Diabetes mellitus is a major health problem worldwide. It covers 5.

2% of the

total world population death. According to WHO (2007), 190 million diabetics

worldwide and is expected to increase to 330 million by 2025. According to the

National Health Interview Survey, between the years 2008 to 2009 a total of 23,525

million teenagers in the United State newly diagnosed diabetes mellitus. Whereas in

2009-2012 a total of 208,000 million in the diagnosis of diabetes. This shows an

increase in cases of diabetes among adolescents.

I served as the Assistant Medical Officer (AMO) at the Medical Outpatient

Department (MOPD) in a government hospital in Malaysia. Has served over 10 years

in this department. On annual record collected, found cases Type 2 Diabetes Mellitus

(T2DM) at MOPD is increasing especially among teenagers. Despite all efforts, such

as health education, health promotion and seminars, but the increase in cases of

T2DM among young people is a serious concern. I would like to do some research

and criticism of this research to evaluate the effectiveness of strategies for education

conducted by researchers on youth at risk for T2DM disease. The strength of this

strategy will be implemented in the workplace in the health education program.

Evidence Based Practice (EBP) method will be used to review the problem. In this

paper, the focus is on educational strategies and types of research studies used to

support evidence in practice. The next step will be the presentation of the study will

extract method used to support the current health care practices and in the future.

The critical appraisal tool used to critique the study will also be described. Next I

made a criticism of the research evidence. I also discuss the implications of the

findings and a final conclusion to the main points that have been documented in this

paper.
 EBP is defined in a variety of forms and meanings. It is a process to evaluate

research, information resources, and clinical guidelines based on the findings of

quality and practice it in the work arena. Sackett et al. (1996), defines EBP as the

integration of systematic clinical research experience with individuals with the best

external evidence. According to the IOM (2001), EBP is the integration of best

research evidence with clinical expertise and patient values. The importance of EBP

is to provide quality care and service to patients. This will increase the efficiency and

effectiveness of health care services when based on research (Burns & Grove,

2007). However, like any concept, there are strengths and weaknesses using EBP in

health care. EBP strength is to learn from the mistakes of others, seeking

procedures, use of resources and best clinical practices (Straus 2000).

In this assignment, I will explain critically review an example of the research

article I have selected. To find research papers related education strategy diabetes

mellitus, I use Database academic vary. In addition to NORA official website

Northumbria University, I also use a Pubmed, Proquest, Ebsco to extract relevant

literature. By simply inserting the word 'education strategy' I found various research

papers on educational strategies related to diabetes mellitus. However, the search is

limited to studies in English only and articles published in the last 4 years. I have

taken a total of 100 relevant articles from the database. That amount was reduced to

10 after the article was made on the screening study abstract and title. In this article,

I have chosen the study by Moura and fellow of educational strategies with

adolescents at risk from diabetes mellitus: a comparative study (Appendix 1). The

action plan was presented to Professor Derek Anthony Hayes and he has given

approval to use the study as criticism research (Appendix 2). This study was chosen
because it is a comparative study comparing the effectiveness of adolescent

knowledge and behaviour after participating in two educational strategies.

In writing this, I use PICOT approaches to research literature. Use this format

could help me find the best research evidence efficiently and quickly. PICOT is

referring to (P) population, (I) intervention, (C) comparison, (O) outcome and (T)

timelessness. Based on the research article is selected, the researcher used the

teenager as population. Interventions refer to the educational strategies used by the

individual and the group. Comparison refers to the method of comparative study.

While the outcome is knowledge assessment and behaviour before and after the

study is done. Timelessness refers to the time period of the study carried out for 4

months.

Critical assessment is a key element in the EBP. It is a process of review of

research papers systematically to find their strengths, weaknesses and new ideas.

According to Brink & Wood (2001), to determine the strengths and weaknesses of a

study should be carried criticism of the study. The findings will be relevant in

implements to improve the quality of patient care and management in the field of

medicine and health. This assertion is supported by Regan (1998), he said optimal

patient care can be implemented through EBP adjustments. According to Valente

(2003), to assess the ability and suitability study has to use the criticism. With this

method, can help researchers make the best decisions that can benefit future

patients and health personnel. There are a number of critical appraisal tools that can

be used for evaluation and critique research paper. Among the cohort study

checklist, checklist case control study, a randomized controlled trial checklist, step by

step checklist and nurse researcher Roe B checklist. In this assignment, I use Roe B

(1993) undertaking a critical review of the literature Nurse Researcher as critiquing

tools for analysing research papers (Appendix 3). It consists of 11 questions that are

easily understood and followed. The questions submitted are covering every aspect

of research and study to determine the findings from this study are valid and reliable.

Its use enables me to analyse and criticize more careful and systematic in all

aspects such as introduction, literature review, hypothesis / objective, design,

methods, results, discussion, conclusions and references.

