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Diabetes is the illness of the chronic character that is common worldwide. Annually, thousands of people are diagnosed with one of the diabetes types. As the illness manifests itself as life-threatening if not treated on time, patients with the confirmed diagnosis of type 2 diabetes tend to dramatically change their life habits. Therefore, the transformation of one’s lifestyle triggers behavioral changes. On the basis of the concrete diagnosis, patients comply with specific interventions. Most individuals become more self-aware and stop taking their health for granted. However, some people perform a poor self-care management. Nola J. Pender did a great work describing behavioral changes in patients. The behavior change model she introduced confirms that human attitude and actions affect the outcome of diabetes treatment. If properly educated, any person with diabetes can achieve major health improvement. On the contrary, poor education and insufficient medical support lead to diabetes complications and unwanted outcomes. Thus, the current research paper investigates the issue of behavioral changes in diabetic patients, the background of these changes, achievable goals of the changes and downsides of negative behavioral responses. If methods of educations are applied correctly, the changes in behavior of diabetic patients might be predictable. However, one can also foresee negative behavioral changes in patients who did not receive education. Thus, it is vital to investigate the case and its related concepts.

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Behavioral Changes in Diabetic Patients

Diabetes is a metabolic disorder, when the blood glucose level increases faster than the level of the insulin hormone, which is responsible for its maintenance. High levels of glucose present in blood may cause various complications to the functioning of organs in the human body. If the disease is left untreated, any person is at a high risk of kidney failure, strokes, blindness, heart attacks, amputation of the lower limbs, and even sudden death. Diabetic patient numbers has grown significantly during the last four decades. The global prevalence of patients with diabetes is at its peak in countries with low or middle income and among adults who are overweight or obese. In 2012, approximately 2.2 million deaths from high blood glucose levels were reported, while 1.5 million died from diabetes itself. However, if patients with type 2 diabetes are educated about self-care and medication appropriately, they will perform correct management of glucose levels and make sure to prevent long-term complications. Therefore, the aim of the current research proposal is to investigate behavioral changes in diabetic patients in view of obtained education or its absence and describe the outcomes in both of the cases.

Definition of Key Terms

Diabetes: is “a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both” (American Diabetes Association [ADA], 2014).

Hyperglycemia of diabetes: “long-term damage, dysfunction, and failure of different organs, especially the eyes, kidneys, nerves, heart, and blood vessels” (ADA, 2014).

Deficient insulin action: “inadequate insulin secretion and diminished tissue responses to insulin at one or more points in the complex pathways of hormone action” (ADA, 2014).

Glucose level: the level of sugar present in the blood, which is 70 – 130 mg/dl if a person is hungry and is lower than 180 mg/dl if a person had a meal (Cherney & Morrison, 2015).


This research is aimed at defining the changes of behavior in diabetic patients only. The paper does not present research concerning ethnicity, age, or gender. Patients with diabetes represent only general information about their behavioral changes, with no concrete measures and definitions exceeding the research limits.

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Theoretical Rationale

The current research proposal is grounded on the theoretical model created by Nola J. Pender called the Health Promotion Model (HPM). This model encloses several constructs. The main background of the HPM is the social learning theory designed by Albert Badura in 1977, who believes that cognitive processes are vital in the aspect of behavioral changes. Initially, the social learning theory included self-attribution, self-evaluation and self-efficacy. The HPM, in its turn, is premised on self-efficacy as the general idea of the model. Another theoretical foundation that influences the HPM is the expectancy value model of human motivation created by Feather in 1982. According to Feather, “behavior is rational and economical” (Alligood, 2014), which becomes important in Pender’s model.

