Developing A Health Promotion Project To Mitigate Diabetes In Indigenous Communities

Needs assessment

Health promotion and disorder prevention can be explained as the programs that are developed with the main focus of keeping people healthy. These programs mainly aim in effective engagement as well as empowering of the individuals as well as the communities for choosing appropriate healthy behaviours. The health promotion programs accordingly make changes that help in the reduction of the risks of development of chronic disorders as well as other morbidities (Thomas et al., 2016). The World Health Organisation had defined health promotion as the main procedures that enable people in increasing their control over health and thereby improve their health. Researchers are of the opinion that the focus of these programs should move beyond a particular individual behaviours towards a wider range of social and even environmental factors. Over the past decade, the statistical analysis had showed that the indigenous communities are showing higher number diabetic patients in comparison to that of the non-indigenous communities (Diouf et al., 2016). They are seen to suffer more not only physically but also economically and emotionally because of the consequences of the disorders. Therefore, it is important to shed more light on the issue and come up with strategies that help the indigenous community to overcome the barriers of diabetes and love healthy quality lives

Diabetes can be defined as the disorder that is marked by increased glucose level on the blood. This is mainly caused by the inability of the body to produce or use insulin effectively. It is one the complex chronic disorders  which are leading to huge number of morbidity, disability as well as reduced quality of life and even premature death among the indigenous communities. Of the disorder is found to be poorly managed as well as undiagnosed, it can result in huge number of complications. The different types of complications are seen to include disorders of the large blood vessels called the macro-vascular disorders. This is seen to include disorders like stroke as well. Other small blood vessels disorders or micro-vascular disorders like that of the kidney disorders as well as eye diseases and nerve disorders (Hawley et al., 2015). Therefore, it becomes important for the indigenous communities to be made aware of the negative health complications associated with the disorder of diabetes and how they might lead to poor quality life. Hence, health promotion initiatives are important to be undertaken.

Researchers are of the opinion that the greatest burden of the disorder tends to be present among the socially disadvantaged groups and the indigenous communities. The latter are seen to experience disproportionately high levels of diabetes. The indigenous communities are found to be thrice more likely to have diabetes in comparison to that of the indigenous communities (Gibson & Regal, 2015). The mortality rate is is also found to be higher in the indigenous communities. Aboriginal and Torres Islander people are also seen to be six times more likely to die from the diabetes than the non- indigenous people.

In the year 2012-2013, studies have found that age-standardised hospitalisation rates for the different types of complications arising for diabetes were about six times higher in the indigenous communities than those of the non indigenous communities. It has been found that the rate of hospitalisation due to renal complications arising from diabetes was found to be about 10 times higher among the indigenous communities in comparison to that of the non- indigenous communities (Narres et al., 2016). Data also shows that in the year 2013, the indigenous people suffering from diabetes, chronic kidney disorder and cardiovascular disorders had seven times more hospitalisation rates in comparison to the non- indigenous communities. Therefore, it can be easily understood that the indigenous communities are highly vulnerable to develop diabetes that remain associated with poor quality life and suffering in different aspects. Hence, it is extremely important for the healthcare professionals to develop health promotion programs by which the problem can be mitigated successfully.

Statistical analysis of needs assessment

Ethnicity plays one of the big roles in making the indigenous communities more prone to develop diabetes. However, this is non-modifiable risk factor. Many modifiable risk factors are also present which when controlled efficiently can prevent the occurrence of diabetes among the indigenous communities. It has been seen that obesity is intricately associated with the development of diabetes and the rate of obese people are quite high among the indigenous communities. Presence of high fat content in cells affects the ability of the cells to respond to insulin and becomes insulin resistant. This makes obese individuals suffer from obesity. Poor quality calorie dense food which is devoid of nutrients can be only afforded by the indigenous communities as they are cheaper. They belong to socioeconomically lower classes and hence they cannot arrange for nutrient dense organic foods (Chamberlain et al., 2014).

They are also seen to have low levels of education. Most of the people in the indigenous communities are not seen to complete their education or have completed the secondary sessions not completing their higher education. Hence, they have poor knowledge on healthy living strategies. So they have poor food habits and they are not aware of low levels of physical activities that they take. They are poor in health literacy and all of these make them probe to practice lifestyle factors that make them develop diabetes.