Title criticized the study for educational strategies with adolescents at risk

from diabetes mellitus: a comparative study. The study was written by Ionara

Holanda de Moura, Abiude Nadabe e Silva, Joaquina Silvaneia dos Anjos, Thiago

Henrique Uchoa de Castro, Ana Roberta Vilarouca da Silva from Federal University

of Piaui: and Paulo Cesar de Almeida from Federal University of Ceara. Here the

researchers did not specify academic qualifications, experience and their positions.

This information is important as an indicator of knowledge and skill of the author in

the study. According Conkin Dale (2005), author of academic qualifications and

positions can measure the knowledge and experience of the authors in this field.

Title of a study published by researchers is clear, concise and informative. Word

length of 10 to 15 words is appropriate where it is easy to understand and has done

research purposes. The title of the study can be written in the form of questions or

statements that are subject to conformity assessment. This study, the title is written

in the form of a statement. The author has clearly stated objective of the study is to

compare the knowledge and attitudes of adolescents at risk for T2DM after the

implementation of two strategies of education for individual and groups. According

Connell Meehan (1999), the title of the study must be clear and objective and

between 10-15 words, While Parahoo (2006), state the title of a study to be

misleading if it is too short and long term.

 In this study, researchers present a clear and concise abstract of the study.

Abstract the study aims to describe the methods used, the number of samples taken

and how the selection was done. At the end of this abstract, the researchers

presenting the results and conclusions of this study. Abstracts should be able to give

a brief overview of the research and has information that includes the purpose of the

study, the method, the size of the sample and the selection method, findings,

conclusions and recommendations (Conkin Dale, 2005). Parahoo (2006), was of the

opinion that the reader can determine the importance of a study by an abstract

submitted.

The literature review is an important element in the research paper. The goal

is to determine or develop research questions as well as identify appropriate data

collection method (Burns and Grove, 1997). Dempsey and Dempsey (1996), argues

literature review aimed to identify the findings of other researchers to solve the same

problem. Researchers typically use a literature review of primary sources and others

using secondary literature sources. In this paper, the researchers used the review of

relevant literature on the topic of the study. Various sources are used as a source of

reference journals, internet, healthcare organizations and related books. There are

14 different references used by researchers in the writing of this study. Most

references were used in the year 2000 and onwards. Referral sources were

prepared in order to use the alphabet of the Harvard reference method. A total of 14

references were submitted is sufficient for researchers to come up with a good

review, informative and relevant to the topic of the study.

Methodology refers to how research is conducted. Here are some important

elements to be analysed, such as design, sampling techniques, sample, sample

size, data collection and ethic. Research design is a plan, blueprint or guide data
collection and interpretation. A research design rule for researchers was getting the

idea of doing a study (Adams & Shavaneveldt 1991). The design study is an

important component is the backbone of research and writing in a research study.

There are many designs of research studies. These include both quantitative and

qualitative. The rules are different in terms of objectives, concepts, sampling, study

design, data collection and data analysis. Quantitative research is a systematic

review, objectives and using numerical data and conducted formally. It is more about

testing a theory, building a fact and then describing the incident as a statistic.

Whereas qualitative research is concerned with the study of the subjective approach.

According Vishnevsky & Beanland (2004), qualitative research cannot be regarded

as an objective. In this assignment, I opted for research papers quantitative

methods. Burn and Grove (2001), said the researchers used a quantitative

approach for collecting information in the form of a numerical and a decision based

on rigor, objectivity and control.

Non experimental techniques used in this study. Non experimental study was

descriptive in nature as it does not manipulate or control variable of the study.

Researchers will describe the phenomenon that occurs as usual. In this study,

researchers did not explain the cause and effect relationship, but it gives a more

accurate research results. Non experimental research used by the author is

characterized by comparative studies. Comparative study is a study to investigate

the differences between the study groups on the dependent variable being studied.

According to the IOM (2009), a comparative study is a comparison of the benefits

and harms to prevent, diagnose, treat and monitor and improve health care. Here it

can be said that the study design is clearly illustrated by the researcher.
 In this study, the authors used the school-going youths in the age group 11-19

years as a sample survey. From the investigation conducted with 794 adolescents in

Fortaleza, found that at least 39 % have two risk factors for T2DM. Thus the

selections of this sample are appropriate, accurate, and focus on the research that

has been done. According to Russell (2008), corresponding to the sample selection

criteria of the study is important to researchers. Calculation of sample size was not

clearly stated. The researcher simply stating a formula adapted to the situation. The

sample in this study consisted of 60 people and divided into 2 groups: GA and GB.

