Community Health Nursing: Application of Epidemiology Principles

This report analyzes the application of epidemiology in nursing, specifically focusing on a study titled "Diabetes self-management education is not associated with a reduction in long-term diabetes complications: an effectiveness study in an elderly population." The report begins with an abstract summarizing the study's observational design, which examined the relationship between diabetes self-management education and long-term complications in an elderly population. The methodology involved using administrative health care data to assess patient outcomes. The findings revealed that diabetes is strongly associated with old age and that the observed associations are strong as the study suggests that older adults are at higher risks for development of type II diabetes. The report also discusses how these findings can be incorporated into community health nursing practice, highlighting the rising prevalence of diabetes and the importance of addressing this chronic disease. The report suggests further research questions such as the relationship between diabetes and emotional health. Overall, the report provides a comprehensive overview of the study, its implications, and its relevance to nursing practice.

Running head: APPLICATION OF EPIDEMOLOGY IN NURSING
APPLICATION OF EPIDEMOLOGY IN NURSING
Name of the Student
Name of the university
Author note

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Abstract
This paper provides a review of the article named “Diabetes self-management education is
not associated with a reduction in long-term diabetes complications: an effectiveness study in
an elderly population”. The article has been evaluated considering parameters such as
research design, content and its methodology. The study has come up with a link in between
the cause and the effect observing the exposure as well as the status of disease of each of the
participants of the research. The exposure of different patients to diabetes has been observed
and the patients have not been subjected to any artificial experimental conditions. All the
observations that have been made are under natural conditions. Lastly, the results and
findings are provided along with future research and conclusion.
Research Design
In epidemiology, the researchers take interest in measuring or assessing the existing
relationship of exposure with a certain disease or a specific outcome. The hypothesis relying
on the research question is defined at the first stage and then it is decided as to which study
design should be used. The experimental or observational study design is made use of in
researches. In this study the study design that has been used can be said to be observational as
the content is based on different observations that have been done to understand the scenario.
In the observational study design, the researchers draw inferences from a specific sample to a
population and in this case the independent variable is not under the control of the individual
conducting the research as because of certain ethical concerns or some logical constraints.
This study observes the exposure as well as the status of disease of each of the participants of
the research. In this study, Shah et al., 2015, observed the behaviour of the patients under
natural conditions and they were not subjected to any sort of experimental environment. The

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effect of the risk factor, diagnostic tests or other such interventions are observed by the
researcher without making any attempt to change the scenario as to who is or who is not
affected or exposed to the disease. This study attempts to establish or come up with a
relationship in between cause and effect. Unlike the experimental design the researcher is not
able to control the way in which various subjects are assigned to different groups or the
treatment that is received by these groups. The author has made use of observational study
design so that the research questions are answered well and the objectives of the research are
met. In this context the research question is diabetes common in aged adults those who have
less income. In observational study, the epidemiologist observes the exposure of the patients
to the disease which in this case is a chronic disease that is diabetes. The reason behind this
research is to find out whether there is any connection in between age, income and a disease
like diabetes. The research is important as diabetes is a chronic disease and with every
passing day more and more people are getting affected by this disease. This chronic disease is
associated with serious consequences and contributes a lot to the mortality rate. The relation
in between old age and diabetes is still known but the relation between income and the
disease is not that known. This study thus has a good research aim and objective.
Methodology
The study makes use of administrative health care data describing the health care utilization
by all the residents of Brampton. The study examined many random patients in a non-
experimental setting and then conclusions were drawn. The reports of Health Canada have
been sued to show the statistics and thus it can be said that the findings that have been
reported are consistent with the knowledge that I have. The principles that I have been taught
during my nursing practice are well adhered to in the article and can connect well to all these.
Yes the reported relationship makes sense as this particular study has different strengths such