Evidently, there are fourteen assertions in the model. Briefly, they speak about prior behavior, challenges, barriers, positive emotions, commitment and engagement in actions that lead to positive behavioral responses. The HPM is quite similar to the health belief model in its construction and explains the disease prevention behavior. However, HPM does not put fear or threat as motivational sources. Essentially, it includes behaviors that enhance health and are applicable during the life span. The HPM is a theoretical framework that can predict “overall health-promoting lifestyles and specific behaviors such as exercise and use of hearing protection” (Alligood, 2014). The HPM may divide the population into 1) working adults; 2) older community-dwelling adults; 3) ambulatory patients with cancer; and 4) patients undergoing cardiac rehabilitation (Alligood, 2014). In addition, the Health Promotion Lifestyle instrument measures health-promoting lifestyle according to six subscales, namely health responsibility, physical activity, nutrition, interpersonal relations, spiritual growth, and stress management (Alligood, 2014). In other words, the HPM aims to identify cognitive and perceptual factors that are the major determinants of health-promoting behavior.

Problem Statement

The PICO question of the current proposal is the behavioral changes in diabetic patients to prevent complications on the basis of poor insulin-responsive illness. Here, PICO elements are explained as P – a patient with type 2 diabetes, I – patient education, which improves self-management of diabetes, C – medication (metformin) and O – management of glucose levels to prevent long-term complications.

Currently, the situation with exposure to diabetes in the world is rising. If there were approximately 108 million of diabetic patients in 1980s, in 2014, the number was 422 million (Roglic, 2016). Nowadays, these numbers are even higher. The past decade has shown that diabetes tends to prevail in countries with low and middle incomes and among individuals suffering from obesity. Therefore, partial responsibility for the development of diabetes lies in unhealthy choices in one’s lifestyle. What is more, people with diabetes and their families experience economic loss due to extensive medical costs and inability to work. With regard to health, diabetic patients might have complications of various kinds (heart attacks or strokes, loss of vision, kidney failure, limb amputation, and nerve damage) that may occur suddenly and lead to unexpected death.

Contextually, the problem of the increasing wave of diabetes is associated with inappropriate management of medical and lifestyle interventions. The most common behavior diabetic patients tend to practice is sedentary lifestyle. This behavior is characterized by “too much sitting and too little physical activity, which contribute to cardiometabolic health outcomes and premature mortality” (Dempsey, Owen, Biddle, & Dunstan, 2014). According to Walker, Smalls, Hernandez-Tejada, Campbell, and Egede (2014), self-efficacy is “a well-studied psychological construct that is consistently associated with health behavior” (p. 3). Badura, in his turn, defines self-efficacy as “the ability to perform goal-directed behaviors, when confronted with impediments, in a confident manner” (Walker et al., 2014). Numerous studies have investigated the role of self-efficacy in behavior prediction in patients with manifestations of diabetes. It was established that positive patient attitude is one of the strongest factors in self-care and leads to accurate disease management. On the basis of results, self-efficacy strategy can predict self-care management. Thus, Clark indicates that self-efficacy is “a relevant construct trying to explain the adoption of healthy behaviors such as exercise” (Walker et al., 2014).

According to Zhuo et al. (2014), the failure to change negative behavioral manifestations that prevail in patients with type 2 diabetes might lead to devastating results (Zhuo et al., 2014). On the grounds of the research conducted by Zhuo et al., the lifetime spending for diabetic patients was $124,600, $91,200, $53,800 and $35,900, when the diagnosis was given when they were forty, fifty, sixty, and sixty-five years old (Zhuo et al., 2014).

Among the presented scope of information available, there are issues, which require certain attention. For instance, behavioral changes in diabetic patients are not being discussed concerning ethnicity, age, gender, economic status and severity of type 2 diabetes. Unfortunately, the data is very broad and there is a need to investigate and group it in several years. Although some information relating to the age category and gender is present, it does not give the picture of international diabetic patients, namely a picture of every ethnic representative and their behavioral changes in view of the obtained education.

In order to solve the occurring problem, there is a need to investigate what kind of behavioral changes are present in diabetic patients, who underwent specific education, and were advised how to lead a healthier way of life. Only after finishing the current research, it will be possible to conduct further researches and deeper investigate the problem and its character.

