The article is attached. Your critique should include the following: 1. Briefly summarize the study (give us context, but do not spend a significant amount of time here. We are most interested in learning about the methods). 2. Introduce the research problem and research objective. 3. Describe the theory used to inform the research. 4. Describe the methodology in detail. 5. Briefly describe the findings and results 6. Provide a personal critique of the research methods, specifically identifying potential threats to reliability and validity and ways to minimize those threats. 7. An APA formatted reference of the article on the final page. 8. A pdf of the article must be submitted with the critique.
articlecritique_written.docx
the_effect_of_diabetes_and_knowledge.pdf
knowledge_of_diabetes_type_2.pdf
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Article Critique
Student will be responsible for choosing one scholarly, peer-reviewed research study from appropriate
scholarly journals. Students will analyze, summarize and critique the study. The study may have a
qualitative, quantitative, or mixed methods study design. It is highly recommended that students choose
an article that informs their research proposals. Students will analyze potential threats to reliability and
validity and ways to minimize those threats. Students will write a two-page critique of the article. The
review should introduce the research problem, research objective, methodology, findings/results
addressed in the article, as well as YOUR critique of the research methods. Please include the source
of the article (reference) in APA format in the reference section. Additional information will be
provided in class. A grading rubric is posted to Blackboard.
Project Description and Rubric
Your critique should include the following:
1. Briefly summarize the study (give us context, but do not spend a significant amount of time here.
We are most interested in learning about the methods).
2. Introduce the research problem and research objective.
3. Describe the theory used to inform the research.
4. Describe the methodology in detail.
5. Briefly describe the findings and results
6. Provide a personal critique of the research methods, specifically identifying potential threats to
reliability and validity and ways to minimize those threats.
7. An APA formatted reference of the article on the final page.
8. A pdf of the article must be submitted with the critique.
Be concise and thorough of your critique. The document should include two full pages of text in APA
format. The APA formatted reference should be on the third page.
The reviews can be prepared from published literature. Students should observe the following rules
about article selection:
1. The selected journal article should come from a scholarly journal.
2. The selected journal article should be at least 6 pages.
3. The selected journal article should have been published within the past 5 years.
4. The selected journal article should focus on research studies related to human health.
Example Public Health Journals:
American Journal of Public Health
Health Promotion Practice
Environmental Health Perspectives
International Journal of Public Health
Public Health & Prevention Journals – Medscape
HLTH 625
Journal Article Critique Scoring
Page 1 of 2
Category
A Level
B Level
Analysis/
Critique
Provides a comprehensive
critique of the research methods
of the article. Addresses
strengths and weakness of study
design, threats to reliability and
validity, and provides ways to
minimize the threats.
Provides a good critique of the
research methods of the article.
Addresses some strengths and
weakness of study design, threats
to reliability and validity, and
provides ways to minimize the
threats.
Provides a weak
Does not provide
critique of the research required analysis and
methods. Lacking detail critique.
in the strengths and
weakness of study
design, threats to
reliability and validity,
and recommendations
to minimize the threats.
Shows a full understanding of
the topic. Comprehensive
coverage of topic (research
problem, research objective,
methodology, and
findings/results)
Shows a good understanding of
the topic, but left out important
information.
Shows a good
understanding of only
parts of the topic.
Does not understand
topic.
Article from a peer-reviewed
scholarly journal; 6 or more
pages long, published in the last
5 years; Included in Bb
submission
Article from a peer-reviewed
scholarly journal; lacking in either
page length or date of publication
requirement; included in Bb
submission
Article from a peerreviewed scholarly
journal; lacking in page
length AND date of
publication
requirement; not
submitted to Bb.
