DNP project

1.Project Title

Improving diabetes management in black Americans through cultural competency training

2.Select if your project is using a translational science model or a theoretical framework and change model. Identify the model used. (translational science model or a theoretical framework)

This project will use a translational science model. Specifically, the Awareness-to-Adherence Model will be utilized.

3.Provide a problem statement (no less than 5-6 fully structured sentences) to explain the issue/problem you are addressing. Please describe current practice/process leading to the issue. Provide any reports or currently available data to document the need identified by primary decision maker(s) at practicum site. NOTE: in this section, you must include in-text citations with your evidence-based intervention.

Black Americans suffer worse diabetes control and higher complication rates compared to other racial groups, with average HgbA1c levels 0.5-1% higher (Assari, 2018). Socioeconomic factors partly drive this disparity but also reflect gaps in cultural competency among healthcare providers (Amuta et al., 2020). Implementing cultural competency training for providers at ABC Clinic, where 38% of our diabetic patients are Black American. This aims to improve cross-cultural communication and treatment adherence in this population. Our clinic’s average HgbA1c for Black patients was 8.1% in 2022 compared to 7.2% for White patients, indicating poor diabetes control.

4.Provide a brief Question, using in-text citations/references, to support the need for change from both a global and practicum site perspective.

Racial disparities in diabetes outcomes are well-documented globally and match patterns observed at our clinic (Goff et al., 2020). Enhancing providers’ cultural competency through training interventions has improved minority health outcomes (McGregor et al., 2019). This evidence supports the need for and potential benefits of implementing a cultural competency program at our site.

5.What is the purpose of your proposed project? Begin your formal purpose statement by stating:

The proposed DNP assignment goals are to enhance diabetes management, as measured with the aid of HgbA1c degrees, amongst Black American patients through implementing a cultural competency education application for healthcare providers at ABC Clinic over a 3-month.

6.Provide your one-sentence PICOT question below. Be clear and concise. Note: your population cannot be students or faculty; your intervention cannot be educational and your time frame must be 8-12 weeks.

How does enforcing cultural competency education for healthcare vendors compared to no training in Black American adults affect HgbA1c tiers over 3 months?

7.Fully describe the population (keep in mind students and /or faculty are not allowed) of your proposed project. What is your anticipated participant size? What inclusion and exclusion criteria will be used to identify your population?

The populace will be healthcare carriers (physicians, nurses, medical assistants) worrying for Black/African American adults with diabetes at ABC Clinic. The predicted sample length is 50 carriers. Inclusion criteria consist of direct care companies for diabetic patients. Exclusion standards include the non-scientific body of workers and carriers not treating diabetic sufferers.

8.You are required to have a minimum of 5 contemporary research articles s (<5 years old) to support your practice problem and evidence-based practice intervention. A minimum of 2 articles should be related to your practice problem and a minimum of 3 articles related to your evidence-based intervention. Please provide a full listing (APA formatted) of the evidence you have to support the EBP intervention you will implement.

Amuta-Jimenez, A. O., Jacobs, W., & Smith, G. (2020). Health disparities and the heterogeneity of Blacks/African Americans in the United States: why should we care? Health promotion practice, 21(4), 492-495.

Assari, S. (2018). Health disparities due to diminished return among black Americans: Public policy solutions. Social Issues and Policy Review, 12(1), 112-145

McGregor, B., Belton, A., Henry, T. L., Wrenn, G., & Holden, K. B. (2019). Improving behavioral health equity through cultural competence training of health care providers. Ethnicity & disease, 29(Suppl 2), 359.

Goff, L. M., Moore, A., Harding, S., & Rivas, C. (2020). Providing culturally sensitive diabetes self-management education and support for black African and Caribbean communities: a qualitative exploration of the challenges experienced by healthcare practitioners in inner London. BMJ Open Diabetes Research & Care, 8(2).

Paguio, J. A., Golbin, J. M., Yao, J. S., Eala, M. A., Dee, E. C., & Yu, M. G. (2022). Self-reported cultural competency measures among patients with diabetes: a nationwide cross-sectional study in the United States. The Lancet Regional Health–Americas, 7.

9.Explain the intervention you will implement to address the issue identified based on the needs of the practicum site. Remember, educational only interventions are not allowed. The intervention should be based on the translational science model you have chosen. You must provide an overview of the intervention so the reader(s) will be able to duplicate the intervention on their own. (Include or attach any relevant documents, if available such as protocols, procedures, guidelines, etc. that you will implement).

A cultural competency training program will be implemented, consisting of interactive online modules focused on implicit bias, cultural awareness, cultural knowledge, and cross-cultural skills. Additionally, providers will engage in open dialogue sessions to facilitate perspective-taking. Relevant training materials on cultural competency from resources such as Think Cultural Health will be utilized.

10.Given you only have 8-10 weeks to implement your project, discuss the project’s feasibility. Will you be able to accomplish everything you want to do as far as implementation in 8-10 weeks? What barriers might you have and how will you overcome them?

While limited to 8-10 weeks for implementation, the online and dialogue components can realistically be completed in this timeframe. Potential barriers like scheduling or technical problems would be proactively troubleshooted. Short-term assessments will determine the feasibility of longer-term sustainment.

11.Fully explain your plans for data collection to measure the impact of your intervention. Include a concise Question of the measurable outcome you identified in your PICOT question. Provide the name of the tool/instrument you will use (if applicable) and discuss its validity and reliability with in-text citations from supporting literature. Additionally, fill out the chart below to concisely convey your measurable outcomes and the name(s) of the valid/reliable survey instrument/tool(s) you will use

To measure the impact of the cultural competency training intervention, the primary data that will be collected is HgbA1c levels from the medical records of Black American adult patients with diabetes at our clinic. The measurable outcome identified in the PICOT question is a change in average HgbA1c levels among this patient population after the intervention is implemented. HgbA1c provides an objective measure of serum glucose control over the previous 3 months. Reduced HgbA1c indicates improved diabetes management. No additional tool or instrument must be utilized as HgbA1c lab values will be directly extracted from patients’ medical records. HgbA1c testing is considered a valid and reliable method for assessing glycemic control, with performance meeting National Glycohemoglobin Standardization Program standards (Paguio et al., 2022). Average HgbA1c levels will be calculated for Black American diabetic patients at baseline before intervention implementation and at the 3-month conclusion of the project. Medical records data will be extracted and deidentified before analysis. The comparison of averages pre- and post-intervention will determine the impact on diabetes outcomes.

12.Measurable Outcome(s) as identified in the PICOT question

HgbA1c levels (average for Black American diabetes patients at the clinic)

13.Data collection process pre- and post-intervention

Medical records will be used to collect HgbA1c levels at baseline before intervention implementation and at 3 months post-implementation.

14.Explain your plan for data analysis. Identify the statistical test(s) you will use to bring meaning to the final data you collect at the completion of your project

Paired samples t-tests will be used to analyze changes in average HgbA1c levels pre-and post-intervention. Statistical significance will be set at p < .05.