Exploring Diabetes Self-Management

The provided text is a comprehensive study on diabetes self-management. It covers various aspects of diabetes self-management, including its importance, benefits, and challenges. The study also explores qualitative research methods and reviews multiple studies on diabetes self-care, providing insights into the experiences of older patients with diabetes mellitus.

1
Dissertation on:
Self-management for people with types 2 diabetes among elderly in England
Student Name:
Student ID:

2
Contents
Chapter 1: Introduction.............................................................................................. 3
Research background.............................................................................................. 3
Research rationale.................................................................................................. 4
Research limitations................................................................................................ 4
Aims and objectives................................................................................................ 5
Chapter 2: Literature review....................................................................................... 6
Chapter 3: Methodology........................................................................................... 15
Research purpose.................................................................................................. 15
Research philosophy............................................................................................. 16
Research approach................................................................................................ 16
Research design.................................................................................................... 17
Sources of data..................................................................................................... 18
Sampling............................................................................................................... 19
Ethical considerations........................................................................................... 20
Questionnaire........................................................................................................ 20
Chapter 4: Data and findings.................................................................................... 23
Chapter 5: Conclusions and recommendations........................................................39
Conclusions........................................................................................................... 39
Recommendations................................................................................................. 40
References............................................................................................................... 42
Appendix.................................................................................................................. 45

3
Chapter 1: Introduction
Research background
Diabetes is a physical condition that occurs when the pancreas inside the body becomes
incapable of producing adequate amounts of insulin or the body becomes incapable of properly
using the insulin to manage blood sugar levels. The result is that blood sugar levels remain
unregulated and become either excessive or deficient. Hyperglycemia often results in a high
spike in blood sugar that can lead to a range of complications. Type 2 diabetes is the most
common type of diabetes and it occurs in most people who have diabetes. It largely results from
overweight and obesity that causes the person’s body to become bad at regulating the blood
sugar levels due to the malfunctioning of the insulin inside the body.
A person with type 2 diabetes is often stated to have insulin resistance in their body. One of the
biggest risk factors or enablers of diabetes is old age. The onset of age is often associated with
contracting the condition. It is a lifelong condition meaning that diabetes patients usually have to
contend with the condition for the remainder of their life. But there are cases of diabetes in
children and young people, which is often due to genetic factors or as a result of childhood
obesity.
As stated already, diabetes is a condition that mainly affects the older population i.e. the elderly
population, especially those over the age of 65 years old, are most vulnerable to this condition
and are often found to be most frequently contracting it. As the people within this age group have
a weaker body compared to the younger populations, their body may also have several other
complications due to their age or due to lifelong accumulation of problems and complications.
As a result, their health deteriorates and the incidence of diabetes makes their other conditions
worse.
Unlike most other conditions or diseases that are severe and impact a lot of people, diabetes is a
condition that can be prevented and once contracted, controlled and managed by the patients
themselves. As stated already, the condition is often caused as a result of bad habits such as diet
and inadequate physical activity that result in excessive or obesity that messes the internal body
systems and affects the body’s insulin in a way that it becomes incapable of managing the sugar
levels in the body. So not only is diabetes very preventable, but it is also manageable through
steadfast maintenance of own body conditions through the development of healthy habits related
to diet and lifestyle.

4
Because of this, there has been a growing interest in the prospect of self-management and self-
care as an effective response to treating or managing diabetes. While diabetes can be managed
and maintained with the constant help and support of a healthcare practitioner, it is more
practical and more empowering if the individual suffering from the condition is allowed to take
control of their health by making appropriate choices related to health, diet and lifestyle.
Practitioners have been emphasising the role and significance of self-management and as a
result, this topic has gained a lot of attention which has resulted in a wealth of research.
The purpose of this research project is to address a significant gap that lies in research the area of
self-management of elderly patients with type 2 diabetes. The gap has been left because elderly
patients often have a wide range of issues along with diabetes that also affect their health and
that impacts how their treatment is to be approached. This gap in research literature has
prompted this particular research project which seeks to address this gap by making an
investigation of this issue on a sample of patients within the target demographic.
Research rationale
The main prompt for this research project is the significant gap in the research literature
regarding the self-management of elderly patients with type 2 diabetes. This is a very critical
issue as the elderly population are the most vulnerable to diabetes complications and are
therefore more deserving of the attention of the researchers on how self-management affects the
quality of diabetes care and treatment. The elderly are more likely to have a range of
complications, diseases and conditions that are worsened by the onset of diabetes, so that issue
must be understood better. That makes their care much more complicated and at the same time
very necessary as they are more vulnerable to the effects of the condition and associated
conditions. The purpose of this research project is to focus on this area of study and address this
gap in knowledge by making an investigation of a sample of people from this demographic in
England.
Research limitations
This research will only be done with participants from England. Other countries may have their
specific issues that will not be represented here, only that of patients from England will be
represented here. Regardless, the findings will still be valuable to anyone regardless of what
country they belong to since the study is on a demographic that exists in every country and that
also experience that same main issue of diabetes. The study also involves quantitative research

5
and not qualitative, so the answers will be very simplistic and somewhat of a planned nature with
a limited set of outcomes that will be explored. Individual experiences are not being explored
here, rather the objective understanding of the condition on a general level is being investigated
here.
Aims and objectives
Aim
This research project aims to make an investigation on the self-management of type 2 diabetes
among the elderly population in England.
Objectives
The objectives of this research include:
 Make a literature review on the self-management practices of type 2 diabetes among the
elderly
 Develop appropriate research tools to make the required investigation on self-
management of type 2 diabetes for elderly patients in England
 Make the required research using the appropriate sampling techniques
 Develop recommendations for further research and development in the research literature
on type 2 diabetes self-management for the elderly population in England

6
Chapter 2: Literature review
Diabetes self-management education has assumed a very important role in the treatment of
diabetes. It has found through various studies that any care that involves self-care routines are
more likely to be effective than any program that does not involve self-care procedures. So the
goal of DSME is to empower the patients to handle their care, and that requires proper education
and training for managing self-care (Suhl and Bonsignore, 2006). Studies on self-management
interventions even show them to be more effective to the point that in one study, patients that
never experienced DSME were 4 times more at risk from increasing complications than those
that had experienced DSME treatment. More than 20% of all diabetic patients are above the age
of 60. This age group are heavily under-represented in DSME research as older adults have a lot
of issues that make their treatment much more complicated than their younger counterparts.
Diabetes Self-Management Education (DSME) for older adults who are diabetic can be very
sophisticated because people within this age tend to suffer from many different types of
comorbidities and conditions other than just diabetes. The complexity of their conditions and the
fact that every single individual suffers from a different set of conditions make it very difficult to
propose a general, all-purpose, all-encompassing solution for this age range. That is why the
DSME treatment must be individualized so that they are tailor-made for dealing with individual
conditions. It is also necessary to involve multiple disciplines since the conditions they suffer are
usually more than one just one. And if the patients are incapable of handling their care, then care
workers have to be involved in their treatment.
Diabetes is a condition that mainly manifests as a case of hyperglycemia that occurs as a result of
insulin hormone deficiency. The WHO has stated that 346 million people globally have type 2
diabetes, which is likely to double by the year 2030 (Shrivastava, Shrivastava and Ramasamy,
2013). Managing diabetes involves more than merely glycemic control, there is also the aim of
reducing the possible complications that can result from it as well as preventing disability and

