PICO (T) Question and Evidence-Based Approach
PICO(T)-Formatted Research Question
Overview
Diabetes Mellitus Type-1 is a chronic ailment that causes high blood sugar. As it affects many people in the United States and throughout the world, Makori (2019) states that low-income African-Americans exhibit a high prevalence of the disease than other races. However, extensive evidence shows that enhanced glycemic control would significantly reduce African-Americans’ microvascular complications and healthcare costs. In the wake of this, although diabetes self-management education (DSME) approaches are effectual at reducing hemoglobin A1c, the intervention has not been effective in this population (Lynch et al., 2019). This text seeks to apply the PICO(T) mechanism to initiate research into a viable care plan to help diagnose and reduce the severity of type-1 diabetes A1c levels among the identified population without pharmacological techniques.
PICO(T) Question
How does African-Americans’ perception of dietary and lifestyle changes and glycemic control affect newly diagnosed A1c levels in the initial three months of identification and diagnosis?
Identification of Evidence of Sources
Epidemiologists utilize primary and secondary sources of information to conduct research, develop programs and policies, and make sound conclusions about specific diseases. There are numerous evidence-based resources related to type-1 diabetes, most of which provide descriptive and analytical epidemiology on its associations with variable interests. Brownson et al. (2018) assert that deciding on the most appropriate sources depends on several factors, including the purpose of the analysis, the researcher’s level of access, and the scope of time available. For this PICO(T) question, the most valuable data sources include peer-reviewed scientific journal articles, websites, and books. These sources may contain various types of information, including systematic reviews, clinical guidelines, qualitative research, cohort and randomized studies, and controlled trials (Lynch et al., 2019). In addition, whereas some sources provide a wide range of data types, others, such as the Cochrane Database of Systematic Reviews, specialize in one class. Besides the institution’s library, the researcher used Google Scholar to locate databases and articles on the management of type-1 diabetes.
Library databases, websites, and books contain a wide range of reliable, evidence-based information. Using library databases to find peer-reviewed, scholarly journals that would potentially solve the question of African-Americans’ regulation and treatment of type-1 diabetes, the researcher will use keywords (Brownson et al., 2018). Practical keywords include terms such as “best practices,” “treatment guidelines,” “practice guidelines,” “type-1 diabetes,” “hemoglobin A1c,” “African-Americans,” and “dietary and lifestyle changes,” among others. Still, in the same context, the researcher could focus on such renowned databases as the Cochrane Database of Systematic Reviews, PubMed, and information gateways such as NHS Evidence, TRIP, and CINAHL. Further, it would be pertinent to consult primary sources such as Medline, MedlinePlus, Embase, HMIC, and CENTRAL for controlled trials. When it comes to websites, Chen et al. (2018) state that one should maintain caution when using selected blogs and articles that feature evidence-based practice guidelines written and published by experts in particular disciplines. Overall, peer-reviewed journal articles are the best picks for evidence-based information to address the research question.
Findings from Articles and Information Sources
Firstly, Phillips (2019) and other websites assert that A1c, a long-term blood glucose measure used to diagnose and evaluate the management of diabetes, is less reliable and contains shortcomings that can misdiagnose people of African descent. Khosla et al. (2021), a peer-reviewed scholarly article published in the Journal of Preventing Chronic Disease, supports that specific finding. The journal article posits that diabetes prevention programs incorrectly view African-American people as a single ethnicity when the group comprises many ethnicities under the label, Black people. In his book, Makori (2019) states that instead of making these generalizations, healthcare professionals should aditionaly run more conventional blood-sugar tests because traditional measures are not influenced by race or sickle-cell status. As the American Diabetes Association advises African-Americans and all people of African descent to be aware of the issue, research states that they should employ their best judgment in improving their glycemic control (Khosla et al., 2021).
