Assessment of Diabetes Type 2 as a Health Need

Assessment of Diabetes Type 2 as a Health Need

Discussion in this essay will be an assessment of Diabetes Type 2 as a health need. This will entail statistics and epidemiology associated with Diabetes type 2, why it is considered a public health issue, the identification of a target of those most at risk of developing diabetes type 2, the culture specific populations at risk, relevant global and national policies and where this health need is identified in Bradshaw’s theory of needs.
This will be followed by an overview of the health promotion approach and SMART objectives of the health promotion group.
Finally an evaluation of the health promotion activity will be discussed. Enlisted in the evaluation will be the evaluation process applied to the health promotion activity, statistics from the public , the role of the health promoter, other environments that would have been more appropriate for the health promotion activity to be conducted.

Assessment of Health Need
The health promotion group were given Diabetes Type 2 as the topic for the health promotion activity. The group gathered relevant epidemiological and demographic statistics regarding to diabetes type 2.
Figures in relation to type 2 diabetes show that the prevalence of the condition almost doubled between 1994 and 2003 (study net slides). Evidence now shows that diabetes type 2 has become a global epidemic. Shaw, Sicree and Zimmet (2010), report that the world prevalence of diabetes among adults aged between twenty and seventy-nine years will affect 285 million adults in 2010 and will increase by 2030 to 439 million adults. Diabetes within developing countries will increase by 69 % and will increase by 20 % in developed countries. The pattern in which people develop type 2 diabetes is considerably different according to the country’s economic status.
Diabetes type 2 now accounts for 95% of all diabetics and affects approximately 2.4 million people in the UK alone with predictions of significant increase in the future. Statistics show that prevalence of type 2 diabetes is most common to people in the Asian communities (Amos et al, 1997). Even with evidence targeting the Asian communities to be most at risk of type 2 diabetes it is estimated that in India alone the prevalence of the condition will reach 57 million by the year 2025.Also within these statistics it is estimated that the prevalence of the condition in China will reach 38 million in 2025. From these statistics is it evident that health promotion with regards to diabetes type 2 is very important. (Amos et al, 1997). Countries in Africa have shown the lowest prevalence of type 2 diabetes. However, this is predicted to increase in the next decade.
According to Diabetes UK (2010), Indian men aged 40-60 are at most risk of developing type 2 diabetes. In relation to the age factor to the development of diabetes type 2, The World Health Organisation (2010) has found the average life expectancy to be 68 years globally. With this statistic in mind, people are living longer now than they were 100 years ago which has an effect on the increase of people developing type 2 diabetes when they are older.(ref to life expectancies). The graphs show that the largest increase was men and women aged over 45. The morality rates in the UK show that males are greater risk of death from diabetes type 2 than women. The Department of Health (2002) have stated that people from the South Asian community are six times more likely to develop type 2 diabetes. Other factors that contribute to the risk of developing type 2 diabetes include obesity; physical inactiveness, family history and living in socio-economic deprived areas.
From these statistics the health promotion group have been able to identify the group most at risk of developing type 2 diabetes as Indian men aged between 40-60 years old. When the group analysed the findings to create a target group, in order to develop an awareness to prevent diabetes type 2, the target group age needed to be much younger. The target group for diabetes type 2 prevention is Indian males aged between 20 and 40.
Prevention is the key for this situation. The importance of it arises in diabetes type 2 in the UK where resources could be used for illnesses that aren’t preventable in this country. Thus there are major improvements needed in the prevention side of the condition. (Wareham, 2001).
Contributing factors such as culture, behaviour and genetics can affect diabetes type 2. Within the Indian and Pakistani cultures it is considered a sign of wealth and wisdom if a man has a large stomach. Excess fat around the lower abdomen of the stomach is metabolised differently in Asian men and they have a predisposition to store fat there too. A high circumference waist line is a major risk factor of the development of type 2 diabetes.
In traditional Indian cooking there is usually a high content of fat and sugar. In more recent years Indian foods are now used more often because the resources have become more affordable. A continuous high level of sugar in the blood can have serious complications to the body like nerve damage and even blindness can occur if not dealt with properly (NDIC, 2009). Indian community family commitments take a lot of priority in life. With family commitment being a major priority exercising becomes more of a chore than a healthy lifestyle change. This issue contributes majorly to the risk of type 2 diabetes within the Indian communities and also that childhood obesity becoming an increased problem amongst the middle class people of India.
A study of 4,000 children in India showed that 23% of these children were overweight while 11% were already at the obesity stage. However, it is not just the children and young adults with issues regarding exercise (Dixit, 2008).
A qualitative study was done on the reasons behind the large amount of Asians diagnosed with type 2 diabetes. Some of the participants interviewed stated that they believed that Allah/God had given them this disease and God wanted it to happen. From this same study it was found that many Asians diagnosed with diabetes type 2 blamed it on external factors outside of their control rather than looking at the facts surrounding the issue and the major risk factors involved. This lotus.....
The National Service Framework for diabetes aim to make best practice the norm in primary care, acute hospitals and community services. There are 12 new standards set out in the framework to raise the standard of diabetes. These standards will be targeted to communities at greatest risk such as the Asians. (NSF, 2001).
The World Health Organisation(2010) aim to prevent and control diabetes in low and middle-income countries. The WHO is building up the awareness on the global epidemic of diabetes. The WHO conducts surveillance of diabetes and its risk factors. The WHO’s global strategy on diet and exercise work in sync with awareness of diabetes by reducing global obesity. (WHO, 2011).
The International Diabetes Federation is aiming to encourage health professionals to identify people with risk factors, manage/treat to reduce risk factors and develop community education programs. The IDF also want to raise awareness to a wide range of sectors including education in schools, transport and agriculture.
