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Research Summary and Ethical Consideration

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Research Summary and Ethical Considerations

Grand Canyon University NSR-433
Professor Stone
August 15, 2015

Research Summary and Ethical Considerations
Type 2 Diabetes can be prevented with certain lifestyle changes such as increased physical activity, healthy dietary habits, and weight loss. However, A better understanding of what motivates lifestyle changes and the barriers that prevent the life style changes, especially among overweight individuals with risk of T2D was needed. The study, Motivators and barriers to exercise among adults with a high risk of type 2 diabetes – a qualitative study, was preformed to help fill this knowledge gap. The purpose of this study was to describe the motivators and barriers to exercise among subjects with a high risk of T2D. (Korkiakangas, 2010)

Background of study
While there was previous research study, the Finnish Diabetes Prevention Study, motivations and barriers to exercise with individuals with Type 2 Diabetes. Prior to this study, there was only one research study on motivation and barriers to exercise with individuals at risk for Type 2 Diabetes. The purpose of this current research study is to obtain more information and to identify and describe the motivators and barriers to exercise among subjects with a high risk of T2D. The obtained information will be used to develop content and methods for counseling. Nursing will be able to use this new developed content and methods for counseling to help guide the patient that is at risk for T2D to improve their overall quality of life. Research has shown that diet and exercise has prevented and improves glucose tolerance and insulin sensitivity, and positive effects on blood pressure, HDL cholesterol, weight loss, muscle preservation, and increase in quality and quantity of sleep. (Korkiakangas, 2011) The benefits for exercise are obvious, but the most challenging question is the how to increase the level of regular exercise among obese adults with high risk T2D. The information of importance is rarely enough to motivate a sedentary adult to exercise. Individuals need to be motivated by energy, direction, persistence, and goal orientation. Motivation means intentional activity towards intentional activity towards individually meaningful goals that answers two questions, what and why. Extrinsic motivation is based on activity for attaining separable outcomes. Intrinsic motivation is born through satisfaction with the activity itself. Intrinsic motivation is greater than extrinsic motivation, for continuous physical activity and maintenance have been shown to be fostered by greater intrinsic rather than extrinsic motivation. They are not opposites due to the former can lead to the latter. (Korkiakangas, 2011)

Methods of study The qualitative research study included 74 participants: 33 men and 41 women with the mean age of 49 from 4 municipalities in Finland. Either nurses or doctors recruited each participant from either an occupational or a primary health care. The subjects had to score greater than 15 points on the diabetes risk test score or an increased risk of work disability assessed by the occupational nurse or doctor or elevated fasting blood glucose, or impaired glucose tolerance an oral glucose tolerance test in the last 12 months. During the recruitment duration the following exclusion criteria was applied to potential participants: anyone taking medication to treat obesity, poor control of depression or other mental problems (medication) or those with crises in their lives. Five video conferencing groups (VC) lived greater than 80-100 Km from the counsellor. Six face-to-face (FF) groups that lived in the same proximity and the counsellor were present in the same room as the participants. Formation of the groups included 5 to 9 participants per group. Individuals formed groups from the same municipalities, one male only, one female only, same employer, same city, and one from multiple employer group. Every 2 weeks for 1.5 hours, the groups would meet both face-to-face or video conference for counselling on dietary and exercise for the total of 6 months. The focus of dietary included: dietary habits, behavior changes, and frequency of meals, food quality, and weight management. Exercise interventions: the participants were informed of a previous study of that T2D could be prevented through lifestyle changes including the positive impact of exercise and given a pedometer. Prior to the fourth session, the participants were asked to do a voluntary exercise-related homework. The homework asked each participant to exercise with a family member or friend and record the amount of time and number of steps taken during the week. In previous sessions, the participants had already started several discussion of exercise; this was the similar topics in all 11 groups. All sessions were video-recorded and individuals participated in the group discussion and individual recording sessions. (Korkiakangas, 2011) The data from exercise discussions were sampled from the video-recordings (81.5 hours) which formed the qualitative data of this study for analysis. All and any discussion of exercise was transcribed verbatim from recordings. The data was analyzed by inductive content analysis and qualitative research software (QRS International Pty Ltd). During the analysis the researchers, read and watched the transcripts and videos multiple times until to obtain an overall idea of it. The units of analysis were specified as word, clause, sentence, part of a clause and part of a sentence. The gathered content was further divided and subdivided into categories and labeled either motivators or barriers. The application of QRS software to inductive content analysis was an excellent tool for inductive content analysis. Nursing will be able to take the results and apply it to their current practice to motivate and dismiss any barriers that are indicated by this study to their current patients. (Korkiakangas, 2011)