7
ensuring better rehabilitation. Diabetes self-care involves 7 key types of behaviours that include
diet control, physical exercise/activity, regulating blood sugar levels, taking appropriate
medications, developing skills for solving problems, coping mechanisms, and risk-reducing
actions. The aforementioned 7 actions and behaviours are positively linked to and affect better
glycemic control, reduction of complications and an overall improvement in the quality of life.
Engaging in self-care behaviour for patients of type 2 diabetes has been found to have positive
implications for the diabetic patients themselves, but there is still the issue that many people fail
to maintain the appropriate self-management guidelines especially on a long-term basis.
(Norris et al., 2002) made a review of the literature to determine how effective is self-
management education on impacting changes in GHb levels for patients diagnosed with type 2
diabetes. The purpose of the study was to determine the impact of self-management education on
improving GHb levels in type 2 diabetes patients. For this literature review, the authors went
through numerous literature sources and only included studies that met the following criteria:
1. The study is a randomized controlled trial, i.e. it involves a control group and an intervention
group to compare the results of the intervention.
2. The study evaluated the effect of self-management education on adults with type 2 diabetes.
3. The study reported results of the intervention in the form of changes in GHb LEVELS as a
result of the applied intervention.
In total, the authors reviewed 31 studies. The results of the studies showed that on average, these
interventions had a significant impact on the GHb levels of the patients, thus resulting in
significant improvement of health outcomes.
(Wu, Tai and Sun, 2019) made to analyze the experience of older adults with diabetes mellitus
with self-management interventions to deal with the disease. The study involved the use of a
focus group to understand the subjective experiences of these patients. 23 patients were included
in the study that involved 2 different focus groups. 4 focus group discussions were held and 3
themes were explored in the sessions:
1. Understanding diabetes and the challenges of diabetes
2. Taking a good look at the physical condition and take note of the physical changes that are
observed
3. The key dilemmas involved in self-management treatments

8
The authors concluded that healthcare teams must assume a greater role in the self-management
education programs as it helps reduce the anxiety of the patients in maintaining self-care and to
enable the development of clinical skills that are more patient-oriented and culture-sensitive.
Pennbrant, Berg and Fohlin Johansson (2019) made a research on the literature to investigate the
experience of elderly diabetes patients with self-care treatment. To make this research, the
authors investigated literature sources on diabetes, self-care and elderly patients with diabetes.
The results showed that elderly patient was only concerned about blood glucose testing, issues
relating to their diet, information on diabetes, motivation for self-care and moral support. The
authors argued that nurses undertaking the care of diabetic patients must be given the
opportunities to enhance their knowledge and be able to reflect their experience as care
providers.
Saunders (2019) understand that diabetes is a very common health condition that comes with
increasing complications as people get older. People over 60 years of age are especially
vulnerable to these complications and are therefore more likely to be affected more severely. Yet
the literature on this age group is scant compared to younger age groups mainly to the fact that it
is difficult to generalize the factors that affect diabetes during this age and the treatments that can
be prescribed. Every individual within this age range deals with some sort of issue due that adds
to their list of complications along with type 2 diabetes mellitus. One of the key issues the author
recognizes as important for studying diabetes for this age group is the experience of the disease
from the patient’s point of view as each encounters unique experiences and challenges. Therefore
(Saunders, 2019) examined the literature on type 2 diabetes self-management for elderly patients
in which 10 articles were analyzed to find barriers to self-management treatment In the study, 4
major themes resulted-
1. Gap in knowledge and understanding
2.Challenges in implementation of self-management
3. Barriers to culture and language
4. Barrier of Health care providers to self-management
Diabetes is most commonly prevalent in older adults, most notably the age group of adults over
the age of 65. This age growing is a growing demographic, so the problem continues to grow.

9
Self-care for diabetes patients can be extremely complex as there are multiple factors to consider,
including diet, nutrition, physical activity, fluctuating glucose levels medication etc. The issue is
more pronounced with older adults who are increasingly at risk of suffering from a range of
complication. When people grow older, their health conditions, support systems, physical
capabilities, mental function, nutritional and diet requirements continue to change (Weinger,
Beverly and Smaldone, 2014). On top of this, they have to deal with a range of comorbidities
that may or may not have to do with their rising age. Depression is also another issue that
becomes more prominent during old age. As a result, self-care behaviours become more
complicated. But due to issues relating to cognitive deterioration and the existence of numerous
comorbidities, adults within this age are often not included within the trials dedicated to research
on self-care. This has resulted in a lack of research data to support reliable recommendations.
(Powers et al., 2016) understands that diabetes is a disease condition that requires careful and
self-aware self-management actions and a set of complex activities for managing self-care. The
purpose of diabetes self-management education is to help people with diabetes with the tools and
resources they need to take care of themselves and protect themselves from the harms that are
associated with diabetes. DSME actions are very effective at ensuring the improvement of
several health outcomes. DSME is stated to be the actions that involve the development of skill,
know-how and other assets that are needed for diabetic patients to take care of themselves. Along
with DSME, patients also need Diabetic Self-Management Support (DSMS), which is the
support provided by care workers to help diabetic patients with the skills and resources that they
will need to sustain their self-management activities continually. While the support can be
provided by various members of the care teams involved as well as the community as a whole,
health care providers and the health care clinics or hospitals they belong to should have the
necessary tools to provide an anchor to the self-management practices of patients. These
programs should be developed in a way that they take account of the individual cultural and
religious beliefs, beliefs and perceptions about health, current level of knowledge, physical
capabilities and limitations, emotional issues, available family support, financial state and
various other factors that may also affect the overall health outcomes.

