20 Ideas For Writing A Research Paper On Childhood Diabetes
Students often write their research papers on childhood diabetes, so they learn more about the condition, how to deal with it, and what possible risks are involved. The following tips and sample ideas for choosing a topic for your assignment will help you complete it successfully.
Choosing an Appropriate Research Paper Topic
You should clearly understand what your instructor is expecting you to do. Then, ask him or her to share some sample topics. If you are not provided with a list of ideas to choose from, you should come up with your own one. You should consider the subject that you are interested in and approach your professor to ensure that your topic is manageable and meets the research paper requirements.
If you have no idea what to write about, you may study some literature sources related to childhood diabetes to get inspired. Students also use a brainstorming technique, rework their old topics, or search for sample topics on the Web.
Considering Great Research Paper Ideas on Childhood Diabetes
There are plenty of issues that children with diabetes and their parents have to tackle. You can research one of them, learn more about the disease itself, or concentrate on how to fight it effectively:
- What type of diabetes is the most popular among children?
- What medication do children with type 1 diabetes have to take?
- The basic description of childhood diabetes: vital things to know.
- The differences between diabetes type 1 and type 2.
- How can parents help their child manage diabetes?
- Diabetes in teens: how to make healthy food choices.
- What methods are used to help a child stay at a healthy weight?
- Who are diabetes educators and why do people need their services?
- What are the most popular methods to check child’s blood glucose?
- What treatment plan is used to help young patients?
- How does diabetes affect the way a child behaves?
- What common age-related issues do children with diabetes have?
- What are in-person diabetes support options in your area?
- How can diabetes online communities help children maintain their emotional health?
- The basic rules of living with childhood diabetes type 1.
- Children’s health insurance programs: benefits for those with diabetes.
- How can people prevent type 2 diabetes in their families?
- What are the most common complications of childhood diabetes?
- What diabetes-related research is going on?
- What institutions are providing the necessary assistance for children and their parents?
Objective. Our aim was to examine how diagnosis is perceived by a sample of newly diagnosed type 2 diabetes patients.
Methods. A qualitative study was carried out in the Lothian region of Scotland using in-depth interviews of 40 newly diagnosed type 2 diabetes patients recruited from 16 general practices in four Local Health Care Co-operatives and three hospital clinics. Purposive selection ensured that the sample's demographic characteristics were broadly representative of newly diagnosed type 2 diabetes patients in Lothian/Scotland.
Results. Clarity, timing and authority of the diagnosis delivery were highly salient for patients. Many patients perceived their GP as unwilling to deliver/confirm the diagnosis. Patients who were not referred to hospital were unclear why a referral had not taken place. Those referred perceived confirmation of diagnosis by the consultant as a central reason. Waiting for a hospital appointment could be problematic for patients. Most wanted the diagnosis confirmed before they felt confident making lifestyle changes. Input from health services during the period prior to the hospital visit was highly valued. Waiting was taken by some asymptomatic patients to indicate that they did not have the condition. Others used a lengthy period of waiting to confirm their view that they had a ‘milder’ or ‘less serious’ form of diabetes than other patients.
Conclusions. Adequate input from practitioners is needed to ensure that diagnosis is fully exploited as a crucial period in which patients learn to adapt to their condition. Being explicit about the diagnosis at first contact may avoid the problem of patients feeling ‘in limbo’ or uncertain whether they have type 2 diabetes. Practitioners should convey to patients that post-diagnosis/initial care is a process, stages of this process should be clarified to avoid misunderstanding and services should be integrated during this interim period to best effect.
Diagnosis, patients' experiences, qualitative study, type 2 diabetes
Parry O, Peel E, Douglas M and Lawton J. Patients in waiting: a qualitative study of type 2 diabetes patients' perceptions of diagnosis. Family Practice 2004; 21: 131–136.