Results of study
This study was to describe the motivators and barriers to exercise among high risk individuals for T2D. The top five main category motivators include: tools for monitoring own exercise, pleasure from exercise in nature or with a pet or loved one, encouragement and social support, increased health benefit of decreases in weight and blood pressure, and the important life value of exercise as a role model for their family. (Korkiakangas, 2011) Success in increasing exercise included both intrinsic and extrinsic motivators. Intrinsic motivators include pleasure, good feelings, feeling of success, company of pet, loved one, or friend. Extrinsic motivators included the dietary and exercise journals, pedometers, heart rate monitors, social networking, group counseling and fellow companionship. (Korkiakangas, 2011)
According to the study exercise, motivation has an important role in long-term weight management with intrinsic and extrinsic sources of motivations as the most important. (Korkiakangas, 2011)
Nurses should discuss which intrinsic motivators in their counseling sessions are most important to the patient. Provide the patient with access to extrinsic motivators. The combination of these motivators will produce results of continued health, weight loss, and prevention of type 2 diabetes. The top five main category barriers include: work related stress, fatigue, and long workdays, season or weather, health problems like chronic illness or back or knee pain, no interest exercise had no meaning at all to the participants. The total number of barriers reported was less than the motivators described. (Korkiakangas, 2011)
Assessment of the reliability of the study including the three aspects of credibility, dependability, and transferability to verify the outcomes were evaluated during this study. The aim of the study was to describe the motivators and barriers experienced by adults with high risk or T2D. The participates already had prior knowledge of their risk for T2D and voluntarily participated in the group counselling sessions to learn to control their weight to live better, thus the individuals were motivated to change their lifestyle. Data analysis confirms credibility as good. Cameras could have influenced the results, but the individuals were relaxed and neutral. Having group decisions could potential influence the viewpoint of the individual of the perception of a barrier vs motivator. This was alleviated by providing individual recorded sessions. Situation specific factors in the group that may affect or influence group discussions include age, sex of individual, role of counsellor, group type (VC or FF), content ,and methods of counselling. (Korkiakangas, 2011)
Nursing can mitigate the barriers to exercise to prevent diabetes by already having the solutions to the barriers. Exercise will decrease stress and provide the mind to clear. Providing education on how to overcome the barriers at work include: walking during breaks and lunch, parking the furthest away from the front door, or taking the stairs vs elevators. (Haupert,n.d.) Chronic illness and pain can be great barriers, educating the patient to start slow and continue to make slow but steady progress will build endurance and stamina. Weather is always a challenge, education including exercising indoor at the mall or joining a community center, preparing for the weather by having the right equipment can make the patient successful. The barrier of no interest can be a challenge, continuing to motivate, include, and encourage might change the mind of the patient. Nursing can make frequent contact with the patients and provide praise and recognition. Instead of telling at risk individuals to exercise, this allows the nurse to provide an action plan for the individual. The benefit of exercise to the individual could be unlimited. Nursing will be able to have an educated response to barriers and be able to assist with providing solution.
Ethical Considerations
The study received approval from the ethics committees of the Hospital District of Helsinki and Uusimaa. The participants received oral and written information regarding the study and signed consent was given. During the recruitment duration, the potential participants had given permission to be a potential participant. During the first session, the counsellors repeated the information in the face-to face or video conference. During the discussion the level of confidentiality on both participant and study were approved. The results of the study were reported with assurance that the identification of participants has been render impossible. (Korkiakangas, 2011)
Conclusion
Motivators are personal and have to have meaning to the adult that is at high risk of developing T2D. It is promising that the barriers are less than the motivators providing a basis for counseling and education potentials. Further research is needed regarding work related barriers for at risk adult. The results can be useful when developing a counselling plan for at risk adults. (Korkiakangas, 2011)
Nursing can affect the lives of high-risk adults by educating the individuals of the motivators and barriers to improve the individual’s quality of life. Prevention of type 2 diabetes is important to reduce the number of other complications. Nursing is able to apply this to a variety of situations and help the individual succeed.
References
Haupert, T. (n.d.). Lose Weight With a Busy Schedule. Retrieved August 15, 2015, from http://www.health.com/health/gallery/0,,20568004,00.html
Korkiakangas, E., Alahuhta, M., Husman, P., Kienanen-Kiukaanniemi, S., Toonila, A., & Laitnen, J. (2010, February 14). Motivators and barriers to exercise among adults with a high risk of type 2 diabetes – a qualitative study. Retrieved August 9, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/20384973
Lindstrom, A., Louheranta, A., Mannelin, M., Rasta, M., Salminen, V., Ericksson, J., . . . Tuomilehto, J. (2003, December 1). The Finnish Diabetes Prevention. Retrieved August 10, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/14633807

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