10
(Bai, Chiou and Chang, 2009) studied the factors and issues connected to self-care for diabetes
management in patients over the age of 65. In the study, the impact of various factors on self-
care behaviour was examined. A major focus of the study was on analyzing the relationship
between self-care, depression and social support, with greater emphasis on elderly patients over
65 years of age. In the study, a total of 165 diabetic patients from 3 different hospitals were
recruited and sampled for the research. A Questionnaire was used for the study. It was found
through the results of the questionnaire that self-care was affected by multiple factors including
differences in gender, education status, financial state, religious faith and how long the person
had diabetes when it came to elderly patients. Social support, duration of the condition and
education had a strong impact on self-care, while depression had the inverse effect. The results
have encouraged the authors to argue that social support should be considered vitally important
to self-care for diabetes.
(Captieux et al., 2018) understands the purpose of self-management support is to enable people
with any type of disease to proactively their disease conditions with the assistance of a healthcare
provider. Therefore, the author made a meta-review study to inform policymakers and health
care managers about the efficacy of self-management strategies for type 2 diabetes patients and
which specific interventions are most effective at improving health outcomes for such patients.
The study involved a meta-review of randomized controlled trials with self-management
interventions. The primary outcomes assessed in the studies was glycemic control which was
measured using glycated haemoglobin with secondary outcomes including body mass index,
lipid profiles, blood pressure and quality of life. In total 459 randomised controlled trials were
included in the meta-review and the RCTs included a diverse array of socio-economic and ethnic

11
communities from a total of 33 countries. Results assessed 6 months post-intervention showed
mostly positive outcomes as the primary outcome of glycated haemoglobin was found to have
increased by at least 0.2%, although the positive outcomes were reduced 12 months after the
interventions were implemented. While the primary outcomes were shown to have improved
significantly, the secondary outcomes did not show changes to the same degree. In the study, no
particular intervention was found to be especially effective, with the most effective interventions
including multiple components and involving a minimum contact time of 10 hours. Technology-
assisted interventions showed similar results as the conventional ones.
Whittemore et al. (2019) conducted a qualitative study involving both health care providers and
type 2 diabetes patients to identify the perception of key challenges that arise in type 2 diabetes
self-management. The study conducted was qualitative involving semi-structured interviews that
were then analyzed using content analysis. 20 diabetic adults were included in the study. The
challenges that were encountered were divided into 2 major categories- personal challenges and
system-level challenges. Personal challenges were cultural beliefs, shortage of resources,
difficulties of changing lifestyles, lack or absence of support from family, other demands that
interfered with the goal of lifestyle changing and issues related to mental and emotional health.
The system-level challenges that were identified included a shortage of resources, perceptions of
care quality and obstacles to engaging the patients. Whittemore et al. (2019) argue that evidence-
based programs of diabetes self-management needs to gain more accessibility and must be
developed by considering the social factors that affect health outcomes to develop diabetes
management programs. Various factors must be considered as the challenges to effective self-
management that can be categorized as either personal or system-originated challenges. A
multidisciplinary approach is necessary that includes aspects of mental health and financial
health.

12
Nowadays, diabetes is considered to be one of the major health emergencies worldwide. As a
result, various types of digital tools have been developed to facilitate diabetes management. A
scoping review (Villalobos, Vela and Hernandez, 2020) was made to examine what are the
advantages, disadvantages and obstacles to the use of digital tools in diabetes self-management.
In the scoping review, 25 studies were included which included a major focus on the interactions
between patients and health professionals as well as the effect of digital tools in enabling self-
management behavioural changes. The findings from the scoping review showed great benefits
for the use of electronic health systems, which include greater awareness for patients toward
their health, keeping tabs on own health information, as well as improvements in self-care and
self-management behaviours among the patients and their family members.
There has been an increasing focus on making diabetes care more self-care focused and putting
less emphasis on pharmacological solutions. The role of self-care has therefore been viewed as
more effective and significant for improving healthcare outcomes for diabetic patients. Nurses
have been touted to be more likely to support and promote healthcare behaviours that prioritise
prevention, backed by numerous studies. The purpose of a study by (Azami et al., 2018) was to

13
make research on the efficacy of the DSME program led by nurses on changing the amount of
glycosylated haemoglobin. A randomized controlled trial involving two different groups of
participants totalling 142 were made. The control group were prescribed the usual diabetes
treatment, while the intervention group were prescribed a treatment that involved the usual
treatment plus a diabetes self-management education program led by nurses. The intervention
lasted for 12 weeks and outcomes were measured at the beginning and the end of the 12-week
trial as well as a post-randomization trial at 24 weeks. The primary outcome was glycosylated
haemoglobin, but secondary outcomes also included blood pressure, body weight, fat/lipid
amounts, self-efficacy, self-management and self-care behaviours, quality of life, social support
and depression. It was found that the intervention group experienced positive improvements in
the following outcomes- blood pressure levels, glycosylated haemoglobin, body mass, efficacy,
outcomes and self-management.
(Lee et al., 2019) states that effective self-management of the condition for diabetes patients has
the potential for the prevention of health issues on a long term basis, but the issue of self-
management is difficult and complicated, with various factors and issues to consider. (Lee et al.,
2019) understands that support from health care professionals toward diabetes patients helps
patients manage their conditions better and produce better outcomes in the form of better
glycemic control.
(Lee et al., 2019) studies the experiences of patients perceptions of the care and support they
receive from their main health care supporter which is very often their own family or
acquaintance. 326 type 2 diabetes veterans were included in the study. The patients were asked
to report their experiences using the following measures of social support, diabetes distress, self-
efficacy, and self-care. Greater autonomy support resulted in lower diabetes distress, improved
self-efficacy, a higher number of SMBG and improved glycemic control during the 12-month
post-intervention period. The results showed that autonomy support from healthcare providers
lead to an improved attitude toward diabetes, self-care and glycemic control which of course
resulted in better health outcomes for the patient.

14
(Erdem and Korda, 2014) set up 2 different programs for diabetes self-management, termed as
Chronic Disease Self-Management Program and the second one called the Diabetes Self-
Management Program. The authors analyzed the participation and completion of these programs
by diabetic adults. The results showed that adults participating in these programs have a higher
probability of going through the programs to completion in one of the following scenarios:
1. Diabetic individuals taking part in the Diabetes Self-Management Program
2. Both programs in the introductory classes
3. If the class sizes and durations are small.
Less likelihood of participation and subsequent completion is seen for patients that have
depression.
(Archer, 2014) understand that shame is a significant emotion that people self-managing diabetes
often face and encounter as they perceive themselves as inadequate at taking care of themselves.
Shame is an issue that many people face during psychotherapy. Yet the role of shame in
affecting health outcomes or the self-management actions of patients is often understated during
care. In diabetes consultations, some clients appear quite frequently that keep stressing their
inadequacy in self-management and how they are a failure at managing their glucose levels.
They speak with low self-esteem and in a tone that shows that do not regard themselves very
highly. These signs are clear indicators of the presence of shame which is an important factor
that affects the performance of self-management for diabetic patients. Such poor self-esteem and
shame act as a significant barrier for the patient in achieving proper self-management outcomes.
To ensure that the expected outcomes of self-management are met, it is essential to address
shame as a significant factor in diagnosis. Archer, (2014) argues that shame should be considered
during diagnosis and addressed to ensure the proper health care outcomes of diabetes self-
management are met