Secondly, maintaining strict glycemic control should be the priority of African-American patients. Multiple randomized controlled trials have demonstrated that improving one’s glycemic control reduces the risk of microvascular diseases, macrovascular incidences, and cardiovascular symptoms (Khosla et al., 2019). In the fifth edition of their book, Buttaro et al. (2017) allude to specific dietary and lifestyle changes enabling African-Americans to meet the Centers for Disease Control and Prevention’s nutritional goal. These changes include a list of evidence-based diabetes foods containing Mediterranean-style eating patterns and diets, low-glycemic index foods, specific guidelines to a low-fat diet, and an emphasis on eating salads, fresh fruits, and vegetables. Notable peer-reviewed journal articles provide a rationale for these recommendations, highlighting the challenges people of African descent face in managing their diets and type-1 diabetes. Lynch et al. (2019) state that besides inadequate access to high-quality healthcare, this population faces issues to do with institutional racism, racial discrimination and segregation, unreliable socioeconomic status, poor literacy levels, and high poverty rates. These three data sources, library databases, books, and websites, contain constant findings on the need for elevated glycemic control through dietary and lifestyle shifts.
Relevance of the Findings
A PICOT approach serves many purposes. The main one is that researchers use the mechanism to pinpoint the terminologies to analyze and search for the most compelling evidence to answer a specific clinical question. Essentially, a PICO(T) question is an unbiased and reliable search strategy (Brownson et al., 2018). This study’s data sources, evidence, and findings are relevant as they answer the question and underpin the evidence-based recommendations, decisions, and practice. Instead of providing hundreds of preliminary studies, most of which do not offer credible insight into the problem of type-1 diabetes among African-Americans, the PICO(T) question allows the researcher to discover only the most relevant studies. Pappachan (2019) states that this step of the evidence-based practice is undervalued and can lead to the provision of biased recommendations, which conflicts with the primary intent of the evidence-based practice. Therefore, after generating an idea research question for this study, the researcher proceeds to analyze the findings of the most appropriate sources and conclusions from selected articles.
The researcher asked the PICO(T) question to obtain more information on the best practice. The findings of this text’s inquiry enable the researcher to make more reliable decisions on the best course for addressing the variability of type-1 diabetes among the population in question. If the researcher had searched for something that they had already decided on, they would make a critical error that would provide the wrong evidence, change the trajectory of the analysis, and inadvertently change the intent of the investigation (Pappachan, 2019). However, in this case, the findings from the articles contribute to the success of the PICO(T) question as the initial results provide the general knowledge and background of the issue. Other findings provide more insight into the topic by challenging the researcher to seek the answer to particular foreground questions that examine comparisons, such as two perceptions of African-Americans’ glycemic control. In addition, the findings help define major study types, such as randomized controlled trials, meta-analyses, and systematic reviews, and enable the researcher to decide on the best data sources.
References
Brownson, R. C., Fielding, J. E., & Green, L. W. (2018). Building capacity for evidence-based
public health: reconciling the pulls of practice and the push of research. Annual review of public health, 39, 27.
Buttaro, T. M., Trybulski, J., Sandberg-Cook, J. (2017). Primary care. A collaborative practice
(5th Ed.). St. Louis, MO: Elsevier.
Chen, Y. Y., Li, C. M., Liang, J. C., & Tsai, C. C. (2018). Health information obtained from the
internet and changes in medical decision making: questionnaire development and cross-sectional survey. J Med Internet Res, 20(2), e47.
Khosla, L., Bhat, S., Fullington, L. A., & Horlyck-Romanovsky, M. F. (2021). HbA1c
performance in African descent populations in the United States with normal glucose tolerance, prediabetes, or diabetes: a scoping review. Preventing chronic disease, 18, E22.
Lynch, E. B., Mack, L., Avery, E., Wang, Y., Dawar, R., Richardson, D., ... & Fogelfeld, L.
(2019). Randomized trial of a lifestyle intervention for urban low-income African Americans with type 2 diabetes. Journal of General Internal Medicine, 34(7), 1174-1183.
Makori, E. (2019). The Hemoglobin A1C of African-Americans/Blacks with Diabetes Mellitus
Type Two Using Low-Fat Diabetes Plate Diet. Andrews University.
Pappachan, P. (2019). Use of Dietary Education Intervention for Adult Asian Americans with
Type 2 Diabetes (Doctoral dissertation, University of Massachusetts Global).
Phillips, Q. (2021, April 29). A1C less reliable for diabetes diagnosis in people of African
descent - DSM. Diabetes Self-Management.
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