Type 2 diabetes is a complex, progressive disease which requires a variety of risk management strategies.1,2 It often remains undiagnosed for many years because hyperglycaemia develops gradually and, at early stages, may not be severe enough for patients to recognize classic symptoms.3 The conditions' long subclinical phase is associated with increased morbidity and mortality,4,5 and those affected are at increased risk of developing macro- and microvascular complications.6 It is important that disease self-management begins promptly once a diagnosis has been made.
The identification and naming of disease has attracted much research interest because it is an important marker for the subsequent course of treatment.7 Diagnosis tends to be portrayed as occurring at a discrete point in time.8 Research on diagnosis has highlighted the importance of doctor–patient communication,9,10 establishing that the reactions and attitudes of health professionals towards patients may be crucial in influencing patients' perceptions of disease seriousness and consequent compliance.11
Findings from patient studies tend to portray diagnosis as functional in that it facilitates the process whereby they begin to adapt to their condition.8,12 Patients can also experience diagnosis as very traumatic.13–15 The enormous variation in the psychological and social impact of diabetes upon patients cannot be explained solely by the type or severity of the condition.16 There has, however, been little exploration of the broader context of diagnosis from patients' perspectives; for example, how patients understand and reflect upon their experiences of diagnosis, including the ordering and timing of events, the roles which different health professionals play, patient satisfaction with diagnosis delivery and perceptions of unmet needs.
Here we explore how newly diagnosed type 2 diabetes patients, resident in the Lothian region of Scotland, perceive their diagnosis. In Scotland, as elsewhere, diabetes care increasingly is being devolved from secondary to primary settings.17 While service delivery differs by location across Lothian, most newly identified type 2 diabetes patients currently are referred to hospital where they usually receive three structured sessions of education before meeting with a consultant. Although this study can only report patients' perceptions of diagnosis, these perceptions are important because they have implications for how patients understand and self-manage their condition.
The study used in-depth interviews which enabled patients to display their own understandings and perspectives, and themes and hypotheses to be identified and tested during the study that might not have been anticipated initially.18,19 Patients were interviewed three times at 6 monthly intervals over 1 year, enabling their experiences to be tracked over time. The findings presented here are based upon an analysis of round 1 interviews, which focused upon patients' experiences of diagnosis.
In the interests of developing ‘substantive theory’ in this under-researched area, the study took theoretical direction from grounded theory, otherwise known as the constant comparative method.20 This study used a grounded theory approach from a social (rather than psychological) perspective to examine processes of social action/interaction rather than to create theories about individuals. Data collection and analysis occurred concurrently.21 Emerging themes (indicated below) were identified and explored throughout and across different stages of data collection, and were revised and refined where necessary.
Recruitment and sample
Following approval from Lothian Research Ethics Committee, clinicians recruited 40 patients who had been clinically diagnosed as having type 2 diabetes within the previous 6 months face to face or by letter (with an ‘opt-in’ procedure). A sample size of 40 was chosen as it would be large enough to generate an adequate range of themes and perspectives without creating a data set too big to analyse in depth.18,19 Recruitment took place in 16 practices [in four Local Health Care Co-operatives LHCCs] and three hospitals in Lothian. This ensured that the sample had diverse experiences of primary and secondary care diabetes services, some patients receiving GP-based care only (n = 5), the remainder having varying amounts of contact with both GP and hospital-based services (n = 35). The LHCCs spanned poor and affluent areas, enabling the recruitment of patients from different social classes. Purposive sampling ensured the sample's demographic characteristics were broadly representative of all newly diagnosed type 2 diabetes patients in Lothian/Scotland22 (see Table 1).
Demographic characteristics of the sample
|Sex||Age at first interview (years)a||Socio-economic groupb||Site of recruitment|
|Sex||Age at first interview (years)a||Socio-economic groupb||Site of recruitment|
LHCCs in Scotland are voluntary groupings of GPs and other local health care providers and are intended to strengthen and support the primary health care team in delivering local care. LHCCs are part of the management structure of the Primary Care Trust (PCT). There are 70 LHCCs in Scotland, based on natural communities. The exact scope of each LHCC is determined by agreement among member practices and the PCT management.