15
Chapter 3: Methodology
Research purpose
There are 3 main purposes for starting and implementing a research project. Classification based
on the purpose of research shows 3 different types of research projects- descriptive, explanatory
and exploratory.
Exploratory: The first research category based on the purpose of the research is called
exploratory research. Research into every single topic begins with exploratory research. The
purpose of such research is to initiate an investigation into the relevant topic. Exploratory
research clearly defines the research problem or question that requires addressing (Stebbins,
2001). It lays the groundwork for future research so that future investigations will have a focal
point to focus on when research is being made. It sets up the priorities for future research and the
standards that must be maintained to ensure successful research. It allows the researcher to
become creative with their research and come up with ideas that can generate a successful
investigation.
Descriptive: The purpose of descriptive research is to examine the characteristics and traits of
the population or topic that is being researched (Goswami, 2020). The question that it addresses
and focusses on is “what” instead of how, when or why. The purpose of such research is to bring
more detail to the researched topic. It builds upon the data and information that are uncovered in
exploratory research and uses that as a foundation for adding more information and depth. As
stated already, the focus lies on the what and not the how or why. So the focus remains on
merely gathering as much information as possible so that there is a wealth of information that
adds depth to the field and allows the identification of research gaps that open up room for
further investigation.
Explanatory: The purpose of explanatory research is, as the name suggests, to explain. The aim
of a research project that makes use of explanatory research is to explain a particular

16
phenomenon. Research gaps receive the main focus of explanatory research (Saldaña, 2011) .
This step succeeds in descriptive research, which adds a lot of new information to the research
literature, which results in gap areas that were not previously discussed or addressed. Instead of
adding new information that paves the way for further research, specific areas of confusion that
did not receive previous attention but yet bear significance to the research literature overall
receive the full attention of explanatory research.
The purpose of this research project is to make an investigation into type 2 diabetes management
among elderly adults. This is an area that has not received much research which poses a gap in
the research literature. This has therefore resulted in a research need that will be addressed here.
Therefore, the research that will be made here is explanatory.
Research philosophy
Research philosophy is a belief about what constitutes research (Hughes and Sharrock, 2017).
What are the ways that research can be done and what should be considered appropriate research
information is the subject of research philosophy. It deals with the various schools of thought
that have arisen out of the research. A research philosophy sets the appropriate foundation upon
which an entire research project can be set up. There are several such schools of thoughts, 4 of
which are pragmatism, positivism, interpretivism and realism. Each of these different
philosophies has different types of applicability, advantages and disadvantages. Out of these 4
different philosophies, the one that is most appropriate for use in this project is positivism.
Positivism is the idea that only that which can be studied and interpreted using a scientific
approach is considered proper knowledge (Salkind, 2010). Positivism rejects ideas that originate
from metaphysics and theology. It does not concern itself with vague ideas, rather the emphasis
lies on the concrete- what can be perceived using the basic human senses such as touch, sight and
hearing. Abstract ideas do not qualify as proper knowledge under the philosophy of positivism.
The investigation being made here is on the self-management practices for elderly patients with
type 2 diabetes. A specific context is provided here with the inclusion of patients in England
exclusively. Such research will require an objective, scientific approach that cannot be
interpreted using ideas from metaphysics or theology. And positivism ensures an objective
approach to research with a focus on concrete facts. It only involves research practices where the
knowledge acquisition, analysis and interpretation are made objectively. Therefore this research
will only involve positivism philosophy.

17
Research approach
The research approach deals with hypotheses. More specifically, it explains what role will be
played by the hypothesis in the research. All research projects will involve some form of theory
or explanation as to the end goal of the research. That is the role of the hypothesis. A hypothesis
is an idea or theory that explains a particular phenomenon based on a limited amount of evidence
(Bodden and Smith, 2013). There are two research approaches to developing a hypothesis. The
first approach is called deductive. Deductive involves deduction. Deduction means to take
something away from a total (Bengtson, 2005). In research or reasoning, deduction means to find
the specific out of the general. Deductive research involves finding a specific explanation from a
set of general information. Regarding the role of a hypothesis, a hypothesis is formulated at the
commencement of the research when the research problem or question is specified. The
hypothesis is then used as a criterion for evaluating information. If the information that is
gathered in the research fits with the hypothesis, then the hypothesis is justified. Otherwise, the
hypothesis is deemed to be false or inaccurate. The second approach is called inductive. Just as
deductive involves finding the specific out of the general, inductive research involves finding the
general out of the specific. A set of very specific information is interpreted to form a general
theory. Regarding the role of a hypothesis, no hypothesis is taken at the commencement of the
research (WINCH, 2015). Rather, the purpose of this research approach is to gather as much
information as possible which are then used to formulate a theory or an explanation for the
information that has been revealed. The information is not evaluated to fit within a certain
hypothesis, but rather it is analyzed to formulate a new and original theory that fits the
information. When comparing the two different approaches to research, both have their
advantages and disadvantages. But for the sake of this project, an inductive research approach
will be taken as it allows the formulation of a new and original theory.
Research design
There are two major groups of research methods that are used for different contexts and to
achieve different research outcomes. The two groups that require research methodology are
termed qualitative and quantitative research methods. The difference between the two types of
research is the type of data that is involved. The main key difference is the use or involvement of
numbers in the process. If numbers are involved, then the research is stated to be quantitative.
Otherwise, it is called qualitative. Qualitative research involves detailed information that requires

18
subjective interpretation by the researcher to form opinions and conclusions. Mostly the
information consists of a person’s detailed experience, thoughts and perceptions that cannot be
calculated (Vogt, 2011). Rather these perceptions and thoughts have to be understood by
understanding the perceptions of the person recounting them. Therefore, there is a major focus
on subjectivity in qualitative research. Key methods that are commonly used for qualitative
research are open-ended interviews and focus groups. Quantitative research, as stated already,
involves the use of data that can be analyzed scientifically and numerically to form statistical
models and interpretations. The research tends to involve very simple facts that do not require
very sophisticated interpretation (Gorard, 2008). Key methods that are used for quantitative
research include action research and questionnaires. Both involve the acquisition of information
that can be interpreted very simplistically to form statistical data. Quantitative research will be
made here. This investigation aims to investigate the self-management practices for type 2
diabetes patients of the elderly age group. This will require a scientific approach to research
investigation. This can be achieved simply with the use of quantitative research. Various
methods can be applied for quantitative research, but a questionnaire should be sufficient in
acquiring the required information and analysing the data to form appropriate conclusions.
Sources of data
There are two main ways that data can be acquired for research and they involve two different
types of sources of data. The first type of data source is called primary, and the second data
source data is called secondary. So there is an indirect approach to research and a direct approach
and each involves the type of data source being involved in the research. In the primary research,
the sources used are called primary sources and these are sources that act as the main source of
the data. In the primary research, the researcher is very directly involved with the process of data
collection which requires them to set up a research methodology and design combined with an
appropriate sampling approach. The tools and techniques employed depend on what the research
requires (Bodden and Smith, 2013). Such research tends to be very specific and have a very
specific context around which the research is developed. The researcher has to develop research
methods and design based on what is the most appropriate strategy to gain the required research
outcomes. The advantage of such research is that the researcher has the freedom to decide how
they want to approach the research and achieve results that are most relevant to their specific
research need. The results also tend to be more objective but the researcher may also have a bias