Article not from a
peer-reviewed
scholarly journal; not
submitted to Bb,
Zero spelling, grammar,
punctuation or other editing
errors
1-2 mistake in spelling, grammar, 3-4 mistakes in
punctuation or other editing errors spelling, grammar,
punctuation or other
editing errors
5 or more mistakes in
spelling, grammar,
punctuation or other
editing errors
1-2 mistake in APA formatting or 3-4 mistakes in APA
formatting or other
other errors
errors
5 or more mistakes in
APA formatting or
other errors
40%
Content
30%
Article
10%
Editing
15%
APA Reference/ Reference in APA format; no
mistakes in APA formatting or
Editing
errors on slides
5%
C Level
Failing
Page 2 of 2
Psychology, Health & Medicine, 2017
VOL. 22, NO. 2, 138–144
http://dx.doi.org/10.1080/13548506.2016.1147055
The effect of diabetes knowledge and attitudes on
self-management and quality of life among people
with type 2 diabetes
Yee Cheng Kueha,b, Tony Morrisa and Aziz-Al-Safi Ismailc
a
Institute of Sport, Exercise and Active Living, College of Sport and Exercise Science, Victoria University,
Melbourne, Australia; bUnit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti
Sains Malaysia, Kelantan, Malaysia; cDepartment of Community Medicine, School of Medical Sciences,
Universiti Sains Malaysia, Kelantan, Malaysia
ABSTRACT
We examined the effect of diabetes knowledge and attitudes on selfmanagement and quality of life (QoL) of people with type 2 diabetes
mellitus (T2DM). We employed a cross-sectional study design. A
total of 137 female and 129 male participants with T2DM completed
the diabetes knowledge scale (DKN), Diabetes Integration Scale-19
(ATT19), Summary of Diabetes Self-care Activities (SDSCA) scale, and
Diabetes Quality of Life (DQoL) scale, measuring diabetes knowledge,
attitudes, self-management, and QoL respectively. The SDSCA scale
measures diet, exercise, blood glucose monitoring, and foot care. The
DQoL scale measures satisfaction and impact of QoL. An initial path
model that tested the inter-relationships of the study variables was
first identified based on previous research. Then, the path model was
tested using Mplus 7.3. In the final model, diabetes knowledge was
a significant predictor of attitudes and self-management in terms of
blood glucose monitoring and foot care. Attitudes was a significant
predictor of impact of QoL. Self-management in terms of blood
glucose monitoring was a significant predictor of impact of QoL and
diet was a significant predictor of satisfaction and impact of QoL.
Exercise and foot care aspects of Self-management were significant
predictors of satisfaction and impact of QoL respectively. The final
model showed a good fit to the data: RMSEA = .045 (90% CI: .009, .071;
Clfit = .601), CFI = .950, SRMR = .058. The findings suggest a theoretical
basis to direct the development of appropriate health programs and
interventions for improving QoL in people with T2DM and warrant
replication in diverse samples.
ARTICLE HISTORY
Received 18 August 2015
Accepted 22 January 2016
KEYWORDS
Diabetes knowledge;
attitudes; self-management;
quality of life; type 2 diabetes
Introduction
Diabetes is a chronic disease for which there is currently no cure. However, diabetes can be
managed with various treatments that are available in most developed countries (Ambler,
Ambler, Barron, Cameron, & May, 2008). In the health system of many countries, there are
CONTACT Yee Cheng Kueh
[email protected]
© 2016 Informa UK Limited, trading as Taylor & Francis Group
Psychology, Health & Medicine
139
Knowledge
Basic physiology
Hypoglycaemia
Food/ food substitutions
Sick day management
General diabetes care
Duration of
diabetes
since
diagnosis
Self-management
Diet
Exercise
Blood glucose monitoring
Foot care
Age
Quality of life
Satisfaction of treatment
Impact of diabetes
Attitudes/ Psychological
Adjustment
Attitudes toward diabetes
Diabetes integration
Emotional adjustment
Figure 1. Proposed conceptual framework.
Notes. — Hypothesized direct relationship; —– hypothesized indirect relationship.
multidisciplinary diabetes teams that assist people to make changes to a healthier lifestyle
and other aspects of diabetes management. Diabetes self-management plays an important
part in diabetes because it can impact the quality of life (QoL) of people with type 2 diabetes
mellitus (T2DM; Khanna, Bush, Swint, Peskin, & Naik, 2012).
Research on major aspects of diabetes suggests that the variables, such as knowledge,
attitudes, and self-management could contribute to predicting diabetes QoL. For example,
Ménard et al. (2007) illustrated that a change in QoL was associated with more positive
attitudes. Some researchers have reported that self-care behaviour of people with T2DM
was associated with QoL (Misra & Lager, 2008), adherence to self-management has been
shown to improve QoL (American Diabetes Association, 2003), and it has been reported
that success in diabetes control through self-care can influence the QoL of people with
T2DM (Gilden, Casia, Hendryx, & Singh, 1990; Luker & Caress, 1989). QoL in people with
T2DM can be considered to be associated, in many ways, with the presence of satisfaction
with diabetes treatment, which is the positive aspect of living with diabetes, and the impact
of diabetes, which is the negative aspect of living with diabetes. There could be a possible
link between diabetes self-management, individual satisfaction and the impact of T2DM on
QoL. How diabetes knowledge and attitudes might link to satisfaction and impact remains
open to question.
The present study examined relationships between key variables (i.e. knowledge,
attitudes, self-management, QoL) and background variables, including age and duration
of diagnosis with T2DM in a path model. We then examined the direct and indirect
effects of diabetes knowledge and attitudes on QoL. These relationships are depicted
in Figure 1.
140
Y. C. Kueh et al.
Method
Participants
A total of 266 people with T2DM completed the questionnaires (129, 48.5% Male, 137, 51.5%
female). Participants had a mean age of 57.0 (SD = 8.51) years and duration of diabetes of
10.4 (SD = 7.49) years.