All patients were white (except one Pakistani woman) and, with the exception of one insulin-treated patient, were treated by diet alone or diet and metformin and/or gliclazide.
Round 1 interviews were carried out in April–July 2002. All interviews were conducted by EP, averaged 1 h, and were tape recorded and transcribed verbatim. The interviews were semi-structured, and data reported here derive largely (although not exclusively) from the following questions: “can you tell me how you came to be diagnosed with diabetes?”; “how did you feel when you found out you had diabetes?”; “who within the health services have you seen, when and where did you see them?”; and “what do you want from diabetes services?”
Transcripts were read repeatedly by members of the research team (EP, JL and OP) and cross-compared both during and after data collection. Regular team meetings were held to identify recurrent themes, to explore patients' underlying reasoning, to discuss deviant cases and to identify new research questions. Data were organized into initial and higher thematic categories once consensus regarding themes had occurred. Initial thematic categories included ‘symptoms’, ‘contact with services’, ‘reaction to diagnosis’, ‘patient concerns’, ‘support networks’, ‘medical therapies’ and ‘lifestyle changes’. Higher order categories cut across these and included: ‘time’, ‘perceived disease seriousness’, ‘risk’, ‘clarification’ and ‘knowledge (lay and professional)’. NUD.IST, a qualitative data-indexing package, facilitated data coding and retrieval.23,24
Data from the themes which bear upon diagnosis form the basis of this paper. Patients' emotional reactions to diagnosis, and their views about information provision are described elsewhere.25
Prior to diagnosis, 25 of the 40 patients presented illness symptoms to their GP, 10 of whom suspected their symptoms to be diabetes related. For the remainder (n = 15), diagnosis was initiated by medical procedures such as routine blood tests. Where patients presented with symptoms, the initial stage of the journey towards diagnosis was often speedily expedited. Symptoms such as excessive thirst, frequent urination and weight loss are commonly associated with diabetes, and prompted many of the patients' GPs to carry out urine tests. Some patients, such as R37, claimed the urine test was almost a formality, as the GP “kind of knew herself when I described the symptoms”. Only a minority of patients reported that their GPs had not suspected diabetes when they first presented with symptoms.
Receiving the results of the urine test from the GP was often a telling and significant experience. Patients talked about the results going “right off the scale” (R10) and “through the roof” (R36). The majority reported coming away with the impression that diabetes was the likely cause of the “abnormal readings” (R16), and that their GPs had initiated further tests (blood glucose testing) for diagnostic purposes.
The hospital appointment
Following the results of the blood test, the majority of patients (n = 35) were referred to a hospital clinic by their GP. Those patients not referred to hospital (n = 5) belonged to general practices with their own diabetes clinic/diabetes specialist. However, these patients assumed that there were other reasons why they had not been sent to hospital. R8, for example, thought that a hospital referral only occurred when the clinic was not oversubscribed and/or in the most serious cases:
“I thought maybe they (hospital clinic) were just full or you had to be, I don't know, maybe twenty times worse than I am before you got referred. I just assumed that, that it must be if you are really bad you know.” (R8)
Patients referred to hospital were very positive about their experiences. Hospital education sessions were appreciated because “they [staff] explained everything” (R16) and covered aspects of diabetes management that previously patients “had not thought about” (R28). Patients perceived themselves as the focus of attention at hospital. They reported that their condition had been addressed with appropriate concern and that they had been treated “as though you're something special and they are giving you kid glove treatment sort of thing” (R25).
Patients, however, did not generally perceive these benefits as being why they had been referred to hospital. Most assumed that they had been sent to hospital in order to receive a confirmation of diagnosis by a diabetes consultant. In some case, patients made this assumption because they perceived their GPs as being unwilling to deliver a definitive diagnosis. R19, for example, described how before being diagnosed at the hospital, his own GP had “sort of like hedged around it”. Similarly, R20 reported that his GP “was obviously wanting them (hospital staff) to tell me”.