19
that affects the research outcomes. Examples of how primary research is made include
techniques such as interviews, questionnaires and experiments where the researcher has to
develop the tools and resources and prepare a sample of participants (if required) based on what
information their research requires. On the other hand, secondary research does not involve such
a direct approach. Instead, secondary research actions involve going through literature sources to
find research and information that is more relevant to the researcher’s topic of investigation. The
researcher has to go through many sources to find academic work that is most in line with what
they are trying to learn about and try to contextualise the research findings with their specific
area of interest (Lew, 2018). For this research project, both primary and secondary research
approaches will be implemented. Primary research will involve a questionnaire with appropriate
participant sampling as required. And the secondary research will be implemented with a
literature review of the relevant topic which is on type 2 diabetes self-management of elderly
patients of the disease.
Sampling
Sampling is the process of selecting a research sample to take part in a research project. It
depends on what type of outcomes are expected from a research project to set up the appropriate
research sample (Krishnaiah and Rao, 2012). The research sampling process can be done in two
ways. The two different approaches are called purposive and random sampling. The difference
between these two sampling approaches is the randomness (or lack thereof) of it. In random
sampling, a target demographic is specified. But the sampled participants are chosen randomly
without any form of criteria-based selection or exclusion. It is an inclusive approach to sampling
that does not discriminate against any specific set of criteria. The only criteria that are considered
here are that they belong to the target group that becomes the subject of the research. All
members of the target population are treated equally eligible for the research and this enables the
assemblage of a large number of participants in the study very easily. The purpose of random
sampling is to gather simple information on a large number of people quickly to make general
assumptions or findings of them with relation to a particular issue phenomenon (Ray, 2015).
Purposive sampling, on the other hand, is the opposite of random sampling. In purposive
sampling, exclusive criteria are used to exclude a specific group of people from within a large
population that is the subject of the study. The criteria are set by the researcher who decides on
what type fo characteristics should be present in the sampled participants. This is to generate as

20
much information as possible on a specific type of demographic of people that become the
subject of the study. The sampling is done in a way that ensures that the sampled participants are
a logical representation of a particular population and not one that is haphazardly formed. It
ensures that the sampled participants provide the most accurate information in line with the
research requirements. In this research project, purposive sampling will be used. Since the
population needs to be very specific and fit a certain set of criteria, the sampling must be done
very carefully to generate the most accurate findings.
Ethical considerations
Ethical considerations are a big part of any research project. The purpose of ethics is to ensure
that the research activities are being conducted in a way that is fair and generates the best results.
Ethical issues can include various issues that relate to privacy, consent, confidentiality,
appropriate use of methods and tools, issues relating to validity and reliability, the conformance
to appropriate standards of research etc. These issues are a very pressing concern as they are
critical to ensuring the most accurate and best results for the research while also maintaining the
satisfaction of various stakeholders that also include policymakers and standards setters. The first
issue of concern concerning ethics is privacy and confidentiality. There is not much need to
elaborate on why privacy is important as it is a right of every individual in a free society to have
the right to keep their information private and free from intrusion from other people. Therefore,
Data Protection Laws and Standards have been developed for the specific purpose of ensuring
that researchers conform to these standards of the ethical usage of data without crossing any
form of lines. Lines are drawn to show how far one can access another person’s data as set by the
Data Protection Act 1998 that was revised as the Data Protection Act 2018. Another issue of
concern is consent. Consent is another right that every individual is entitled to have, and it is
what the research participants also are entitled to. Just as research participants are entitled to
have their data remain private without the right to misuse with restrictions on fair use, there are
similar policies regarding consent that must be adhered to by researchers. If the participants are
not willing to provide their consent on the conditions of research, then they have the right to
withdraw participation from the research. This policy must be maintained in all types of research
work, including this one.

21
Questionnaire
1) Do you have type 2 diabetes?
a) Yes
b) No
2) Are you above or below the age of 65 years old?
a) Above 65 years old
b) Below 65 years old
3) Has diabetes increased other complications of your health condition?
a) Strongly agree
b) Agree
c) Neutral
d) Disagree
e) Strongly disagree
4) Do you use self-management techniques to take care of your diabetes condition?
a) Yes
b) No
5) Do you support self-management as the right approach to treating type 2 diabetes?
a) Strongly agree
b) Agree
c) Neutral
d) Disagree
e) Strongly disagree
6) Do you find it challenging to implement self-management practices for your condition?
a) Strongly agree
b) Agree
c) Neutral
d) Disagree
e) Strongly disagree
7) Do you experience shame in your perceived inadequacy at implementing self-management
practices?
a) Strongly agree

22
b) Agree
c) Neutral
d) Disagree
e) Strongly disagree
8) Would you prefer if you had more support from healthcare providers in facilitating self-
management practices?
a) Strongly agree
b) Agree
c) Neutral
d) Disagree
e) Strongly disagree
9) Was the self-management education you received adequate support for self-management
practices?
a) Strongly agree
b) Agree
c) Neutral
d) Disagree
e) Strongly disagree
10) Has self-management improved your condition?
a) Strongly agree
b) Agree
c) Neutral
d) Disagree
e) Strongly disagree
11) Has self-management practices changed your outlook on diabetes care and self-care as a
whole?
a) Strongly agree
b) Agree
c) Neutral
d) Disagree
e) Strongly disagree

23
12) Do you believe there should be more research on self-management practices and their
efficacy in improving health outcomes for diabetic patients?
a) Strongly agree
b) Agree
c) Neutral
d) Disagree
e) Strongly disagree

24
Chapter 4: Data and findings
1.Do you have type 2 diabetes?
Response Total
Yes 100
No 0
Total 100
100%
1.Do you have type 2 diabetes?
Yes No
100 people participated in the questionnaire. All the 100 participants of the questionnaire stated
that they have type 2 diabetes. Therefore, all the answers and responses they have provided here
are based on their own experience of diabetes and diabetes management.
2. Are you above or below the age of 65 years old?

25
Response Total
Above 65 years old 100
Below 65 years old 0
Total 100
2. Are you above or below the age of 65 years old?
Above 65 years old Below 65 years old
All 100 participants of the study have stated that they are above the age of 65 years old. The
purpose of this study is to gain insight into the self-management of type 2 diabetes for elderly
patients. Since 65 is an appropriate minimum age to identify and separate this demographic, the
participants were asked first whether they are above this age. Since all the responses stated that
they are above 65, the responses here can be taken as the word of people who have experienced
diabetes and diabetes self-management and are within the appropriate age for this study. The
study results, therefore, satisfy one of the aims of this research, which is to gain insight into type
2 diabetes in a specific demographic, which is the elderly population over the age of 65. The
participants have also been chosen to live within England, so that also further satisfies the
purpose of this investigation.