It is crucial to handle the problem of behavioral change in diabetic patients is significant, as it can prevent negative responses of an individual and program them to lead a healthier lifestyle, eat healthy foods, exercise more and take the required medicine. Being aware of the opportunities and changing one’s way of life, a person may achieve positive outcomes and limit diabetes-related complications. People who are not properly educated on the possible changes and lifestyle interventions tend to be depressed and not willing to cooperate with doctors in any kind of treatment programs. Therefore, they consciously “kill” themselves due to sheer unawareness that there is another way of coping with type 2 diabetes.

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Review of Related Literature

The book Nursing Theorists and Their Work by Alligood (2014) is a valuable source providing information about theorists and their theoretical frameworks. Among such theorists, there is Nola Pender and her Health Promotion Model that is described in detail. This model is created to investigate behavioral changes in individuals with one of the common illnesses and trace these changes. What is more, the model of behavior of a concrete human can be projected on the basis of the way a person is educated and treated in the medical setting. Therefore, the current book is an outstanding source for the particular research.

The chapter of the book “Health Promotion Theories” by Raingruber (n. d.) also discusses health promotion theories and concepts dedicated to these theories. It mentions various theories, among which one can find that of Nola Pender. In addition, the chapter displays certain steps and processes that should be performed for changes to take place.

The article “Diagnosis and Classification of Diabetes Mellitus” by American Diabetes Association defines diabetes mellitus and explains the reasons for its occurrence, the way this disease manifests itself and the related factors. Therefore, the paper underlines every fact in relation to diabetes, the way a person can be diagnosed with diabetes, factors that show the possibility of developing diabetes and different interventions, and treatment that should be implemented in order to prevent possible complications. If not treated properly, diabetes may cause malfunction of the body organs, limb amputation and even sudden death. Thus, the given source is valuable to understand the progression of the illness and possible outcomes.

The report “WHO Global Report on Diabetes: A Summary” by Roglic (2016) is a source providing concrete data on diabetes manifestations over the past 36 years. The occurrence of diabetes has not only doubled by 2014, but also lowered the age of its sufferers. The report discusses such issues as obesity, low-income territories and poor medical support or sanitary circumstances that predispose people to the development of diabetes. This source is valid because it gives insights into the world situation with diabetic patients and marks different ways to overcome the disease.

The article “Effect of Diabetes Self-Efficacy on Glycemic Control, Medication Adherence, Self-Care Behaviors, and Quality of Life in a Predominantly Low-Income, Minority Population” by Walker et al. (2014) is a very good source of information on self-efficacy and self-management of any disease diagnosed. The paper speaks about possible interventions and how self-efficacy is important and life-changing. Glycemic control, which is one of the types of diabetes treatment, is an inevitable part of the healthy lifestyle and healthy choices. Therefore, the article is very important to the current research paper.

Another source that provides valuable information is the article “The Lifetime Cost of Diabetes and Its Implications for Diabetes Prevention” by Zhou et al. This article examines the lifetime costs that were spent on diabetic patients of certain ages. Zhou et al. believe that preventive behaviors will reduce the enormous sums diabetic patients incur and promote good lifestyles. Thus, the situation with regard to cost spending is rather crucial and needs improvements.

The article “Budgeting for Diabetes Health Costs” by Iliades (2016) elaborates on the costs of supporting a patient with the diagnosis of diabetes. According to the author, the spending is extremely high and should be reorganized (Iliades, 2016). If patients had the knowledge of positive self-care, medical institutions would not have to spend numerous dollars on maintaining the blood glucose levels of diabetic patients.

You may find the article “Nursing PICO Writing Help” useful.

The article “Managing Sedentary Behavior to Reduce the Risk of Diabetes and Cardiovascular Disease” by Dempsey et al. (2014) defines sedentary behavior as one of the negative means leading to health complications. If patient, who have diabetes lead a sedentary life, the chances of sudden death are inevitable. Therefore, the paper discusses the gathered evidence about sedentary lifestyle and tries to improve the current lifestyle and develop targeting interventions. This article is useful in the current research, as it sheds light on the behavior of people with diabetes and the dangerous consequences it hides.

The article by Cherney and Morrison (2015) “How to Lower Blood Glucose Levels” presents information about normal levels of sugar present in blood of both normal people and people diagnosed with diabetes. Therefore, this article is valuable to the following research, as it gives an insight into why high sugar levels are dangerous for human health.

