RESEARCH PROPOSAL Title: FRUITY-VEGS: ALTERNATIVE DIET FOR BLOOD GLUCOSE CONTROL

Presented by: BSN 4K Abubakar, Fatima Jonah Arakama, Nurdalyn J. Anoos, Ericka Christy B. Aquino, Danielle Dae B. Aquino. Khrysty Rose B. Baginda, Zehara Ann J. Bernante, Jerrybhelle C. Balajadia, Gee-ann Caas, Ralizha Olivia K. Dequia, Reb Carnell De Guzman, James Dale Dumdumaya, Antoniette

To Research Committee of the College of Nursing Western Mindanao State University Zamboanga City February 28, 2013

RESEARCH PROPOSAL Title: FRUITY-VEGS ALTERNATIVE DIET FOR BLOOD GLUCOSE CONTROL

CHAPTER I BACKGROUND OF THE STUDY/INTRODUCTION Diabetes is a serious health concern considering it is a pandemic and one of the top leading causes of mortality in the Philippines based on the 2009 Philippine Health Statistics. According to International Diabetes Federation (2011) diabetes is fast rising affecting 300 million people all over the world with about 344 million people at risk of developing type 2 diabetes. If nothing is done to reverse the epidemic, the International Diabetes Federation predicts that by 2030, 438 million people will live with diabetes and almost the same numbers are still unaware that they have Diabetes. In the Philippines, one out of five Filipinos had diabetes according to Bohol Standard National Survey 2009. Diabetes mellitus is the 8th leading cause of mortality in the country, considering 18% number of annual deaths based on the 2009 Philippine Health Statistics. According to the World Health Organization study of 2011, the Philippine is projected to have an estimated number of 7.8 million cases by 2030 and eventually may rank 9th in the list of countries with the highest estimated cases worldwide. According to American Diabetes Association, diabetes Mellitus is marked by elevated levels of blood sugar which affects millions of lives and causes a severe health problem such as damage to the eyes, kidney, heart, peripheral nerves, ulcers on the feet and amputations.

However, there are measures on how to prevent diabetes since it is preventable disease according to American Diabetes Association. It is also mention that the main goal of diabetes treatment is to normalize insulin activity and blood glucose levels towards reducing the development of vascular and neuropathic complications. According to the Diabetes Control Complication Trial there are five components on how to manage diabetes; exercise, blood glucose level monitoring, pharmacologic therapy, education and nutritional therapy. The American Dietetic Association states that nutritional therapy is one of the most challenging aspects in managing diabetes, considering that one must have a meal plan that keeps the blood glucose at normal level. Healing wonders of diet an effective guide to diet therapy mention that there are diverse foods in the market that are preferred for a diabetic individual which are simple to prepare, these foods are also very accessible in the market. Whole grains, legumes and low fat dairy products, leafy vegetables and fruits are recommended for diabetic patients. Fruits and vegetables contribute greatly in the management or even helps prevent diabetes based on the Healing Wonders of Diet Effective Guide to Diet Therapy. Considering fruits and vegetables are very high source of fiber that improves blood sugar control. The U.S National Academy of Sciences, The U.S Department of Agriculture and The Institute of Medicine all advice to consume 14 grams of fiber per 1000kcal. A study in the 2000 New England Journal of Medicine revealed that fiber slows the digestion of foods; it can help blunt the sudden spikes in blood glucose that may occur after a lowfiber meal. Such blood sugar peaks stimulate the pancreas to pump out more insulin. National Institute of Health believe that a lifetime of blood glucose spikes could

contribute to type 2 diabetes which typically strikes after the age of 40, and more than doubles the risk of stroke and heart disease. According to the Diabetes control and complications trial, 64% of people having diabetes are disregarding their meal plans advised by their doctors or dieticians they are following their meal plan only on the first to second week and after a while they no longer follow the diet regimen recommended. It is the researchers interest and intention to introduce an alternative nutritional intervention for diabetic clients. It is an alternative, simple and less costly prepared meal from the most accessible and available fruits and vegetables at the local market. With that the study will bring about awareness among food caterers in preparing the nutritional meals that are good for diabetic clients and non-diabetic as well.

STATEMENT OF THE PROBLEM The study aims to answer the following questions: Is there a difference in the blood glucose level before and after the Fruity-Vegs Alternative Diet intervention among diabetic clients?