26
3. Has diabetes increased other complications of your health condition?
Response Total
Strongly agree 37
Agree 30
Neutral 10
Disagree 11
Strongly disagree 12
Total 100
37%
30%
10%
11%
12%
3. Has diabetes increased other
complications of your health condition?
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Diabetes has the potential to increase the likelihood or seriousness of other conditions if present
in the body. It can act as a catalyst for other conditions and make the overall health condition
worse as a result. The participants here asked whether other health conditions, if present, were
worsened by the advent of diabetes. 30 of the participants agreed that their conditions worsened
with the advent of diabetes. A further 37 people stated that they strongly agreed that their

27
condition got worse after they contracted diabetes. Therefore, in total, 67 people agreed that their
condition got worse after diabetes and therefore believe that diabetes acts as a catalyst for
causing other physical conditions to worsen. That is an overwhelming majority of the
participants that believe that diabetes is dangerous that can make the other diseases and
conditions present within a person’s body worse and thus cause deterioration for their overall
health and wellbeing.
4. Do you use self-management techniques to take care of your diabetes condition?
Response Total
Yes 98
No 2
Total 100
98%
2%
4. Do you use self-management
techniques to take care of your diabetes
condition?
Yes
No

28
The purpose of this research is to gain more knowledge and insight about self-management for
type 2 diabetes. Therefore, it is important to know whether the participants of the research have
type 2 diabetes or not and if they are using self-management practices to manage their treatment.
If the participants who are patients of type 2 diabetes are stating that they are using self-
management practices to manage their condition, then the other questions that are being asked
here are relevant to their cause and also meets the objectives of this study. That is why the
participants here were asked this question and the response shows that 98 of the 100 participants
use self-management practices. Therefore, the findings generated here are relevant to the aim of
this project.
5.Do you support self-management as the right approach to treating type 2 diabetes?
Response Total
Strongly agree 34
Agree 31
Neutral 15
Disagree 10
Strongly disagree 10
Total 100

29
34%
31%
15%
10%
10%
5.Do you support self-management as the
right approach to treating type 2
diabetes?
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
The research here involves understanding various aspects of self-management for patients with
type 2 diabetes, which includes how they view and approach self-management and whether they
believe this to be the correct or best approach to handling the treatment of this disease. Patients
might have differing views and consider alternative approaches that they view to be more
effective or helpful. That is why the purpose of this question was to address their perception and
view of self-care in diabetes. 65 of the participants are in agreement that they support self-
management to be the right approach to treating and handling type 2 diabetes. Out of these 65
participants, 31 stated that they agreed, and the other 34 strongly agreed. Among the rest of the
participants, 15 were neutral. 10 of the remaining 20 participants stated that they disagreed and
the other 10 strongly disagreed that self-management should be viewed as the best approach to
treating type 2 diabetes.
6. Do you find it challenging to implement self-management practices for your condition?
Response Total
Strongly agree 22
Agree 23

30
Neutral 3
Disagree 25
Strongly disagree 27
Total 100
22%
23%
3%
25%
27%
6. Do you find it challenging to implement
self-management practices for your
condition?
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Self-management practices will pose some challenges to implement, especially for those that not
very experienced at it. This is why healthcare practitioners are required to provide support,
training and education to assist the patients in implementing these actions. It is important to
understand how the patients perceive these actions and how challenging or difficult they view
them to be. The actions may pose challenges on multiple levels and these issues must be
addressed. So the participants of this research were asked to state whether they find these actions
or this approach overall to be very challenging for them. There are mixed responses here as not
all the participants are equally in agreement on this. 22 of the 100 participants stated that they
agree that this approach is very challenging for them, and another 23 states that they strongly
agree. So in total, 45 of the 100 participants are in agreement about the difficulty of this
intervention. But then, 25 of the participants disagree and a further 27 strongly disagree that this

31
is not very challenging. In total, 52 disagree that these actions and approach are too challenging
in contrast to 45 who find this approach to be very challenging. Only 3 of the participants gave a
neutral response.
7. Do you experience shame in your perceived inadequacy at implementing self-management
practices?
Response Total
Strongly agree 32
Agree 23
Neutral 6
Disagree 25
Strongly disagree 17
Total 100
31%
22%6%
24%
17%
7. Do you experience shame in your
perceived inadequacy at implementing
self-management practices?
Strongly agree
Agree
Neutral
Disagree
Strongly disagree

32
Shame is an emotion that many diabetes patients experience regarding their self-management. It
is a reaction to their perceived inadequacy at taking care of themselves. This is an important
issue as it often goes unnoticed and it does not receive much attention. If the patients feel shame
for a perceived lack of ability to take care of themselves, then it impacts their self-management
performance and affects how they take care of themselves. The result is often that they often end
up not taking proper care of themselves that results in the worsening of their condition as well as
other complications that they may be facing. This is why the participants in this study were asked
whether they experienced such feelings of shame and whether they feel inadequate about their
ability to take care of themselves that may be causing them to feel this shame. The results show
that 20 of the participants agree that they experience shame and 32 others strongly agreed that
they too feel shame about this issue. Among the rest of the respondents, 25 stated that they
disagreed and 17 others strongly disagreed about feeling shame i.e. they attest to not feeling
shame as they do not experience the feeling of inadequacy at their ability to manage their
conditions. Only 6 of the participants gave a neutral response to this question.
8. Would you prefer if you had more support from healthcare providers in facilitating self-
management practices?
Response Total
Strongly agree 35
Agree 33
Neutral 8
Disagree 12
Strongly disagree 13
Total 100

33
35%
33%
8%
12%
13%
8. Would you prefer if you had more
support from healthcare providers in
facilitating self-management practices?
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
The previous question asked about the feeling of shame that may result from a feeling of
inadequacy or inability to take proper care of oneself, particularly in the case of managing
diabetes for elderly patients. This is a feeling that is also associated with the patient feeling they
cannot or are unable to take proper care of themselves. As a result, they consider that they need
more support from healthcare providers in assisting them in taking more effective care of
themselves. So the patients might think that they need more support which would help them do
better at self-management and self-care. That is why this question was asked to the participants
of this survey to see how they respond when they are asked if they think they needed more
support. 33 of the participants agree that they would benefit from more support from healthcare
providers. They are not the only ones that believe this, as 35 others strongly agreed that they
could use more support with their self-care practices. But some participants do not think they
need more support. 12 of the participants stated that they disagree and 13 others stated that they
strongly disagreed that they needed any more support for their self-care actions. Only the
remaining 8 gave a neutral response to this question.
9. Was the self-management education you received adequate support for self-management
practices?