Materials
Demographic and Health Measures Form included participants’ personal attributes, duration
of diabetes since diagnosis and how it was being treated (e.g. diet, tablets, insulin).
The Diabetes Knowledge Scale (DKN; Dunn et al., 1984) consists of 15 multiple-choice
items. The total correct responses was obtained and converted to a percentage. The original
English version of the DKN questionnaire was translated into Malay version prior to the
study.
The Diabetes Integration Scale-19 (ATT19; Welch, Beeney, Dunn, & Smith, 1996) contains
19 self-report attitudinal items that are scored on a 5-point Likert scale. The Malay version
of ATT19 which was tested in a previous study was found to be reliable with Cronbach’s α
of .78 (Kueh, Morris, & Ismail, 2014).
The Summary of Diabetes Self-Care Activities measure (SDSCA; Toobert, Hampson, &
Glasgow, 2000) evaluates the frequency of completing self-management task (i.e. diet, exercise, blood glucose monitoring, and foot care) in the past seven days (Toobert et al., 2000).
The Malay version of the SDSCA was found to be reliable with high correlation between
items ranging from .53 to .93 within each subscale (Kueh et al., 2014).
The Diabetes QoL Measure (DQoL; Jacobson, Groot, & Samson, 1994) consists 15 items
on the satisfaction subscale, and 20 items on the impact subscale. Each item is measured
on a five-point Likert scale. The Cronbach’s α for the Malay version of the DQoL were .78
for the satisfaction subscale and .81 for the impact subscale, which indicates good reliability
(Kueh et al., 2014).
Procedure
The research was approved by the Universiti Sains Malaysia Human Research Ethics
Committee. The participants were recruited through the Diabetes Clinic of the Hospital
Universiti Sains Malaysia (HUSM) in Kelantan, Malaysia. Participants were referred to the
researcher by staff nurses during their visits to the Diabetes Clinic for medical check-up.
Participants were diagnosed with T2DM for at least a year. Malay language is the only
language spoken by most of the participants, thus all questionnaires were in Malay language. Participants took approximately 20–30 min to complete the self-administered questionnaires. Their written consent was obtained when they volunteered. Participants were
informed about their right to withdraw from the study at any stage without penalty and
their involvement in the study would not affect their treatment at the clinic.
Psychology, Health & Medicine
141
Table 1. Participant characteristics.
Mean (SD)
Age (years)
Duration of Diabetes since
diagnosis (in years)
Education background
Less than high school
High school
College
University
Working
Yes
No
Treatment
Diet
Diet and tablet
Diet and insulin
Diet, tablet and insulin
General health
Excellent
Good
Fair
Poor
Diabetes knowledge
Attitudes
Self-management
Diet
Exercise
Blood glucose testing
Foot care
QoL
Satisfaction
Impact
Potential range (midpoint)
Number of participants
(%)
57.0 (8.51)
10.4 (7.49)
65 (24.4%)
136 (51.1%)
32 (12.1%)
33 (12.4%)
156 (58.6%)
110 (41.4%)
6 (2.3%)
155 (58.3%)
22 (8.2%)
83 (31.2%)
52.5 (17.01)
60.5 (9.49)
0–100 (50)
19–95 (57)
5.2 (2.15)
2.5 (2.34)
1.2 (1.81)
3.0 (2.65)
0–7 (3.5)
0–7 (3.5)
0–7 (3.5)
0–7 (3.5)
70.8 (14.37)
20.9 (13.85)
0–100 (50)
0–100 (50)
20 (7.5%)
109 (41.0%)
133 (50.0%)
4 (1.5%)
Statistical analysis
The path analysis was conducted using Mplus 7.3 (Muthen & Muthen, 1998–2012) to assess
the inter-relationship between the study variables. The assumption of multivariate normality was not met based on multivariate skew test of fit (p < .001). Therefore, alternative
estimator robust to maximum likelihood, MLR (Muthen & Muthen, 1998–2012) was used
to examine the path models.
Several fit indices were taken into consideration in assessing the model, there were
the root mean square error of approximation (RMSEA), standardized root mean square
(SRMR), the comparative fit index (CFI) and Tucker and Lewis index (TLI) (Kline, 2011).
Sample size
Kline (2011) suggested that an acceptable sample size for studies using structural equation
modeling (SEM) is about 200 cases. Path analysis used in this study is one of the components of SEM. Therefore, the sample for the present study of 266 people with T2DM is
considered adequate.
142
Y. C. Kueh et al.
Table 2. Summary of the models’ fit indices.
Path model
Model 1
Model 2
Model 3
RMSEA (90% CI)
.144 (.115, .176)
.093 (.072, .115)
.045 (.009, .071)
CIfit*
<.001
.001
.601
CFI
.756
.772
.950
TLI
.105
.645
.919
SRMR
.069
.077
.058
*Close fit for RMSEA; RMSEA with desired value of less than .08; Close fit more than .05; SRMR with desired value of less than
.08; CFI and TLI both with desired value of more than .95 (Hair, Black, Babin, & Anderson, 2010; Kline, 2011).