In other cases, patients perceived hospital consultants as having more expertise and specialist knowledge than GPs, and hence as having the competence necessary to make a “proper diagnosis” (R37). Even where GPs were felt to have been clear about the diagnosis, some patients described how they had been unwilling to accept that they definitely had diabetes until confirmation from a consultant had occurred.
“But at the moment I feel that I'm sort of still on probation you know, whether I've got it or not [laugh]. Well I mean they've said I have and that's all right but em, I'm not being snooty about this but I'd like to hear it from the top man.” (R17)
Patients also attached importance to their consultations with hospital doctors because they perceived these as the settings where an accurate assessment of their disease would be made and the regimen required to manage it would be determined.
“… that's when they'll say you maybe need a tablet, you'll maybe no need a tablet, maybe need an injection.” (R16)
Those patients who appeared most satisfied with a diagnosis delivered by the GP reported receiving a prompt and clear communication:
“When I went to the appointment he (GP) took my sugar level and my urine and it was sky high so he immediately told me to come tomorrow morning, first thing to get my bloods taken. He took them. He didn't fob (me off) and say ‘Oh go and get an appointment with the nurse and that’, he was—he was good. Aye I was fine pleased. That next morning there at half past eight and I was taken dead on half past eight. (He) took my bloods and I was told by the afternoon. So he was quick and fast like. I was fine pleased.” (R10)
Patients who received a hospital clinic appointment generally perceived delays as inevitable: “you hear about waiting lists and there are often things said on the radio, and television these days” (R19). However, waiting (even for a short period of time) for an appointment was experienced by some as problematic, especially those who saw diabetes as a potentially serious condition warranting prompt medical attention. R10 described the 2-week wait for an appointment as difficult to bear because: “I've got diabetes that's what they were telling me and oh I was scared”. Similarly, R9 complained, “you can't just tell me I've got diabetes and then leave me to splash around in the water, panicking”. Many patients were depending upon clinic staff to “clear up a lot of anything that's unknown” (R35) and, like R7, described themselves as “still in limbo” while waiting for the appointment, unsure about “what am I doing–the right thing or what?”
In most cases, patients waited several months for their hospital appointment. In the interim period, the majority saw a dietician/nurse in a primary care setting. Most patients welcomed this referral, particularly to the dietician, because “I had so many questions that I wanted answered at the time” (R7). Dissatisfaction stemmed from delays in being seen and/or the perception that the consultation was too short:
“How can you sit and get advice from somebody that's supposed to—supposedly only giving you five minutes—and she kept looking at her watch.” (R7)
Lengthy waits for a hospital clinic appointment also had implications for the way in which patients perceived their condition. The delay, for some, was taken to indicate that their condition could not be potentially serious:
“If it is going to be bad when the tests come back surely to God they would phone you and say ‘look things are not too good here we would like you to come in’.” (R16)
“I'm sort of saying to myself ‘it can't be that serious if you can be left that long’, you know.” (R37)
In addition, the perceived absence of a clear steer from the GP combined with a delayed hospital appointment led some patients to assume that they might not have diabetes:
“It wasn't until I saw the doctor at the very end of the course that he said ‘well you do realize you have got diabetes? Somebody has actually said you have got diabetes'? And I said ‘well no really’.” (R20)
In one case, a patient reported that her success in reducing her blood sugar level to within the normal range prior to the clinic appointment led the diabetes consultant (after consulting his notes) to ask: “why are you here? … there's nothing showing” (R31). This patient, contrary to the opinion of her GP, now claimed “I'm not diabetic”.
The findings illustrate how, from patients' perspectives, diagnosis is more than simply the identification and naming of disease. Clarity, timing and authority of the diagnosis delivery have emerged as salient issues.
