promoters, to enhance process effectiveness and complement organizational employees.

The organization will use the next three months to prepare for the implementation phase, where the oversight board will review test systems and employ advanced technologies to aid data collection, information sharing, and data analysis. Also, organizational professionals will train newcomers to avert the likelihood of change resistance and promote competencies necessary for the success of the wellness initiative. The sixth month with be crucial for selecting participants, contacting their parents, and preparing them for weekly wellness programs that will run for the next six months.

The Resources and Changes need for Proper Implementation.

Undoubtedly, the initiative will require several changes and resources, including financial, technological, and human resources. Regarding the change, the organization will require to transfer patients from clinical settings to rooms where they will participate in physical activities, insulin therapies, and monitored diets. In this sense, it is essential to collaborate with schools or other social amenities to acquire strategic spaces for the initiative. According to Himalowa et al. (2020), schools promote physical activities and diet control for children who have diabetes. As a result, the organization may consider collaborating with nearby learning institutions for effective interventions.

Similarly, the wellness initiative will require the organization to install advanced technologies for testing diabetes, collecting and analyzing data, and aiding other clinical processes (Alcantara-Aragón, 2018). In turn, these technologies will require the organization to employ competent information technology (IT) specialists and train healthcare practitioners or parents on how to use some of them for testing their children away from clinical settings.

Methods and Instruments

Two hundred children were enrolled in community-based wellness education initiatives, while another 200 children were enrolled in clinical wellness initiatives to serve as a control experiment. During the participant selection, the organization randomly selected patients with type 2 diabetes from the electronic health register. Also, the organization informed parents/guardians about the initiative and encouraged them to allow their children to participate. The overall criteria for selecting participants were prior confirmation of diabetic or prediabetic statuses, past use of diabetes medication, and confirmation of weight issues. The participants will engage in frequent testing after completing daily physical activities and taking controlled meals. Also, healthcare professionals will teach parents and guardians how to conduct home-based diabetes tests and report their progress to the institution for evidence-based interventions.

Data Collection Plan

The primary strategies for collecting data during the initiative will be open-ended interviews and test results obtained by professionals during the routine testing of hyperglycemia episodes among participants. The semi-structured and open-ended interviews will allow participants to contribute their views regarding the initiative and communicate concerns (Dejonckheere & Vaughn, 2019). Social workers will help other clinical professionals interpret questions to the participants and address communication barriers between initiative facilitators, parents, and children. Further, healthcare professionals will ensure data confidentiality by interviewing participants in rooms instead of open places. Regarding data handling, nurses will play a researcher role by analyzing findings, transcribing interviews, and recording data according to set themes for the initiative.

Strategies to Deal with Challenges

The initiative facilitators will anticipate various challenges, including communication barriers, staff commitment, ineffective resource utilization, and negative perceptions regarding the initiative. Arguably, the commitment to address these issues will require healthcare professionals to align their activities to the program’s goal, develop effective leadership competencies to address resource challenges, and impart commitment through training officials to value participants (Nkrumah & Abekah-Nkrumah, 2019). Prior training for facilitators will be fundamental in enhancing patient-centeredness in evidence-based practices and addressing multiple challenges involving ethical, professional, and policy considerations.

The Feasibility of the Implementation Plan

Undoubtedly, the wellness initiative will require massive investment to complement the cost of personnel, consumable supplies, equipment, travel costs, and technologies. Fortunately, the organization has a structured deal with volunteer groups, healthcare professionals, and social workers to provide essential services and goods. As a result, the six-month wellness program and 6-month preparation would have required roughly $500000 inclusive of testing technologies and other logistical arrangements. However, the estimated cost would be $250000 after great inputs from philanthropists and volunteers. Arguably, these estimated expenditures will cover remuneration for facilitators, technological updates, and health promotion activities.

Plan to Maintain, Extend, Revise, and Discontinue the Proposed Solution

In collaboration with sponsors, philanthropists, and volunteers, the organization is willing to revise, extend, maintain, or discontinue the initiative based on frequent evaluation and the desired outcomes. The organization board will determine the thresholds for discontinuing the initiative, where possible reasons may include poor resource allocation, failure to realize the desired outcomes, and any emerging issue compromising the initiative continuity. Based on the findings and stakeholder reflection after the plan implementation, it will be possible to determine whether the organization will extend, maintain, or revise the plan. Probably, the organization may decide to revise the plan to address emerging issues, including economic, ethical, legal, and patient-centered concerns.

References

Alcantara-Aragón, V. (2019). Improving patient self-care using diabetes technologies. Therapeutic Advances in Endocrinology and Metabolism, 10, 204201881882421. https://doi.org/10.1177/2042018818824215
American Diabetes Association. (2018). Standards of medical care in diabetes—2019 abridged for primary care providers. 37(1), 11-34. https://doi.org/10.2337/cd18-0105
Bellou, V., Belbasis, L., Tzoulaki, I., & Evangelou, E. (2018). Risk factors for type 2 diabetes mellitus: An exposure-wide umbrella review of meta-analyses. PLOS ONE, 13(3), e0194127. https://doi.org/10.1371/journal.pone.0194127
DeJonckheere, M., & Vaughn, L. (2019). Semi-structured interviewing in primary care research: a balance of relationship and rigor. Family Medicine and Community Health, 7(2), e000057. https://doi.org/10.1136/fmch-2018-000057
Himalowa, S., Mweshi, M., Banda, M., Frantz, J., & Kunda, R. (2020). Strategies to prevent type 2 diabetes mellitus among school children: A systematic review. Research In Health Science, 5(2), 64-74. https://doi.org/10.22158/rhs.v5n2p64
Nkrumah, J., & Abekah-Nkrumah, G. (2019). Facilitators and barriers of patient-centered care at the organizational-level: a study of three district hospitals in the central region of Ghana. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4748-z