SCOPE AND DELIMITATION OF THE STUDY This research study will be conducted among known diabetic clients. Limited only to those who will voluntarily submit to be study participants. Ten female clients will be taken as study subjects and study duration is 10 days.

The study focuses on the FRUITY-VEGS ALTERNATIVE DIET intervention that will be served to study participants during lunch for 5 days. The lunch meal will be in the form of shake prepared by the researchers themselves.

SIGNIFICANCE OF THE STUDY The result of the study Fruity-Veg: An alternative Diet for Blood Glucose Control" will be sinificant to the following: To The Student Nurses This study will enrich and enable the student nurses at an early beginning of their clinical practice to explore their future nurses role as a health educator and collaborator by giving information and health teaching, and create awareness about the Fruitie-Vegs Diet intervention for blood glucose control to diabetic individuals in collaboration with the College of Nutrition and Dietetics. Clinical Instructors of the College of Nutrition and Dietetics and College of Nursing The findings of the study may provide references to future related researches on nutritional interventions. Participants of the Study: This study is intended for the benefit of diagnosed diabetic clients as well as the general population afflicted with the disease that they may become empowered and motivated to continue the "Fruity-Veg Diet" as one of their daily regimen to control their blood glucose level. Medical Practitioners: The Fruitie-Vegs Diet will be a great help to the health care team because it is an natural and modifiable aid in lowering the blood glucose level of the diabetic individuals but as well as the general population.

CONCEPTUAL FRAMEWORK

Figure 1.1 The paradigm of the study shows the flow of the actions used and each shapes represents the interventions and its effects. The dependent variable is contained on the first box on the left that is the blood glucose monitoring of the diagnosed diabetic client before the Fruity-Vegs intervention. The process or independent variable in the study is on a circle at the center, this will be the implementation of the Fruity-Vegs Diet intervention prepared by the researchers. The output on the right portion will be the result of blood glucose level after the Fruity-Vegs Diet intervention. The result of the interventions used is shown on the lower box, it comprises the difference between the gathered values of the Pre-intervention and Post-intervention Blood Glucose Monitoring.

HYPOTHESIS There is a significant difference on the blood sugar level among the participants before and after the FRUITY-VEGS DIET intervention.

DEFINITION OF TERMS The Fruity-Vegs Diet: In the study, it refers to the diet consisting of fruits and vegetables combined and measured accordingly to meet the ideal daily calorie intake of diabetic participants. Blood Glucose Control: Refers to a variable that will be influenced by the intervention of Fruity-Vegs diet and that will result to lowering glucose level that is within the normal range. Diagnosed Diabetic client: Refers to the participants in this study that are officially diagnosed by physicians to have diabetes. Blood Glucose Test: refers to the measuring of the blood glucose level of the participants using glucometer before and after the fruity-vegs intervention. Pre-intervention Blood Glucose: Refers to the blood glucose level of the participants before the Fruity-Vegs intervention. Post-intervention Blood Glucose: refers to the blood glucose level of the participants after the Fruity-Vegs intervention.

2 hour Post Prandial Blood Glucose: is a 2-hour postprandial blood sugar measuring blood glucose exactly 2 hours after you start eating a meal.

CHAPTER

II

Review of Related Literature

Understanding Diabetes According to the New Medical Dictionary Manual (2004) diabetes Mellitus is a type of condition wherein the blood glucose level in our body is not in the average rate. It occurs when your body cells dont respond appropriately to insulin, and when your pancreas cant produce enough insulin in response.

Pathophysiology of Diabetes Based on the New Medical Dictionary Manual (2004) the pancreas particularly the islets of Langerhans secretes insulin and glucagon directly into the bloodstream, that helps to regulate the blood glucose level within its healthy range so after eating, our blood sugar rises hence our pancreas detected its rise thus secreting insulin to return the blood sugar level within its usual range. But if our blood sugar goes down, glucagon is then secreted to signal the liver to breakdown glycogen into glucose. In the case of diabetes mellitus, insulin resistance happens. The body cells doesnt function properly in the presence o insulin. The underlying pathophysiologic defect in type diabetes does not involved auto immune beta-cell destruction. Rather, type 2 diabetes is characterized by the following three disorders; Peripheral resistance to insulin, especially in muscle cells Increased. Altered pancreatic insulin secretion. Increased tissue resistance to insulin generally occurs first and is eventually followed by impaired insulin secretion.

