Behavior for Chronic Disease: Critical Review and Clinical Application

This report presents a critical review of an article examining the food security issues faced by low-income individuals with type 2 diabetes. The study, conducted in Perth, Australia, employed a qualitative methodology, including focus groups and interviews, to explore the impact of socioeconomic disadvantages on dietary habits. The findings revealed that participants, despite having knowledge of dietary requirements, struggled with access to healthy food due to financial constraints and dependency on others. The review highlights the article's contribution to nursing practice, emphasizing the need for healthcare workers to address patients' socioeconomic circumstances, particularly in diabetes management. It also discusses the importance of an interdisciplinary approach, including nurses and dieticians, in providing comprehensive care. The review concludes by discussing the study's strengths, limitations, and its implications for clinical practice, particularly for student nurses. The report stresses the importance of nurses addressing the socioeconomic factors influencing patients' ability to manage their chronic conditions effectively.

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Running head: BEHAVIOUR FOR CHRONIC DISEASE
Behaviour For Chronic Disease
Name of student:
Name of university:
Author note:

BEHAVIOUR FOR CHRONIC DISEASE
Introduction
Beatriz et al., (2011) aimed at studying the food security issues as experienced by
individuals with low income and suffering from type 2 diabetes. The research was set the
backdrop of increasing prevalence of diabetes across the world, including Australia, where
800,000 individuals live with this chronic condition. The study was a qualitative examination
that explored the influence of socio-economic disadvantages on diabetes. Data collection was
done through focus groups and semi-structured interviews. 38 patients took part in the
research that included both indigenous and nonindigenous groups. Recruitment was done
from areas in Perth that had high indices of socio-economic disadvantage. Deductive data
analysis was done from a conceptual framework for indicating the relationship between
diabetes health outcomes and socioeconomic position. An inductive approach was taken fro
identification of new themes. The results indicated that participants had an up-to-the mark
understanding of their respective dietary requirements. Nevertheless, access to food that is
healthy was not realised under all circumstances. In addition, participants indicated high
levels of dependency on others for their diet and meal preparation. Further, they could not
accommodate the price for the healthy food due to a constraint of the budget. The primary
inference drawn was that low-income earners faced food security issues.
The present paper aims to undertake a critical review of the chosen article as it
contributes greatly to the best nursing practice of assisting low-income earning patients
suffering from type 2 diabetes for addressing food security issues.
Research methods and design
The research adopted a qualitative methodology for addressing the research objective
of understanding the challenges faced by low-income earners suffering from diabetes
pertaining to their food intake. Focus groups were conducted with 38 patients as the data

BEHAVIOUR FOR CHRONIC DISEASE
collection method. Thematic analysis was done subsequently. Silverman (2016) point out that
qualitative analysis is beneficial in recording the feelings and behaviours of study
participamts. It is a good way of stimulating individual experiences of people. A detailed
picture can be built up about why people behave in a certain manner and what exactly are the
changes faced by them. According to Nieswiadomy and Bailey (2016), though qualitative
research has its strnghths, the limitations cannot be overlooked. Since a small group of people
are studied in such cases, it is not suitable to generalise the findings of the study. It is also
difficult to make the systematic comparisons in an appropriate manner. Subjectivity leads to
procedural problems in qualitative research and replicability is difficult. Researcher bias is
also an issue. The small size of the study sample is also a concern since small sample size
influences the result’s reliability. Large sample size also leads to lesser standard deviation
and more accurate results.
As focus groups were conducted in this case, skills of the researcher to extract
information from the participants might have been a concern. This is crucial since the
research topic was experiences of the patients pertaining to their socio-economic background.
As the same is a sensitive issue, the participants had to be motivated and encouraged to come
up with their feelings and experiences (Glesne, 2015). The thematic analysis also has some
limitations. Comprehensive and in-depth narrative analysis limits the scope of the study.
Impact of psychosocial factors
The present paper adds to the existing knowledge of the psychosocial issue of
socioeconomic constraints pertaining to diabetes diet to the extent that it highlights the facts
of food security issues. The study has been prominent in bringing into focus the need for
healthcare workers, including nurses to address the socio-economic circumstances in which
the populations coming from vulnerable background live while caring for their diabetes rated