Bradshaw (1972) identified four definitions of social need which can be used in the aspect of health care. The four needs are normative, felt, expressed, felt and comparative. Normative was used for the purpose of this essay because a normative need is a need which reflects professional judgement and how they identify ways these needs can be met (Naidoo&Wills, 2000) . Professional view points and judgements can be variable. For example, when a patient has been diagnosed with type 2 diabetes, the primary need of that person differs with regards to which health care professional is assessing them. A doctor may see the patient’s primary need being the introduction of insulin and medication where as a nurses perspective of the primary health care need may be to educate the patients about the condition and safe administration methods of medication. Some other professionals may then have the approach of education as a primary need and for the patients to control the diabetes with exercise and diet. Each professional view point is different however the validity of such judgements can be questioned (Jones, 2000). Normative standards are also bound for change over time as standards of professional practice change, knowledge changes, research break throughs and changing values in society. (Horton, 1997)
Approach
The health promotion approach chosen is the educational approach. This approach supplies the client with relevant information as to gather knowledge and understanding of a health issue. From this point the client can make informed decisions. This approach respects the client as an individual and empowers the client to make decisions towards their own health. (Dignan, 2002). There is a theme running through the educational approach that individuals are given the capacity to take control over their lives. The aim of this approach is to advise and instruct (Ewles&Simnett, 2003). However, different external factors such as cultural or social norms can influence the client’s freedom of choice. For a client to make a lifestyle change it requires planning, focus and commitment. (Midref, 2000). The education approach comes with an assumption that with the relevant information people will make the right choice, however as stated before external factors have an influence on this decision making process. (Naidoo&Wills, 2009). According to Naidoo and Wills (2000) learning involves three psychological aspects, cognitive, affective and behavioural. Information is not enough to change a client’s lifestyle. It is important that information giver understands the learning process and the factors that help or hinder learning. (Naidoo&Wills, 2000). A disadvantage to this approach is that clients on this particular occasion had only three to four minutes at the health promotion stall. This short space of time is slightly insufficient to educate a client for the client to make the decision to be healthier or to exercise more.
The aim for the health promotion group was to increase awareness of type 2 diabetes within the Indian community. The health promotion SMART objectives of the group were that at the end of 3-4 minutes participants will be able to identify, three complications of type 2 diabetes, two lifestyle changes that help prevent the onset of type 2 diabetes and two resources of further information regarding any concerns or symptoms.
Evaluation
‘’The intention of health promotion evaluation is that it assesses activities in the light of intended goals and values, so that the outcomes can contribute to future decision making’’. (D.Whithead, 2002).
The reason it is important to evaluate the health forum, so that it can be made clear how appropriate the information was, how effective the information was and was it economic. The activity needs to be looked at closely to identify all aspects of the health forum to see what was good and bad (Ewles&Simnett, 2003).
The evaluation tool the health promotion group used is the process, impact and outcome. The process is the ‘how’ part of the health forum. The process involves uses many different types of resources. The health group used posters, leaflets, CD-ROM’s, freebies and the role of the health promoter to educate the visitors. Alistar et al (2000) stated that the use of poster presentations as a learning method is well recognised within healthcare education, especially in nursing. It is widely believed that leaflets or printed materials are deemed to be effective in health promotion and increasing knowledge of risk factors to health. However, research shows that unless leaflets are given out individually the impact is not as good comparing to if the leaflets are given on a voluntary basis. Research results suggest that the cost of such materials should be weighed against the alternative forms of intervention. (Pub Med, 1991).
The use of CD-ROM’s is useful for raising awareness of health issues and conveying information. It is suggested that with visual displays they should be in different languages, largely typed instead of written and with graphs using colour to bring it to life and attract more visitors (Ewles&Simnett, 2002).
Impact refers to the immediate effect, to assess what the participant had learned questionnaire was provided to measure their knowledge after the health promotion forum.92% of visitors to the health promotion stall were able to identify 2 complications of type 2 diabetes. 100 % were able to identify 2 ways of preventing type 2 diabetes. 76% of visitors were able to identify 2 ways of obtaining further information. To give an accurate measurement it would be beneficial to find out what participants already know to give an accurate measurement of the impact from the information which was given. The evaluation forms had run out so this analyse was based on the first hour and a half. A number of other respondents said they found the stall informative and effective. Ideally the group would have been given the questionnaires before and after the visit to the stall to evaluate effectively the impact of the health forum stall.
The objectives were met to a high standard, more than expected by the health promotion group with very good reviews from fellow students and lectures. If this was to be done all again, more concentration would go into the visual displays making them more simple and attractive. A community centre within an Asian dominant society would be ideal for a health promotion setting.
The outcome of this forum cannot be evaluated as outcome means the long term effect of the information given. In an ideal situation the participants from the health forum would give additional information like an email or telephone number. The participants would be sent the questionnaires after a number of weeks to see how much information was obtained and remembered. However this also can prove to be inaccurate as the information given the second time round could have been obtained from other sources rather than the health forum itself. Also in an ideal setting the health promotion sessions would occur over a number of weeks. This would give participants a better chance to adjust to changes they want to make in their lifestyle with support of other community members and health professional advice. This would also give the participants a better outcome.

Conclusion
This essay has discussed the awareness of type 2 diabetes in relation to health promotion with supporting evidence and policies. The group set out to try and educate the target group involved. Overall the group feels this has been achieved to the extent it could have been done.

References
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