Many patients were under the impression that their GPs, although strongly suspecting they had diabetes, were unwilling to deliver a definitive diagnosis. Patients not referred to hospital were unclear about the reasons for this, while those referred assumed confirmation of diagnosis by the consultant to be a central reason.
Although many patients had low expectations about referral times, waiting for a hospital appointment was experienced as problematic in several ways. Those who claimed not to have received a clear diagnosis from the GP were anxious for a diagnosis to be made. Many of those who claimed that they had been told clearly by the GP still wanted confirmation from a hospital consultant. For these patients, the knowledge that they were to see a hospital consultant may have diminished or undermined the authority of the GPs' communication regarding diagnosis.
Patients' preferences for receiving diagnosis from senior medical professionals has been observed elsewhere.26 Our data suggest that this preference may be exacerbated where patients are uncertain about where, and from whom, they will receive their future diabetes care. Services are currently in flux in Scotland, making this a particularly pertinent issue. The implications of the findings are also relevant to the rest of the UK and elsewhere as a shift in routine diabetes care/diabetic review (from secondary to primary health care settings) is also occurring in these locations.17
Prior to receiving what was perceived as confirmation of diagnosis, many patients were either anxious about or unwilling to make changes to their lifestyles to accommodate a diabetic regimen. Although eager to learn what they could do to reduce their health-related risks, patients worried that, without the appropriate medical input, lifestyle modification might prove detrimental rather than beneficial. Waiting for the hospital appointment also appeared to provide a window of opportunity for patients to reassess their situation. Some asymptomatic patients asserted that they could not have the condition. Others used the lengthy waiting period to substantiate their view that they had a ‘milder’ form of diabetes than those seen more promptly. Those patients who saw type 2 diabetes as a potentially serious condition had heightened expectations regarding the level and frequency of input from health services, which were not always met.
It is also important to note that while waiting for the hospital appointment, input from health services was highly valued by patients (who were aware that future health outcomes, linked to diabetes, might be related to lifestyle behaviours) and was only criticized for perceived infrequency and shortness of duration.
These findings resonate with a body of evidence that highlights the importance of timing and continuity in post-diagnosis care. Studies exploring patients' long-term relationships with health services have demonstrated the importance of providing structured information and education on a continuous basis.27–29 The most successful patient teaching programmes tend to involve frequent contact and reinforcement.20 Such programmes are especially needed in diabetes care where there has been a tendency to focus on ‘laboratory values’ associated with the condition, at the expense of patients' social and emotional needs.31
Our findings suggest that if GPs are more explicit about the diagnosis at first contact, this may avoid the problem of patients either feeling ‘in limbo’ or being uncertain as to whether they have type 2 diabetes. Given the uncertainty among patients regarding who receives a hospital referral and why, it is important that GPs convey clearly to patients who they will be seeing and for what reasons. The findings also indicate how important it is that GPs and patients perceive how different health services will be integrated to best effect.
Although this paper is based wholly upon patients' accounts, it does suggest that delays may be incurred in commencement of treatment because of referral to hospital. This is a pertinent issue for the management of type 2 diabetes, given the importance of implementing disease risk management strategies as quickly as possible. Further research may be needed on the issue of referral to secondary care which includes the perspectives of health professionals.
In conclusion, the study findings highlight a need for appropriate input to ensure that the process of diagnosis is both tolerable for patients and fully exploited as a crucial period in which patients learn to adapt to their condition. While acknowledging the importance of identifying type 2 diabetes at an early stage, we concur with Kinmonth32 that it is crucial to ensure that effective mechanisms for managing patients, both during and following the diagnosis process, are in place first.
Particular thanks goes to the health professionals who assisted with recruitment and the patients who took part, without whom this research would not have been possible. The study described in this paper is funded by the Scottish Executive Health Department (SEHD). The research was conducted at the Research Unit in Health, Behaviour and Change which is funded by the SEHD and the Health Education Board for Scotland (HEBS). The opinions expressed in this paper are those of the authors, not of the funding bodies.
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