The pancreas produces insulin, yet insulin resistance prevents its proper use at the cellular level. Glucose cannot enter target cells and accumulates in the bloodstream, resulting in hyperglycemia. The high blood glucose levels often stimulate an increase in insulin production by the pancreas; thus, type 2 diabetic individuals often have excessive insulin production (hyperinsulinemia). Over the years, pancreatic insulin production usually decreases to below normal levels. In addition to hyperglycemia, type 2 diabetic patients often have a group of disorders that has been called "insulin resistance syndrome" or syndrome X.

Complications Complications of Diabetes Mellitus based on the American Diabetes Association are as follows. 1. Heart and Blood Vessel Disease. Cardiovascular problems like angina pectoris, heart attack, stroke, high blood pressure and atherosclerosis which can result to myocardial infarction. 2. Mental Function, Depression and Dementia. Some studies say that diabetic patients have a much higher risk of developing dementia due to either having Alzheimers disease or damaged blood vessels in the brain. With depression, patients tend to be hyperglycaemic, one factor can trigger is due to their illness condition. Regardless of what age you are, this complication can be triggered if left untreated. 3. Nerve Damage (neuropathy). There are 2 types of neuropathy:

a). Peripheral Neuropathy (which affects the sensation in the toes, feet, legs, hands, and arms). This has the stocking-glove contribution. A tingling sensation, weakness, burning sensation, loss of sense in warm and cold water, numbness (if nerves are severely damaged), and deep pain are some symptoms present. b). Autonomic Neuropathy (which affects the nerves that helps in regulating the digestive system, bowel and bladder control, heart, and sexual function)= Constipation, Diarrhea, Nausea, Vomiting are digestive problems contributed by diabetes. Incontinence in the bowel and bladder occurs. Rapid heart rates, Orthostatic Hypotension when standing up also occurs. 4. Kidney Damage (Nephropathy). Diabetes damages the glomeruli (tiny filters in the kidney) causing the protein to leak into the urine. End-Stage Renal Disease (ESRD) occurs with patients with diabetes. 5. Eye Complication and Retinopathy. Diabetes can cause damage in the blood vessels of the retina (diabetic retinopathy) leads to blindness. This is a common disorder to diabetic patients, cataracts and glaucoma may also be present. 6. Diabetic Ketoacidosis (DKA). This complication is life threatening brought about by insulin deficiency. Causes of DKA are not clear. 7. Osteoporosis. 8. Sexual dysfunction. Men with diabetes, smokers in particular, can damage the blood vessels and nerves which lead to erectile dysfunction. Meanwhile

women with diabetes will have a reduced pleasure from sex, reduced orgasm ability, vaginal dryness, painful sex, and loss of sex drive. 9. Hypoglycemia. As we all know, diabetes requires a strict blood glucose control. Hypoglycemia is also known as insulin shock, this occurs if blood glucose depreciates beyond its normal level. Occasionally, this complication is manageable. 10. Hearing loss. 11. Skin and foot complications. Infection can be present.

Statistic of Diabetes Mellitus Globally diabetes is past rising. Diabetes is a leading threat to global health and development. According to International Diabetes Federation 2011, diabetes now affects over 300 million people all over the world. A further 344 million people are at risk of developing type 2 diabetes, the most common form of the disease. If nothing is done to reverse the epidemic, International Diabetes Federation predicts that by 2030, 438 million people will live with diabetes. The National total cases of diabetes are 25.8 million children and adults in the United States which 8.3% of the population has diabetes. Diagnosed with diabetes about 18.8 million people and Undiagnosed people of 7.0 million. Prediabetes 79 million people. 1.9 million new cases of diabetes are diagnosed in people aged 20 years and older in 2010.

1. Under 20 years of age- 215,000, or 0.26% of all people in this age group have diabetes and about 1 in every 400 children and adolescents has diabetes 2. Age 20 years or older- 25.6 million, or 11.3% of all people in this age group have diabetes. 3. Age 65 years or older- 10.9 million, or 26.9% of all people in this age group have diabetes 4. Men-13.0 million, or 11.8% of all men aged 20 years or older have diabetes 5. Women- 12.6 million, or 10.8% of all women aged 20 years or older have diabetes