Each group of 30 samples chosen at random. According Burn & Grove (1993), the

random sampling method is the most successful. Of the total sample, 56.7 % were

female and 81.7 % among students is low. Total sample between the sexes in this

study was nearly balanced between males and females. However, sample division

between primary and secondary level students there are disadvantages in which

almost the entire sample was selected among the students of primary level. This will

affect the results of the study, given the low level of students immature thinking.

Collecting data in this research are conducted in phases. GA Group

conducted in December 2011 - March 2012. While the GB in March - June 2012.

Questionnaire method used for assessing the level of knowledge and change

behaviour before and after the educational intervention. A questionnaire is the most

common instrument used in data collection. According to Polit & Beck (2006), a

study questionnaire can be done either by interview or by telephone. To measure the

level of knowledge among the group, the scale score is divided into six categories

ranging from 0 - 10. While the measure behavioural change is by changing the diet

and encourage physical activity daily. This intention was self - reported as yes or no.

To get information from the sample, the researcher using the pre - test before the
educational intervention and post -test the day after the intervention and 60 days

from it. The GA of education individually, sample supplied folder on the draft, sign

and symptom, acute and chronic complication risk factors and prevention T2DM.

Divided into three small groups and individual education given once a week for each

group. While GB, education is offered in a group. T2DM subjects which are taught

about the same as GA. The focus on participation, opinion and interaction between

researchers-students. Using teaching aids such as clipping, cardboard, glue, scissor,

paper etc. The sample is divided into two subgroups of 15 people each subgroup.

The meeting was held by 5 times between subgroup. Here, the methods used by

researchers in individual and group education are systematic and consistent with

teenagers. While the division subgroup on education makes learning more effective

strategy. In addition, polling data also using modern methods such as Excel 8.0 and

processed using the statistical package for social sciences (SPSS) 17.0.The Fisher-

Freeman-Halton and Z test were used for proportions. With this method effective

data can be collected.

In quantitative research, a pilot study is an important element. With the pilot

study, the sample size of the study will be obtained to determine the size of the

effect. In this study, the researchers did not follow the correct procedure, which does

not carry out a pilot study to determine the effect size. The importance of the effect

size is to get a real impression of the size and cost of the study. According to Polit &

Hungler (1997), pilot study may avoid wastage costs and doubt the accuracy of the

study.

Every review must comply with the ethics that have been set. This study

follows the proper etiquette. The truth of the respondents was not even mentioned

here. This study is voluntary without any incentives given to respondents. In addition,
all data and information is kept confidential subject. ANMC (2007), said maintaining

individual privacy is a moral obligation in nursing practice. This study was approved

by the Ethics Committee of the Federal Research University Piaui in accordance with

the protocol CAAE 0109.0.045.000-11.

Researchers presented data discovery and analysis of the survey results. The

collected data are analysed in table form. From the analysis performed, there is a

change in knowledge before, on the first day and 60 days after the intervention. The

level of knowledge found between GA and GB is equal to the pre-test: p = 0.923,

post-test: p = 0.999 and late post-test: p = 0.473. While the mean scores on the first

day and 60 days after intervention between GA and GB have a higher average value

than the average before the intervention: p = 0.0001.

In the analysis of attitude, there are lifestyle changes related to eating habits

among the group of GA: p = 0.001 and GB: p = 0.004. As for physical activity, a

change in attitude only in GB: p < 0.0001. In this study, the focus needs to be given

to the respondents of GA and GB is unable to change their attitude. This is because

they claim a lack of interest and the strategies used were not motivating them.

From the analysis, it was found that the research provides many information

and ideas in my practice arena. Although this study has a limitation of the study

period is short and less monitoring, but it managed to increase knowledge

respondent about T2DM. Therefore, this study, according implemented as EBP at my

workplace for the prevention of T2DM program to at-risk youth.

I propose that handle personal health education program to diversify health

information delivery strategy. Use interesting and effective approaches such as

computer use, scissors, paper, glue and so on. Through this method, they can focus
on teaching. In addition, organized outdoor activities such as diabetes prevention

camp. With this activity, participants will undergo a program of practical activities

such as controlling how foods and physical activity proper technique. This situation

can be overcome bored and disinterested as argued by the respondents in this

study.

In addition, I also propose that the program of health education with

recognized qualifications. They should have a basic post diabetic management to

enable them to become a diabetic educator. With these credentials, they can deliver

health education effectively and efficiently. In addition, they can also combine the

information from this study with the knowledge and experience to help the prevention

of T2DM among adolescents.

In conclusion, EBP has an important role to improve the efficiency,

effectiveness and quality of work in the clinical area. Positive results from the study

can be used to improve the quality of prevention, treatment and health care. In

addition, the latest information and ideas of criticism and analysis of informative

studies can improve the development of the profession in which health professionals

will benefit the development of medical technology and health.

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