Research Proposal

Does Physical Activity (PA) Lead To Improved Quality Of Life In

Adults Living With Type-2 Diabetes (T2D)? A Systematic Literature
Review
Introduction

Previous studies have examined the relationship between physical activity (PA) and
type-2 diabetes (T2D), and found an increasingly rapid occurrence that is similar to
the rise in the incidence of obesity, decrease in physical activity and change in diet
(Aune et al., 2015, Smith et al., 2016, Taheri et al., 2020). According to Blicher-
Hansen et al. (2022), about 70% of adults living with T2D are not able to achieve the
150 minutes of suggested weekly target for self-management, and that most of the
interventions that encourage the adoption of PA in T2D seldom attain steady
continuation. The failure of interventions have been linked to lack of patient
participation in decision making in care program, and it has been suggested that the
approach of shared decision-making (SDM) and evidence-based care (EBC) may
lead to positive outcomes by supporting patients to make good quality decisions
along with their physicians (Buhse et al., 2018, den Ouden et al., 2015, Tamhane et
al., 2015). This is based on the concept of person-centred care (PCC) which involve
the recognition of patient needs and values, and their right to make healthy decisions
in the management of acute and chronic diseases (den Ouden et al., 2015, Tonelli
and Sullivan, 2019). Kuipers et al. (2019) found that PCC and SDM were positively
related with care satisfaction and the physical and social well-being of patients living
with multi-morbidity which includes T2D.

The objective of the proposed research is to show person-centred care is used to

promote physical well-being of patients living with T2D using SDM and EBC to
engender behavioural change towards regular physical activity. The proposed
research will provide further understanding on how PCC, SDM, and EBC can be
harnessed to increase quality of life of patients living with T2D through physical
activity.

According to Diabetes UK (2023), approximately 4.3 million people are living with
diabetes in the UK, with an additional 850,000 undiagnosed cases, bringing the total
number of people living with diabetes to 5 over million people, while more than 2.4
million are at risk of developing T2D. Diabetes UK (2023) argued that without the
appropriate support, people living with the different types of diabetes are potentially
at risk of developing severe heath difficulties. Hence, the present annual cost of £10
billion for diabetes care for the NHS is expected to increase, and this necessitates
the formulation of strategies to optimise treatment efforts in order to prevent
complications related to the challenge, and thereby reduce associated costs
(Hodgson et al., 2022).

The Health Foundation (2016) regards PCC as a multidisciplinary approach to

recognising personal needs of a person regarding their healthcare quality outcomes,
and recognising that they require varied professional support. According to Coulter
and Oldham (2016), this approach recognises that people’s individual input is an
essential component of the health strategies that are necessary to control and
advance their own healthcare needs rather that merely regarding them as passive
consumers of healthcare services. However, some people are limited by their mental
capacity to assume such responsibility, and in such cases, carers, relatives or
trained advocates can become involved (Coulter and Oldham, 2016).

SDM is increasingly being regarded preferred standard for patient care due to its
support for patient autonomy and fundamental rights and bodily integrity through its
support for patients’ active involvement in their healthcare decisions (Driever et al.,
2020, Stiggelbout et al., 2015). Murray et al. (2016) argued that nurses participating
in SDM have a higher chance of controlling their practice and achieving job
satisfaction, while hospitals that practice SDM also have a higher chance of
improving patient care. However, there is the possibility of the decision making
process becoming complicated, while low health and numeracy constitute major
barriers to the successful implementation of SDM (Chung et al., 2021).

EBC: The fundamental principle of EBC is based on the premise that good-quality
care decisions are integrated in a mixture of critical thinking of the healthcare
professional’s expertise, best available evidence and the patient’s need within
appropriate practice environment (Barends et al., 2014, Roe-Prior, 2022). The NMC
(2018) outlines a framework for nursing practice standards in The Code and one of
the four philosophies of The Code is effective practise. By that, all nursing registrants
are required to regularly refresh their knowledge using the best available evidence
with the aim of improving outcomes and experiences for patients, individuals and the
public (NHS, 2020).