34
Response Total
Strongly agree 42
Agree 44
Neutral 4
Disagree 7
Strongly disagree 3
Total 100
42%
44%
4%
7%3%
9. Was the self-management education
you received adequate support for self-
management practices?
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Self-management education is a very important tool that acts as a support for self-management
practices for diabetes patients. If the education if effective enough, it can help the patients with
the information and skills that they need to be able to manage proper self-care and self-
management. The patients that were involved in this study were all given some form of
education and training to equip them with the knowledge and skills required to effectively take
care of themselves. The purpose of this question was to ask participants whether the DSME
support they received was adequate support for their self-management practices. The response

35
here shows that the overwhelming response is that the education provided to the patients was
enough to support for them to state that they found it to be very useful. Out of the 100 responses,
44 stated that they agreed and 42 others strongly agreed that the education the received was very
helpful and useful in enabling them to become better at self-care and self-management. So in
total, 86 of the responses were positive. Out of the other 16 responses, 7 stated that they
disagreed and 3 stated they strongly disagreed. Only the remaining 4 stated a neutral response.
10. Has self-management improved your condition?
Response Total
Strongly agree 45
Agree 38
Neutral 7
Disagree 5
Strongly disagree 6
Total 100

36
45%
38%
7%
5%
6%
10. Has self-management improved your
condition?
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
The main aim of this research was to learn about self-management practices for elderly patients
with type 2 diabetes. One of the main focus and objectives of the research was to evaluate the
effectiveness of self-management practices in improving the condition of type 2 diabetes
patients. Therefore, it is necessary to evaluate the perceptions and experiences of the participants
in this study who are all patients of type 2 diabetes. 38 of the 100 responses were agreed and 45
strongly agreed. In total, 83 of the responses stated that the self-management improved their
condition and they are overall stated of their health and wellbeing. Only a minority of 5
disagreed and 6 others strongly disagreed and stated that it did not improve their condition.
11. Has self-management practices changed your outlook on diabetes care and self-care as a
whole?
Response Total
Strongly agree 31
Agree 39
Neutral 15
Disagree 8

37
Strongly disagree 7
Total 100
31%
39%
15%
8%7%
11. Has self-management practices
changed your outlook on diabetes care
and self-care as a whole?
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
One of the effects of self-management is that it changes a person’s perceptions and outlook on
what they view to be the appropriate treatment for their conditions. Normally, it is understood
that patients are to be cared for by a healthcare provider who takes care of maintaining most of
their treatment and assists them in implementing normal day-to-day functions as well as the other
actions that are also necessary for the treatment of contracted conditions. But engaging in self-
management and self-care encourages people to change their outlook on health and care and start
taking more control over their health, becoming more responsible for their wellbeing as a result.
The participants here were asked to evaluate this assumption by asking them whether engaging
in self-management changed their outlook and perceptions of health and care. 39 of the 100
participants stated that they agreed and 31 strongly agreed that self-care and self-management
improved their outlook and taught them to be more responsible for their care. Among the
remaining participants, 15 stated the neutral response, 8 disagreed and the other 7 strongly
disagreed with this assumption.

38
12. Do you believe there should be more research on self-management practices and their
efficacy in improving health outcomes for diabetic patients?
Response Total
Strongly agree 31
Agree 42
Neutral 13
Disagree 8
Strongly disagree 6
Total 100
31%
42%
13%
8%
6%
12. Do you believe there should be more
research on self-management practices
and their efficacy in improving health
outcomes for diabetic patients? Strongly agree
Agree
Neutral
Disagree
Strongly disagree
There is a clear gap in the research literature on the study of self-management care for type 2
diabetes, especially when it comes to elderly adults over the age of 65 years old. This gap needs
to addressed and one of the main aims of this research is to address that specific gap. While it is

39
clearly understood that there is a noticeable gap in the literature regarding this issue, it was
important for the participants to share their opinions on whether they believe more research
should be made on this specific area. Here the participants gave their response as the table and
pie chart show. Here a large majority of the participants are in agreement that there needs to be
more research in this area. In total, 73 of the participants agreed about the need for further
research. Out of these 73, 42 stated that they agree and 31 others stated that they strongly agreed.
Among the rest, 8 stated that they disagree and 6 others stated that they strongly disagree. Only
13 of the participants gave a neutral response.

40
Chapter 5: Conclusions and recommendations
Conclusions
Diabetes increases complications for elderly adults
Diabetes is one of the most common diseases in the world and affects thousands of people
worldwide. It is particularly risky in the case of elderly adults over the age of 65 years old who
also coincidentally suffer from a range of other diseases and health complications that are largely
due to their age. The participants in this study all have type 2 diabetes and they have all stated
that diabetes has facilitated the increase of other complications that they are also currently facing
which is largely due to their age but can also be attributable to other individual conditions that
relate to them specifically. Diabetes not only increases complications in elderly adults but also
other ages as well. In general, it acts as a catalyst for other conditions that a person may be
facing, thus enabling the worsening of health conditions for the suffering person.
The impact of self-management education
Self-management is mostly patients taking care of themselves without requiring any assistance
from any healthcare providers or being dependent on anyone else. But regardless, patients need
to know how to take care of themselves. This is not a simple task and requires proper training
and education. Therefore, self-management education plays a key role here in ensuring that
patients suffering from type 2 diabetes have the necessary knowledge and other forms of support
and aide in taking better care of their own body and physical conditions and reducing the impact
of the various types of complications that they are facing including diabetes.
Self-management changes outlook on health and care
As the responses from the participants show, self-management changes the outlook of a person
toward their health and care. Instead of relying too much on the support of healthcare providers,
they are encouraged to show more responsibility for their health and wellbeing. They become
more active in their care and do not seek help and support from other people. This enables them
to become more health-conscious and make more healthy decisions that prevent further
complications and manage current issues they may be facing.
Self-management improves health conditions
As the results from the secondary and primary research show, self-management is very effective
at reducing health complications and improving overall health and wellbeing. The response from

41
the participants shows that self-management practices have impacted the health of participants
and made their physical condition better.
Recommendations
More research on diabetes in elderly adults
There is a lack of research on elderly adults regarding their self-management of type 2 diabetes.
Much research is needed in this area as there is a significant gap in research on this specific topic
and context. The purpose of the research is to reveal information on areas that have not been
researched before. Due to the complicated situation of elderly adults who also coincidentally
suffer from a range of complications and diseases, it has become very challenging to make
research and theories that relate to all adults within this age group. This has left a significant gap
in research that must be addressed by researchers, practitioners and academics. The participants
in this study have also attested to the fact that the self-management of diabetes is a topic that
does not get as much attention and would prefer it if there is more research that is made in this
area.
Shame as a part of self-management
Shame is an emotional response that many patients have shown that has acted as an obstacle to
their self-management and self-care practices. Patients often report feeling inadequacy about
their ability to take care of themselves. They show low self-esteem that may arise from other
conditions or life issues as well. While it is not usually included in discussions on self-
management regarding diabetes treatment, it is very impactful in the performance of self-care
that impacts the quality of the care and treatment of diabetes. As self-care is considered to be a
priority among different approaches to treating diabetes, this aspect of the emotional response of
patients should not be ignored and should be given more attention.
More research on self-care is needed
Since the results from the research have shown the effectiveness and advantages of self-care, it
shows how important self-care is and the need to integrate it into all forms of health and care
behaviours. Just as diabetes can be managed using self-management and self-care practices,
other health conditions can also be effectively treated using the practices that are involved in
self-care. As a result, there is a need for further research on how self-care can be improved and
developed so that better self-care practices can be developed.
More research on self-management of diabetes