BEHAVIOUR FOR CHRONIC DISEASE
issues. Nurses play a crucial role in self-management of patients with diabetes, and since diet
is a key element of self-management, nurses need to come up with strategies to resolve
challenges (Black, 2016). Patients living with diabetes depend largely on the care provided
by nurses within and outside the clinical setting. Since diabetes is a chronic illness leading to
numerous long term and short term complications, patients are in need of specialist care so
that they are better able to carry out self-management (Dunning, 2013). The present article
contributes to the understanding that nurses need to give special focus on to dietary needs of
patients and the manner in which the patients can be counselled for addressing their challenge
of proper diet intake in spite of constraints.
Contribution of article to the interdisciplinary approach
The present article brings in deeper insight into the knowledge of the involvement of
interdisciplinary team for diabetes care. Best management practices rest upon
interdisciplinary team approaches, and the article focuses on the involvement of such a team
for meeting dietary needs of diabetic patients. Apart from a registered nurse delivery overall
care to the patient, a diabetes specialist nurse must take a central position in supporting
patients over the course of disease with special attention to diet. The nurse can fulfil
responsibilities for costing, planning and developing strategies that can enable the patients to
intake food as per their convenience and accessibility (Sullivan et al., 2016).
The role of the dietician is to be highlighted in this context. Fulfilment of the dietary
needs of the patients as per their economic capability can only be possible with the input from
a dietician. The role of the dietician would be integral since the patients would be from a low
socioeconomic group (Whittle et al., 2017). A dietician would become a lifestyle coach and
meet the patients to educate them about the implications of a healthy diet. In addition to
outlining a diet chart, the role would also encompass education on adjustments in diet and

BEHAVIOUR FOR CHRONIC DISEASE
physical exercise and self-monitoring. Strategies are to be taught to the patients so that they
can actively solve their problems and compensate for their low quality dietary intake through
other measures.
Application of article to clinical practice
The review of the article holds much importance for its findings to be applied to my
practice as a student RN. I have gained the knowledge that nurses are to come to a step
forward for addressing the needs of diabetic patients for those who face food security issues.
It is my responsibility to communicate appropriately with the members of the
interdisciplinary team so that care is of high quality. I would change my current approach in
that barriers to seek information faced by patients would be reduced considerably and patient
communication would be made better. The aim would be to foster optimal quality nursing
practice.
Study strength and limitations
The strength of the study lies in the fact that valuable insights have been added to the
topic of nursing practice for diabetic patients. The limitations of the study are to be
mentioned. Feasibility and time constraints restricted the study to one area in Perth. Due to
financial constraints, no participant was recruited from the Vietnamese community which is
the largest linguistically and culturally diverse group in the area. Lastly, it is to be highlighted
that participants might have agreed to take part in the research due to monetary incentives
offered. The validity of the research data is under question since the data was self-reported.
Recall bias is also there in the study (Beatriz et al., 2011).

BEHAVIOUR FOR CHRONIC DISEASE
Conclusion
The present critical review of the article gave valuable insight into the fact that
socioeconomic disadvantage has a profound impact on diabetes management. From the
analysis, the fact that emerges is that nurses are to address the socioeconomic circumstances
in which the vulnerable populations live. Nurses must engage in further research to highlight
novice and advanced strategies by which patients can be given better care in spite of their low
economic background without compromising on their quality.

BEHAVIOUR FOR CHRONIC DISEASE
References
Beatriz, C. B., Sherry, S., & Alexandra, M. (2011). ‘You get the quickest and the cheapest
stuff you can’: food security issues among low-income earners living with
diabetes. The Australasian medical journal, 4(12), 683. DOI: 10.4066/AMJ.20111104
Black, B. (2016). Professional Nursing-E-Book: Concepts & Challenges. Elsevier Health
Sciences.
Dunning, T. (2013). Care of people with diabetes: a manual of nursing practice. John Wiley
& Sons.
Glesne, C. (2015). Becoming qualitative researchers: An introduction. Pearson.
Nieswiadomy, R. M., & Bailey, C. (2017). Foundations of nursing research. Pearson.
Silverman, D. (Ed.). (2016). Qualitative research. Sage.
Sullivan, N., Dunbar, P., & Murphy, G. (2016). Moving On… with Diabetes: Transition
Education Program for Parents/Caregivers of Youth/Young Adults with
Diabetes. Canadian Journal of Diabetes, 40(5), S29. DOI:
http://dx.doi.org/10.1016/j.jcjd.2016.08.082
Whittle, S., Barrett, A., Humayun, M., Williams, E., & Brooks, A. M. S. (2017, March).
Multidisciplinary team secondary diabetes clinics (MDTSDC): a new role for the
diabetes dietitian?. Diabetic medicine.,32.125-126.