Morbidity and Mortality In 2007 National Health Statistics, diabetes was listed as the underlying cause on 71,382 death certificates and was listed as a contributing factor on an additional 160,022 death certificates. This means that diabetes contributed to a total of 231,404 deaths. Philippines is one of the increasing cases of diabetes which is the so called High sugars. Its incidences are rising in the Philippines. One out of five Filipinos in the Philippines had diabetes according to Bohol standard. National survey of the government in 2009 and it is found that 3.9 percent of Filipinos were diabetic compared to the latest survey that 20.6 percent of adults aged 30 and above has found to have diabetes in the year 2007. Diabetes mellitus is the ninth leading cause of mortality in the country based on the 2003 Philippine Health Statistics. Diabetes mortality rate has increased by 92% over a ten year period from 1986 to 1995 and it is estimated that there are currently 3 million Filipinos who are diabetic. Based on the WHO study (2011), the Philippines is

projected to have an estimated number of 7.8 million cases by 2030 and eventually may rank ninth in the list of countries with the highest estimated cases worldwide

MANAGEMENT AND TREATMENT According to American Diabetes Association the major goal in treating diabetes is to minimize any elevation of blood sugar (glucose) without causing abnormally low levels of blood sugar. Type 1 diabetes is treated with insulin,exercise, and a diabetic diet. Type 2 diabetes is treated first with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugars, oral medications are used. If oral medications are still insufficient, treatment with insulin is considered. Adherence to a diabetic diet is an important aspect of controlling elevated blood sugar in patients with diabetes. The American Diabetes Association has provided guidelines for a diabetic diet. The American Diabetes Association diet is a balanced, nutritious diet that is low in fat, cholesterol, and simple sugars. The total daily calories are evenly divided into three meals. In the past two years, the American Diabetes Association has lifted the absolute ban on simple sugars. Small amounts of simple sugars are allowed when consumed with a complex meal. The Institute of Medicine of the National Academy of Sciences (2000) suggest that weight reduction and exercise are important treatments for diabetes. Weight reduction and exercise increase the body's sensitivity to insulin, thus helping to control blood sugar elevations.

DIETARY MANAGEMENT Medical Nutrition Therapy The American Diabetes Association introduced Medical Nutrition Therapy in 1999 to better articulate the national therapy process. It is defined as the use of specific nutrion services to treat an illness, injury or condition and involves two phases; Assessment of Nutrional Status of the client and treatment, which includes Nutrition Therapy, Counseling and the use of specialized nutrition supplements. MNT for Dm incorporates a process that when implemented correctly, includes an assessment of the patient nutrition and diabetes self management, knowledge and skills, identification and negotiation of individually designed nutrition goals, nutrition intervention including a careful match of both meal-planning approach and educational materials to the patients need, with flexibility in mind to have the plan be implemented by the patient and evaluation of outcomes and ongoing monitoring. These 4 steps are necessary to assist patients in acquiring and maintain the knowledge, skills, attitude, behaviour and commitment to successfully meet the challenges of daily diabetes self management.

The American Diabetes Association Guidelines on MNT are as follows. For Carbohydrates The American Diabetes Association agrees that a dietary pattern that includes carbohydrate from fruits, vegetables, whole grains, legumes, and low-fat milk should be encouraged. There is also overall agreement that for individuals with Type 1 Diabetes Mellitus,insulin therapy should be integrated into the dietary and physical activity

pattern, and that the key to successful Medical Nutrition Therapy is synchronizing carbohydrate intake with insulin therapy. The guideline developers further agree that carbohydrate intake should be kept consistent on a day-to-day basis with respect to time and amount, and that for individuals who are on insulin pump therapy, insulin doses should be adjusted based on the carbohydrate content of meals and snacks.

Protein The guideline groups agree that protein intake in individuals with diabetes mellitus and normal renal function should be the same as for patients who do not have diabetes mellitus, 15% to 20% of daily energy intake. American Diabetes Association adds that protein should not be used to prevent or treat acute nighttime hypoglycemia in individuals with Type diabetes Mellitus, and that high-protein diets are not recommended as a method for weight loss at this time.