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as this study was large with long follow up thus could examine long term diabetes
complications ( Jacklin et al., 2017). This study can be said to be accurate as this considered
long term follow up instead of just focussing on the short term traits such as metabolic as
well behavioural changes. Much number of patients was examined for this purpose and the
criterion of old age and less income was kept in mind. Administrative health care data
sources were referred to for the purpose of comprehensive evaluation of patient outcomes
without bearing any such loss to missing data. The data provided in the study is from reliable
sources thus can be referred to or suggested to others.
Results and Findings
Strength or weakness of observed association is dependent on the risk that is if the increased
risk is of less than 50% or a decreased risk having value less than 30% then it is considered
by epidemiologists to be weak association or no such association. The confounding factor is
mainly responsible in deciding whether an association is strong or whether it is weak. The
observed association is strong enough as studies and medical science suggests that older
adults are at higher risks for development of type II diabetes and the reason is that with age
there is an increase in insulin resistance along with impaired pancreatic islet function. Less
income of the people will be another major factor as it can happen that they skip medicines
and cannot afford to buy vegetables which could help them fight with the chronic disease.
The observed association is strong in the sense that diabetes can be related to old age and
studies suggest that people in their late 60s are victims of this disease (Tait et al., 2018). The
results of the study suggest that there were 344490 people aged more than or equal to 66
years diagnosed with diabetes. 32.2 percent of them were suffering from diabetes for less
than a time span of 5 years. 8485 that is 8 percent of the patients attendant the diabetes self-
management education. Age, sex, use of insulin, duration of diabetes and propensity score

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was matched after which there were 8260 attendees as well as an equal number of non-
attendees. The absolute frequency and the associated risks of each of the short-term quality of
care measure revealed that in case of glycaemia related ED visit the percentage of attendees
were 0.5 percent while the percentage of non-attendees were 44 and the value of relative risk
was 1.02. Similarly in case of retinal screening examination the percentage of attendees was
75.3 percent while the percentage of non-attendees was 70.3 percent with relative risk value
being 1.05 Shah et al., 2015. This reveals that relative risks were not much as values are near
to unity. Thus, as per results it can be said 1 in 12 people of the age greater than or equal to
66 years those who were diagnosed with diabetes had attended a self-management education
program.
Incorporation of the findings in community health nursing practice
Yes, I would incorporate the findings of this study into my community health nursing
practice. The reason is that it is a much required topic that needs attention as there has been
rising number of cases of diabetes in Canada. In the year 2015, as per estimations diabetes
cases were 3.4 million or in other words 9.3 percent of the whole population. Studies suggest
that this value will rise in near future and could reach a value as high as 5 million or 12.1% of
the total population in the year 2025 Tao, Z., Shi, A., & Zhao, 2015). The increase in this
chronic disease needs to be checked and thus the various parameters need to be analysed
properly. The link in between growing age and diabetes is one of the main factors and thus I
will incorporate the findings of the study in my work. This will help to carry on with the
practice in a better way and I will be backed by factual data. The Q-factor of this study is the
link in between this chronic disease and age of patients. The patients and their age are
considered the main parameter to find out the prevalence of this disease in the age group and
the community where the aged have less income.

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Further Research
The research questions that can be added on this study are as follows:
a) Is there any relation in between diabetes and being over emotional?
b) Is there any chance that someone below the age of 45 years of age which is considered as
the age of onset for diabetes in individuals?
c) How important factor is age in case of this chronic disease?
d) Is it like that every person at some point of time will be affected with this chronic disease?
These are some of the questions that, I would like to add to study as this is equally
important and often people are found asking these questions. The age factor has always been
a common thing and people have a notion that it is normal to have diabetes after a certain
age. These research questions can make the study more compact in nature.
Conclusion
From the discussion made above it can be said that the content of the article is topic relevant
and the author does not disgrace from the main aim. Portions can be recognized well due to
the headings and subheadings provided. Thus, overall it can be said that this article can be
referred to by anyone who wishes to research on the topic Diabetes in the elderly population.

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Bibliography
Jacklin, K. M., Henderson, R. I., Green, M. E., Walker, L. M., Calam, B., & Crowshoe, L. J.
(2017). Health care experiences of Indigenous people living with type 2 diabetes in
Canada. Cmaj, 189(3), E106-E112.
Shah, B. R., Hwee, J., Cauch‐Dudek, K., Ng, R., & Victor, J. C. (2015). Diabetes self‐
management education is not associated with a reduction in long‐term diabetes
complications: an effectiveness study in an elderly population. Journal of evaluation
in clinical practice, 21(4), 656-661.
Tait, C. A., L’Abbé, M. R., Smith, P. M., & Rosella, L. C. (2018). The association between
food insecurity and incident type 2 diabetes in Canada: a population-based cohort
study. PloS one, 13(5).
Tao, Z., Shi, A., & Zhao, J. (2015). Epidemiological perspectives of diabetes. Cell
biochemistry and biophysics, 73(1), 181-185.