42
Self-management is very important for diabetes as the research has shown. This needs to
continue to receive more and more focus and it should be prioritized over other issues as an
intervention for diabetes. Currently, there is s wealth of evidence in the academic literature, but
there are still gaps in numerous areas as has been pointed out here. There is a gap in the literature
regarding the use of self-management practices for the treatment and management of type 2
diabetes in elderly patients. That gap needs to be addressed promptly. The more attention this
area receives, the more insightful research will be produced in the future as a result. The
participants’ responses in this study have shown that there is strong support for self-management
as a treatment for diabetes and they believe there should be more research on this area. There is
adequate evidence within the literature that shows how effective self-management is and the
significance or making more research in this particular context. As the population continues to
age in England coupled with the unhealthy lifestyle choices that people are increasingly making,
the incidence of diabetes will continue to increase and the result of this will be that more and
more people will need diabetes treatment and the need for self-management will continue to
become more and more prominent. Hence it is recommended that more research continue to be
made and that the research continues to address the identified gap in research information
relating to the self-management of diabetes of elderly patients.

43
References
Archer, A., 2014. Shame and diabetes self-management. Practical Diabetes, 31(3), pp.102-106.
Azami, G., Soh, K., Sazlina, S., Salmiah, M., Aazami, S., Mozafari, M. and Taghinejad, H.,
2018. Effect of a Nurse-Led Diabetes Self-Management Education Program on
Glycosylated Hemoglobin among Adults with Type 2 Diabetes. Journal of Diabetes
Research, 2018, pp.1-12.
Bai, Y., Chiou, C. and Chang, Y., 2009. Self-care behaviour and related factors in older people
with Type 2 diabetes. Journal of Clinical Nursing, 18(23), pp.3308-3315.
Bengtson, V., 2005. Sourcebook of family theory & research. Thousand Oaks, Calif.: Sage.
Bodden, V. and Smith, E., 2013. Doing primary research. Mankato, Minn.: Creative Education.
Captieux, M., Pearce, G., Parke, H., Epiphaniou, E., Wild, S., Taylor, S. and Pinnock, H., 2018.
Supported self-management for people with type 2 diabetes: a meta-review of quantitative
systematic reviews. BMJ Open, 8(12), p.e024262.
Dorne, R., Pierce, C., Pratt, C., Mahoney, W. and Garbarini, J., 2015. Self-Management of Type
2 Diabetes: The Lived Experience of Older Adults With Life-Altering Complications.
American Journal of Occupational Therapy, 69(Suppl. 1), pp.6911510130p1.
Erdem, E. and Korda, H., 2014. Self-Management Program Participation by Older Adults With
Diabetes. Family & Community Health, 37(2), pp.134-146.
Gorard, S., 2008. Quantitative research in education. Los Angeles, Calif.: SAGE.
Goswami, M., 2020. Descriptive Research.
Hughes, J. and Sharrock, W., 2017. The philosophy of social research.
Krishnaiah, P. and Rao, C., 2012. Sampling. Amsterdam: North-Holland.
Lee, A., Piette, J., Heisler, M., Janevic, M. and Rosland, A., 2019. Diabetes self-management
and glycemic control: The role of autonomy support from informal health
supporters. Health Psychology, 38(2), pp.122-132.

44
Lew, K., 2018. Exploring Secondary Research Investigations Through Science Research
Projects. New York, NY: Rosen Publishing Group.
Norris, S., Lau, J., Smith, S., Schmid, C. and Engelgau, M., 2002. Self-Management Education
for Adults With Type 2 Diabetes: A meta-analysis of the effect on glycemic control.
Diabetes Care, 25(7), pp.1159-1171.
Pennbrant, S., Berg, A. and Fohlin Johansson, L., 2019. Self-care experiences of older patients
with diabetes mellitus: A qualitative systematic literature review. Nordic Journal of Nursing
Research, 40(2), pp.64-72.
Powers, M., Bardsley, J., Cypress, M., Duker, P., Funnell, M., Fischl, A., Maryniuk, M.,
Siminerio, L. and Vivian, E., 2016. Diabetes Self-management Education and Support in
Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the
American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics.
Clinical Diabetes, 34(2), pp.70-80.
Ray, A., 2015. The Methodoloy of Sampling and Purposive Sampling.
Saldaña, J., 2011. Fundamentals of qualitative research. New York: Oxford University Press.
Salkind, N., 2010. Encyclopedia of research design. Thousand Oaks, Calif.: Sage.
Saunders, T., 2019. Type 2 Diabetes Self-Management Barriers in Older Adults: An Integrative
Review of the Qualitative Literature. Journal of Gerontological Nursing, 45(3), pp.43-54.
Shrivastava, S., Shrivastava, P. and Ramasamy, J., 2013. Role of self-care in management of
diabetes mellitus. Journal of Diabetes & Metabolic Disorders, 12(1).
Stebbins, R., 2001. Exploratory research in the social sciences. Thousand Oaks [Calif.]: SAGE.
Suhl, E. and Bonsignore, P., 2006. Diabetes Self-Management Education for Older Adults:
General Principles and Practical Application. Diabetes Spectrum, 19(4), pp.234-240.
Villalobos, N., Vela, F. and Hernandez, L., 2020. Digital Healthcare Intervention to Improve
Self-Management for Patients with Type 2 Diabetes: A Scoping Review. Journal of
Scientific Innovation in Medicine, 3(3).

45
Vogt, W., 2011. SAGE quantitative research methods. London: SAGE.
Weinger, K., Beverly, E. and Smaldone, A., 2014. Diabetes Self-Care and the Older Adult.
Western Journal of Nursing Research, 36(9), pp.1272-1298.
Whittemore, R., Vilar-Compte, M., De La Cerda, S., Marron, D., Conover, R., Delvy, R.,
Lozano-Marrufo, A. and 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).
WINCH, W., 2015. INDUCTIVE VERSUS DEDUCTIVE METHODS OF TEACHING.
FORGOTTEN Books.
Wu, F., Tai, H. and Sun, J., 2019. Self-management Experience of Middle-aged and Older
Adults With Type 2 Diabetes: A Qualitative Study. Asian Nursing Research, 13(3), pp.209-
215.

46
Appendix