They are also seen to have lower levels of employment which makes them financially insecure. Their low levels of education are one of the important contributors of poor employment status. However, studies have also found that racial discrimination and stigma are also the reasons that prevent them to seek for services from the non indigenous organisations. Therefore, they spend more time without any specific activities that makes them bored and frustrated (Fertman, 2016). This contributes to higher levels of alcohol drinking. Researchers have associated drinking alcohol with that of development of diabetes. Therefore, indigenous communities are more prone to develop diabetes.

Inability to access to high quality healthcare for both prevention regimens and treatments of the diabetes are usually avoided by the indigenous communities. They tend to receive culturally incompetent services as well as discrimination and racism from the western healthcare systems. This has often acted as a barrier for the indigenous communities to seek for support and help regarding this chronic disorder. Moreover, sometimes, remoteness of the indigenous communities from western healthcare centre also becomes one of the contributing factors (Sallis et al., 2015).

Hence, after the needs assessment, it can be seen that it becomes important for the healthcare professionals to develop health promotion programs by which the issues can be handled effectively and indigenous communities are made free from development of the disorder and affecting quality lives.

Health promotion that need to be followed:

The best model for the development of a health promotion program that would bring out beneficial outcome is the Health Belief Model. This model would be excessively useful for developing both short term as well as long term interventions that would align with the goals of health promotion program. The health promotion program for preventing diabetes among the indigenous communities would comprise mainly of five important steps:

• Gathering of valuable information by conducting of the health need assessments of the indigenous communities as well as other efforts that would help in determination about who is at risk and the population who is to be targeted. This program would be targeted to mainly adults of the indigenous communities (Rowsell et al., 2015).
• The second step would mainly include conveying the different consequences of the health issues that are associated with different risk behaviours. This should be done in a clear as well as unambiguous fashion for helping to understand the perceived severity.
• The third step would mainly involve in communicating the target population about the steps that are involved in taking the recommended actions. The benefits of the actions would also be highlighted.
• The professionals should also be providing assistance in effective identification as well as effective reduction of the barriers to the actions
• The professionals should also demonstrate actions through the skill development activities; they also need to provide support which helps in enhancing self-efficacy as well as likelihood of the successful behavioural changes (Trinh et al., 2015).

Factors leading to diabetes

Development of short term goal: development of knowledge and awareness by providing health education sessions to the indigenous communities regarding diabetes prevention and management

Specific	measurable	achievable	relevant	time
The health education sessions would be aimed at developing health literacy and knowledge about diabetes prevention and care	Teach back method would be applied for ensuring the success of health education sessions. Moreover, surveys also would be conducted to estimate the satisfaction of the indigenous communities after attending the sessions	This goal can be achieved by encouraging the indigenous communities to attend the sessions after making them aware of the negative consequences that the disorder can result. This will make them feel the urgency to attend the program to develop their awareness and live better quality lives	The indigenous communities  Have adopted poor lifestyles due to their lack of knowledge of the consequences that their improper lifestyles are resulting (Pirbaglou et al., 2018). Therefore, if they are made aware of the lifestyle factors that need to be changed, they can prevent the disorders successfully and hence this approach is effective	This would be completed within 2 to 3 months

Development of long term goal: the indigenous communities need to be developed in ways by which the social determinants of health leading to diabetes development among the indigenous communities can be reduced to considerable limit.

specific	measurable	achievable	relevant	timeframe
Development and strengthening of the indigenous communities so that the social determinants of health that contribute to diabetes development can be managed	Effective social analysis and social surveys would be conducted and the data would be analysed; this would help to understand that the co-relating social determents which were the indirect cause of diabetes development could be managed or not.	The goal can be achieved if efficient healthcare professionals undertake successful planning and strategies and accordingly advocate about the issues to the government; this would help in ensuring the meeting of the needs of the indigenous communities	Low health literacy, poor education, poor employment structures, high drinking of alcohol, poor financial security and others are leading to diabetes in indigenous communities; therefore controlling and managing these determinists would help in development of their health (Northridge et al., 2016)	This would take 8 to 12 months for completion