Diabetes
knowledge
Attitudes
0.14*
Quality of life
0.28*
Duration of
Diabetes
0.15*
-0.19*
R2 = 11%
-0.31*
Satisfaction
0.19*
0.29
0.17*
-0.49
Age
0.14*
0.13*
0.21*
Impact
0.15*
-0.17*
0.22*
R2 = 17%
0.11*
0.17*
Diet
Exercise
Foot care
Blood glucose
testing
0.25
0.26
Self-management
Figure 2. Final path model (model 3) with standardized regression weights.
Notes. *p < .05, two-tailed; R2 = total variance explained.
Results
Descriptive statistics of the demographic variables and the study variables are presented
in Table 1.
The initial path model consisted of 29 hypothesised path relationships. Path analysis
revealed that some path relationships were not significant and all of the fit indices for Model
1 were not within the range of recommended values for acceptable fit (see Table 2). The
model estimates were re-examined and path relationships were reduced to 14.
Although fit indices were improved, they were still not within the range of recommended
values for acceptable fit (see Table 2, Model 2). Adequate theoretical support was identified
to investigate the new path relationships suggested by the modification indices. Thus a path
was added to Model 2 depicted in Figure 2, which was the pathway from age to satisfaction.
Then correlations were added between the self-management components. Table 2 reveals
that for Model 3, all the fit indices were within the range of desired values for acceptable fit
except for TLI, which was close to the recommended fit value.
Although there was no significant direct path relationship between diabetes knowledge
and QoL, the indirect relationship between diabetes knowledge and QoL via other paths was
examined. The path analysis result indicates that there was no significant indirect effect of
Psychology, Health & Medicine
143
diabetes knowledge on satisfaction of QoL. However, there was a significant indirect effect
of diabetes knowledge on impact of QoL via attitudes (β = −.044, p = .031).The negative
slope coefficients (β) based on standardized solution can be interpreted to indicate that as
the level of diabetes knowledge increased, the negative impact of QoL was reduced through
the mediating factor of attitudes.
Discussion
The findings from this research contribute to knowledge concerning the relationship
between diabetes knowledge, attitudes, self-management, and QoL among people with
T2DM living in Malaysia. The present study indicated that there was an association between
diet and satisfaction, and also between diet and impact in QoL among people with T2DM
in Kelantan. Those who practised more regular management of their diet had higher levels
of satisfaction compared to those who practised less diet management and they had lower
levels of impact of T2DM on QoL compared to those who practised less diet management.
Self-management of T2DM in exercise was significantly associated with satisfaction in QoL
of T2DM. Participants who practised more regular self-management of T2DM through
exercise had higher levels of satisfaction in QoL of T2DM compared to those who practised less management of exercise. This result supported research conducted by Smith and
McFall (2005) who reported that exercise to control weight is associated with significant
QoL changes and this may be due to the large reduction in impaired days for people with
diabetes who undertake exercise.
In the final model, diabetes knowledge was not a significant predictor for either satisfaction or impact related to QoL of T2DM. Ménard et al. (2007) also found that improvement in QoL among participants with T2DM was not related to knowledge about diabetes.
However, based on the indirect relationship examined in the present study, we concluded
that diabetes knowledge can be an important indicator in reducing the impact of QoL of
T2DM. Although it does not directly influence QoL of T2DM, diabetes knowledge can
influence other variables such as attitudes that do have a direct influence on QoL.
There are several limitations that need to be considered. The study comprised of Malay
sample that limits generalizability of the findings to other ethnic groups. Therefore, the
results may not reflect the larger diabetes population in Malaysia. However, Malay is the
majority ethnic in Malaysia, thus the present findings can provide indication for future
research in other ethnic groups.
Disclosure statement
No potential conflict of interest was reported by the authors.
References
Ambler, G., Ambler, E., Barron, V., Cameron, F., & May, C. (2008). Diabetes manual. Retrieved from
http://www.rch.org.au/diabetesmanual/manual.cfm?doc_id=2745
American Diabetes Association. (2003). Physical activity/exercise and diabetes mellitus. Diabetes
Care, 26(Suppl. 1), S73–S77.
144
Y. C. Kueh et al.
Dunn, S. M., Bryson, J. M., Hoskins, P. L., Alford, J. B., Handelsman, D. J., & Turtle, J. R. (1984).
Development of the diabetes knowledge (DKN) scales: Forms DKNA, DKNB, and DKNC. Diabetes
Care, 7, 36–41.
Gilden, J. L., Casia, C., Hendryx, M., & Singh, S. P ...
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