Fiber American Diabetes Association notes that, as for the general population, people with diabetes are encouraged to consume a variety of fiber-containing foods. They add, however, that evidence is lacking to recommend a higher fiber intake for people with diabetes than for the population as a whole. American Diabetes Association notes that recommendations for fiber intake for people with diabetes are similar to the recommendations for the general public (14 g/1000 kcal), and that while diets containing 44 to 50 grams of fiber daily are reported to improve glycemia, more usual fiber intakes (up to 24 grams daily) have not demonstrated beneficial effects on glycemia.. American

Diabetes Association also notes that including foods containing 25 to 30 grams of fiber per day, with special emphasis on soluble fiber sources (7 to 13 grams), can help to lower cholesterol. They add that diets high in total and soluble fiber, as part of cardioprotective nutrition therapy, can further reduce total cholesterol by 2% to 3% and LDL cholesterol up to 7%.

Sucrose The groups agree that sucrose does not need to be avoided by patients with diabetes mellitus, but when consumed, should replace other carbohydrates. American Diabetes Association notes that, in addition to being substituted for other carbohydrates, sucrose may also be added to the meal plan, but if so, should be covered with insulin or other glucose-lowering medications. . American Diabetes Association notes that sucrose intakes of 10 to 35 percent of total energy intake do not have a negative effect on glycemic or lipid responses when substituted for isocaloric amounts of starch.

Alcohol Consumption According to American Diabetes Association, for adults with diabetes who choose to consume alcohol, consumption should be limited to 1 drink per day for women and 2 drinks per day for men.. American Diabetes Association also notes that to reduce risk of nocturnal hypoglycemia in individuals using insulin or insulin secretagogues, alcohol should be consumed with food. The developer adds that moderate alcohol consumption (when ingested alone) has no acute effect on glucose and insulin concentrations, but carbohydrate co-ingested with alcohol (as in a mixed drink) may raise blood glucose.

Dietary Fat and Cholesterol The guidelines agree that intake of trans fats should be minimized . American Diabetes Association notes that n-3 polyunsaturated fatty acids have beneficial effects on the lipid profile, and two or more servings of fish per week (with the exception of commercially fried fish filets) provide n-3 polyunsaturated fatty acids and are recommended. . American Diabetes Association cites reduction in saturated and trans fats, as well as reduction of dietary cholesterol and interventions to improve blood pressure, as effective cardioprotective nutrition interventions . BENEFITS OF FRUITS AND VEGETABLES FOR DIABETIC PATIENT According to the Food and Nutrition Institute, food composition table of 2004, Fruits and vegetables are the very rich source of fiber. Although people may pay less attention to fiber, its health benefits have not vanished. Fiber remains an essential nutrient and a vital part of healthy eating for everyone, including those with diabetes. In fact, soluble forms of plant fiber may help to mute blood sugar swings. The New England Journal of Medicine 2011 showed that soluble fiber in oat bran, legumes (dried beans of all kinds, peas and lentils), and pectin (from fruit, such as apples) and forms in root vegetables (such as carrots) is considered especially helpful for people with either form of diabetes. Soluble fiber may help control blood sugar by delaying gastric (stomach) emptying, retarding the entry of glucose into the bloodstream and lessening the postprandial (post-meal) rise in blood sugar. It may lessen insulin requirements in those with type 1 diabetes. Because fiber slows the digestion of foods, it can help blunt the sudden spikes in blood glucose that may occur after a low-fibre meal.

Such blood sugar peaks stimulate the pancreas to pump out more insulin. National Institute of health believe that a lifetime of blood glucose spikes could contribute to type 2 diabetes which typically strikes after the age of 40 and more than doubles the risk of stroke and heart disease. .

Previous Researches of Diabetes in Nutrient Management The evidence for the effectiveness of medical nutrition therapy in Diabetes Mellitus to determine the clinical and cost- effectiveness Medical Nutrion Therapy as a potential preventive benefit in the medi care program, the 105th US congress, in the balanced budget act of 1997 requested that a study be conducted by the Institute of he Medicine of The National Academy of Sciences. In December 1999, Institute of Medicine release their report in reference to diabetes the report concluded that evidences exist demonstrating that Medical Nutrition Therapy can improve clinical outcome while possibly reducing the cost of managing diabetes to medicare. Institute of Medicine recommend to congress that individual Medical Nutrition Therapy be a covered medicare benefits as part of multidisciplinary approach to diabetes care which include nutrition, exercise, blood glucose monitoring, medication. The evidenced from randomized controlled trials that involved 39,444 newly diagnosed patient with type 2 Diabetes Mellitus at 15 centers. All received nutrition counseling upon study entry until 3 months at which they were randomized into intensive therapy resulted to an improvement of metabolic outcome such as fasting plasma glucose was reduce 46mg/dl and Hba decreased by 1.9% from 9 to 7% average weight loose of