Research Design and Method

The research method chosen had the time frame of approximately 30 days. On the basis of Nola Pender’s behavioral change model, the research included two basic groups, namely the intervention group and the control group of working adults. Half of the patients of different ethnicity, gender and age (> 18 years old) were randomly allocated to the first group, and the other half constituted the second group. The intervention group had specific counseling according to the dietary needs, physical exercises, weight control program and education on medication management together with certain lifestyle changes. Several specialists, including the dietarian, specifically trained nurses and lecturer, monitored the intervention group. The control group had no education in regard to the possibility of changing their lifestyle and received the standard care (medication only). As it was predisposed, the control group had to be managed only by several nurses, who simply monitored the status of the patients’ health. By educating one group and simply observing the other one, it was meant to investigate which of the two participating groups will be more likely to develop positive diabetes treatment responses.


In order to learn the differences and behavioral changes occurring between the intervention group and the control group, a survey has been conducted after the experiment took place. The survey contained multiple questions that had to be answered individually. The questions were grounded on the possible changes/no changes in the routine diabetes management and asked whether the patients received solid education and valuable information. In addition, the survey asked whether they continued self-care on the newer and more self and diabetes aware levels or their daily life remained the same. The group that did not receive any education had to pass the survey accordingly. Another instrument was observation, meaning that nurses that handled diabetic patients observed the participants on the daily basis.

Work Plan

The method and the instrument appeared to be appropriate and helpful in the current research. The intervention group had lectures every day, which discussed information about diabetes and its manifestations. Afterwards, the intervention group participants had individual conversation with the dietarian, who advised the patients on the best type of diet; in the end, the current group had the ability to practice some exercises. As it has shown, with the help of guidance, constant support and helpful personnel, diabetic patients found it easy to change their diet and do more exercises as well as they were healthier and looked happier. On the contrary, the control group, which simply came for medication intake and chat with each other, had no visible changes in their attitudes or actions and even showed the lack of inspiration or energy.

According to the behavioral change model (Table 2), the intervention group has met four stages of change, four stages of processes of change, decisional balance, self-efficacy and temptation (Raingruber, n. d.).

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Behavior Change

Source: (Raingruber, n. d.).

The table addresses the steps each human takes on the way towards interventions. Apparently, the intervention group has accomplished all of the stages of behavioral change, while the control group remained unchanged.

Therefore, the current research has shown that positive education, supportive information and general support of clinical workers make a difference to diabetes perception. With the help of the set dietary restrictions, patients became healthier, had their blood glucose level managed and did daily exercises. In thirty days, the intervention group participants reported that they felt better and appreciated the obtained help, while the control group remained unchanged. The participants did not feel any inspiration, did not eat healthy, did not exercise, and had unstable glucose levels, while some of them reported depression.


Diabetes education is a costly procedure. According to ADA, “the cost of diabetes in the United States is more than $245 billion a year, which includes direct medical costs and the cost of reduced productivity” (Iliades, 2016). For a person who lives with the diagnosis of diabetes medical spending is 2.3 times higher than for an average person. Diabetic patients receive $7,900 annually and $5,800 on the grounds of problems with health maintenance (Iliades, 2016). Therefore, the costs of the study will be dependent on the number of diabetic patients in the group, educational support of the lecturer, and services of the dietarian and specifically trained nurses. The approximate cost of such intervention as simple education of patient on how to lead a healthier life and self-care will be cardinally lower than in the absence of the particular education. Thus, the projected costs are $200,000 million annually.


The current research proposal aimed to investigate behavioral changes of patients suffering from diabetes. It was found that people with the diagnosis of diabetes tend to practice a sedentary way of life with possible consequential complications. It was also established that with the help of experts, a person can change their lifestyle, feel healthier, display more affection towards life and learn to manage blood glucose levels on their own. People who can maintain self-care are healthier and happier than those who have no knowledge about its management. Therefore, the study has concluded that human behavior changes into a positive outcome with the help of diabetes education, including dietary needs and physical exercises.

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