Implementation of goal 1: health education session

• Development of health education session in the community halls would be developed under the governance of effective health educators and trainers; the individuals would be discussed about the disorder and pathophysiology in non-professional language so that they can understand easily; they would be then told about the negative consequences and complications that might result from undiagnosed or poorly controlled diabetes (Eldredge et al., 2016). Accordingly, they would be discussed about the management of the lifestyle factors that would reduce the chances of the disorder. Teach back method would be ensured to understand the success of the understanding of the indigenous communities about the disorder (Sorensen et al., 2015).
• Development of pamphlets and brochures along with posters that would be handed to all the members of the indigenous communities. The resources would be mostly diagrammatic and picturesque with colourful and low levels of written information. As their education level is low, the diagrammatic representation would be able to attract their attention and help them to easily understand the information (Powell et al., 2018).

• Advocate to the government and associated departments for development of effective policies that would help in effective management of the diabetes among the indigenous communities. This should be prepared by stalwart healthcare professionals, researchers and policy makers so that the policy covers each important aspect of prevention and treatment of diabetes among indigenous communities (Dickerson et al., 2018).
• Development of culturally competent healthcare services that would align with the cultural expectations of the indigenous communities. This would involve development of indigenous healthcare centres where healthcare professionals from ingenuous background would be working with western healthcare professionals. This would help in giving more culturally competent care and education sessions that would make indigenous communities more accessible to healthcare mediums. This would be free from racism and discrimination. This would help indigenous communities to visit the centres when they have developed diabetes and would help them to ensure follow up and proper treatment of their diabetes (Moungngern et al., 2018)
• Advocate the issue to food departments of the government. They should be told about how calorie dense tale-away foods are affecting the health and their low cost are making them a harmful option for their diet. They should be requested to lower the price of nutrient rich organic foods and make programs for easily distribution of organic foods among indigenous communities and prevent the sale of cheap calorie dense takeaway foods. This would prevent obesity and chances of occurrence of diabetes would also reduce (Poudel et al., 2017).
• Effective development of schools, colleges and employment sessions in the indigenous communities. This would help them to get educated and develop good awareness and knowledge about proper healthcare habits and diets that can prevent diabetes (Basak, Cinar & Schou, 2014). Employment centres would help in development of financial security which can help them to lead better quality lives by affording good food products and accessing healthcare and affording medications required for treatment. This would also reduce chances of alcohol drinking which will indirectly reduce chances of diabetes

• In order to develop and conduct the healthcare sessions, a total of about 1000$ would be required in each month
• Community strengthening is mainly based on advocacy. However, to develop the reports for advocacy, research analysis is required and for this 1500$ would be required
• Manpower and other inanimate resources would be requited and for this 1000$ would be required for each month

After the implementation of the project, an evaluation team needs to be developed. The team would be conducting a survey in the indigenous communities to understand their response and feelings about the project that had been implemented. This survey would help to know whether the people had understood the contents of the health education sessions and are applying in their daily lives or not. The survey would be also containing questions to them regarding the new initiatives that had been made in the communities like new employment centres, new schools and colleges as well as healthcare centres that align with the culture and tradition of indigenous communities. The replies of the indigenous communities would be analysed and accordingly the success of the health promotion plan can be analysed (Macridis et al., 2016). Mainly impact evaluation would be done on an immediate basis about the health literacy skills and outcome evaluation of the community strengthening would be done after few months. Depending on results, further changes would be done.

References:

Basak Cinar, A., & Schou, L. (2014). Health promotion for patients with diabetes: health coaching or formal health education?. International dental journal, 64(1), 20-28.

Chamberlain, C., Banks, E., Joshy, G., Diouf, I., Oats, J. J., Gubhaju, L., & Eades, S. (2014). Prevalence of gestational diabetes mellitus among Indigenous women and comparison with non?Indigenous Australian women: 1990–2009. Australian and New Zealand Journal of Obstetrics and Gynaecology, 54(5), 433-440.

Dickerson, D., Baldwin, J. A., Belcourt, A., Belone, L., Gittelsohn, J., Kaholokula, J. K. A., … & Wallerstein, N. (2018). Encompassing cultural contexts within scientific research methodologies in the development of health promotion interventions. Prevention Science, 1-10.