5kg after 3 months. This evidenced also suggest that Medical Nutrition Therapy is not beneficial at initial diagnosis but is effective at any time during the disease process at ongoing evaluation and intervention are essential. The average Americans daily intake is only 12-18 grams and that may be falling woefully short in fiber intake, but the good news is, is they know it said by Joysa Winter who conducted a study in Illuminas about the awareness of Americans in taking up fiber. According to a 2011 International Food Information Council Survey of 1000 people, 72% of North Americans reported that they were trying to consume more fiber. The third party research firm Illumina and sponsored by the conducted a survey and revealed that 50 percent of Americans believe they need more fiber in their diets, and only 10% believe they get all the fiber they need. It is also stated in the survey,

consumers are more likely to up their fiber intake by including more fruit and vegetable in their diet (61%), eating more whole grains (60%) buying fiber products (44%), looking at labels for fiber content (37%). Shopping for food with fiber claims (27%). Taking fiber supplement (23%) adding probiotics to their diet (12%), adding prebiotic to their diet (4%).

CHAPTER III METHODS OF THE RESEARCH This chapter discusses the procedures to be done by the researchers to gather the needed data. This includes the Research Design, Research locale, Participants, Sampling Design and Data Gathering Procedure.

RESEARCH DESIGN The study entitled Frutie-Vegs Diet for Blood Glucose Control among diabetic client at WMSU is an experimental research that aims to determine the decrease in blood glucose level of the Fruitie-Vegs intervention on the willing participants. This is a quasi-experimental design employing the time-series method. This method and design will select a group of diabetic client to participate in the experiment using purposive-convenience sampling. This group of ten (10) diabetic clients will be subjected to a glucose test for 5 consecutive days, one hour after lunch before the intervention of the Frutie-Vegs diet. During the intervention for five consecutive days, glucose test one-hour after lunch will also be taken. That would mean series of blood glucose test will be done 5 days before and 5 days during the intervention.

PARTICIPANTS/RESPONDENTS The respondents of the study will be randomly chosen from the list of diabetic clients taken from Barangay Tetuan. Only female client that were diagnosed with diabetes will be chosen as participants. Full consent of the client will be taken using a researchers constructed consent for participation.

SAMPLING Purposive and convenience is the method will be used in this study. The researchers will be using this method because the participants in this research study will involve the female clients at Barangay Tetuan who is diagnosed with diabetes and that researchers chose those who voluntarily and willingly consented to participate in the experiment.

DATA GATHERING PROCEDURE To gather the data needed for the research, the researcher will be using the following instrument: There will be a health teaching about the significance and implications of diet. Procedure Those diabetics who willingly signed for participation will be taken as subjects of the study. Five days prior to the intervention of the FRUITY-VEG Diet post-prandial blood glucose test will be taken for five consecutive days among the study participants. Post-prandial would mean two hours after lunch, blood glucose test will be done. Five days prior to the intervention the study participants

will take his/her regular or usual breakfast, midday snack, lunch, afternoon snacks, and dinner. The five-day FRUITY-VEG alternative diet intervention will follow. That would mean, on the next 5 days, the study participants will be served the FRUITY-VEG alternative lunch. Two hours after the FRUITY-VEG lunch, blood glucose test will be taken. During the five days intervention, the study participants, will take their regular or usual breakfast, snacks, FRUITY-VEG alternative lunch, usual afternoon snack and dinner. Only the lunch is being controlled which will be prepared and serve by the researcher. The pre-intervention and post intervention blood glucose test results will be compared and determine the significant difference.

For those study participants who are under medical regimen, their medication will continue as prescribed. ,INSTRUMENT OF THE STUDY All data will be gathered and tabularized to organize the Pre-Intervention Blood Glucose and Post Intervention Blood Glucose of the ten female participants of Barangay Tetuan. The statistics we will be using are the mean (X), standard deviation (SD), and the T-test of difference. The t-test of difference is a statistics method use to compare one set of measurements with a second set from the same sample. It is often used to compare before and after scores in experiments to determine whether significant change has occurred. The T-test formula is:

where

is the mean of the change scores, is the hypothesized difference (0 if testing

for equal means), s is the sample standard deviation of the differences, and n is the sample size. The number of degrees of freedom for the problem is n 1.