The National Institute for Health and Care Excellence and the Social Care Institute
for Excellence advocate the adoption of person-centred care framework to support
patient participation in self-care efforts (NICE, 2024, SCIE, 2017). According to
Rutten et al. (2020) the strategies toward reducing the incidence of diabetes, and
T2D specifically to achieve low glycemic targets must be implemented at the
individual level within an SDM agenda to harness the values and preferences of
individual patients based on the personal features that control the risks and benefits
that are specific to individual patient’s therapy. Essentially, these strategies should be
underlined by a constant assessment of a T2D patient’s health problems with respect
to their personal conditions, while focussing on (a) well-being and utility including
disease control, (2) targeting treatment suggestions to each individual’s core
concerns and circumstances, (3) balancing the merits and demerits of treatment, (4)
prioritising SDM and self-management, and (5) jointly agreed and tailored care plan
(Rutten et al., 2020, Salisbury et al., 2018). All of these support the implementation
of PCC by regarding patients as partners in coordinated, personalised, and enabling
healing (Asmat et al., 2022, Coulter and Oldham, 2016, Health Foundation, 2016,
Rutten et al., 2020). Furthermore, the guidelines of evidence-based care imply that
the progression of T2D can be reduced while serious complications may be avoided
by engaging in healthy self-care behaviour such as modest-intensity physical activity
(Asmat et al., 2022, Harrington and Henson, 2021).

The proposed research will undertake a systematic review of relevant literature

(Smith, 2018), to map and assess the current data and gap, and to further develop
the knowledge base (Mengist et al., 2020), on how physical activity leads to
improved quality of life in adults with T2D, and how PCC, SDM and EBC supports
the achievement improved quality of life for such patients. According to Munn et al.
(2018), a systematic literature review (SLR) discovers, chooses and critically
evaluates previous research with a view to answering a plainly formulated research
question. Hence, a SLR is different from the conventional narrative reviews through
its adoption of a methodical, replicable and visible procedure to synthesise evidence
from previous literature (Munn et al., 2018). One main concern of the SLR is that
while it is scientific and rigorous based on its methodological commitment to a
prescribed protocol, that must ensure objectivity, replicability and control of the
process, these protocols are susceptible to subjectivity of the selection process, and
does not guarantee the comprehensiveness of the literature selection (Boell and
Cecez-Kecmanovic, 2015, Kraus et al., 2020).

Methodology of conducting the proposed research

The proposed research will be conducted in five basic steps:

1. Research protocol to be followed in the proposed study is the PICO

framework of Population, Intervention, Comparison, and Outcome which will
be applied to determine the scope of the research (Booth et al., 2016). The
PICO framework will apply to each step of the SLR, and will be applied to
achieve the objective of the study which has been stated earlier in this
proposal.
2. Step 2 of the proposed research consists of the search strategy. The
appropriate search strings will be defined, and this will be followed by the
identification of the key databases in the medical field (such as PubMed,
Scopus, MedLine, or ScienceDirect) in which the search will be implemented
(del Amo et al., 2018). The search strategy will be based on the standard
protocol for evaluating and reporting systematic reviews as contained in the
PRISMA tool which is the Preferred reporting Items for Systematic Reviews
and Meta-Analysis process (Page et al., 2021). Based on the suggested by
Page et al. (2021), the process to be followed in selecting the articles for the
study will be highlighted in a PRISMA diagram which will presenta flow
diagram of the database search.
3. This is the appraisal step which informs the data extraction and quality
assessment process will lead to the articles to be selected and these will be
evaluated based on pre-defined inclusion and exclusion criteria, and the
quality of each study will be assessed based on the quantitative elements of
the Caldwell Appraisal Tool (Caldwell et al., 2005).
4. This step involves the synthesis of the data from the articles that were
selected for the study. Relevant data from the articles will be extracted and
organised to derive insightful knowledge to enable valid conclusions (Mengist
 et al., 2020). Where necessary, coding of the data will be implemented and
analysed to provide insights.
5. This step entails the analysis and assessment of the data that has been
synthesised from the articles, it is in this stage that answers will be provided to
the research question, and a narration of the results will be provided (Mengist
et al., 2020).

Conclusion

This proposal provides an outline of the procedure to be followed in conducting the

proposed research. The proposed research will be implemented in order to achieve
the research objective which is to show how person-centred care is used to promote
physical well-being of patients living with T2D using SDM and EBC to engender
behavioural change towards regular physical activity. Also, the proposed research
will provide further understanding on how PCC, SDM, and EBC can be harnessed to
increase quality of life of patients living with T2D through physical activity.
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