Diouf, I., Magliano, D. J., Carrington, M. J., Stewart, S., & Shaw, J. E. (2016). Prevalence, incidence, risk factors and treatment of atrial fibrillation in Australia: The Australian Diabetes, Obesity and Lifestyle (AusDiab) longitudinal, population cohort study. International journal of cardiology, 205, 127-132.

Eldredge, L. K. B., Markham, C. M., Ruiter, R. A., Kok, G., Fernandez, M. E., & Parcel, G. S. (2016). Planning health promotion programs: an intervention mapping approach. John Wiley & Sons.

Fertman, C. I. (2016). Health promotion programs: from theory to practice. John Wiley & Sons.

Gibson, O. R., & Segal, L. (2015). Limited evidence to assess the impact of primary health care system or service level attributes on health outcomes of Indigenous people with type 2 diabetes: a systematic review. BMC health services research, 15(1), 154.

Hawley, N. L., & McGarvey, S. T. (2015). Obesity and diabetes in Pacific Islanders: the current burden and the need for urgent action. Current diabetes reports, 15(5), 29.

Macridis, S., Bengoechea, E. G., McComber, A. M., Jacobs, J., & Macaulay, A. C. (2016). Active transportation to support diabetes prevention: Expanding school health promotion programming in an Indigenous community. Evaluation and program planning, 56, 99-108.

Moungngern, Y., Sanguanthammarong, S., Teparak, P., & Sriwijitkamol, A. (2018). Effects of a Health Promotion Program Conducted by Nurses on Stabilization of HbA1C in Subjects at Risk for Diabetes: A Phase III Randomized Controlled Trial. Journal Of The Medical Association Of Thailand, 101(10), 1343-8.

Narres, M., Claessen, H., Droste, S., Kvitkina, T., Koch, M., Kuss, O., & Icks, A. (2016). The incidence of end-stage renal disease in the diabetic (compared to the non-diabetic) population: a systematic review. PloS one, 11(1), e0147329.

Northridge, M. E., Kum, S. S., Chakraborty, B., Greenblatt, A. P., Marshall, S. E., Wang, H., … & Metcalf, S. S. (2016). Third places for health promotion with older adults: using the consolidated framework for implementation research to enhance program implementation and evaluation. Journal of Urban Health, 93(5), 851-870.

Pirbaglou, M., Katz, J., Motamed, M., Pludwinski, S., Walker, K., & Ritvo, P. (2018). Personal Health Coaching as a Type 2 Diabetes Mellitus Self-Management Strategy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. American Journal of Health Promotion, 32(7), 1613-1626.

Poudel, P., Griffiths, R., Wong, V. W., Arora, A., & George, A. (2017). Knowledge and practices of diabetes care providers in oral health care and their potential role in oral health promotion: a scoping review. diabetes research and clinical practice, 130, 266-277.

Powell, S., & Doyle, V. (2018,). Patient education’The Living Well, Being Well programme’: A health promotion initiative aimed at Men’s sheds in the Midlands (Ireland) to raise awareness of Type 2 diabetes and how to take steps to reduce this risk. In Diabetic Medicine (Vol. 35, Pp. 116-116). 111 River St, Hoboken 07030-5774, Nj Usa: Wiley.

Rowsell, A., Muller, I., Murray, E., Little, P., Byrne, C. D., Ganahl, K., … & Nutbeam, D. (2015). Views of people with high and low levels of health literacy about a digital intervention to promote physical activity for diabetes: a qualitative study in five countries. Journal of medical Internet research, 17(10).

Sallis, J. F., Owen, N., & Fisher, E. (2015). Ecological models of health behavior. Health behavior: Theory, research, and practice, 5, 43-64.

Sørensen, M., Korsmo-Haugen, H. K., Maggini, M., Kuske, S., Icks, A., Rothe, U., … & Zaletel, J. (2015). Health promotion interventions in type 2 diabetes. Annali dell’Istituto superiore di sanita, 51, 192-198.

Thomas, M. C., Cooper, M. E., & Zimmet, P. (2016). Changing epidemiology of type 2 diabetes mellitus and associated chronic kidney disease. Nature Reviews Nephrology, 12(2), 73.

Trinh-Shevrin, C., Nadkarni, S., Park, R., Islam, N., & Kwon, S. C. (2015). Defining an integrative approach for health promotion and disease prevention: a population health equity framework. Journal of health care for the poor and underserved, 26(2 0), 146.