Issues/Problem
The prevalence of Diabetes is increasing at an alarming rate across the world. The rate of this chronic illness in Australia has increased from 1.5% to 4.7% from the period 1990-2015 as per the Australian Institute of Health and Welfare (AIHW) (Tran et al. 2014). This public heath priority calls for intervention and prevention. It is important for people diagnosed with diabetes to effectively manage their illness. For this purpose, they need to be empowered and their health literacy needs to be enhanced. The reports present the health promotion program for diabetes for effective coping of illness and reduce the comorbidities. The report discuses the key strategies for health promotion, implementation plan and lastly, presents the evaluation of the program to assess the impact and the outcome.
As reported by the Australian Bureau of Statistics (ABS) National Health Survey, diabetes was reported inn1.2 million Australians aged 18 years in the 2014-2015 (Tran et al. 2014). In the period 1990-2015 the prevalence of diabetes in Australia has increased three fold. The chronic condition was found to be prominent in the members of poor socio-economic background, and those living in remote areas. Diabetes is highly represented by the Torres Strait Islanders and Aboriginals in Australia. The prevalence of diabetes in this community is 13% (Johnson et al. 2015). There is an increasing health care cost, and financial burden on the patients. The health care cost of diabetes has been estimated to be $14.6 billion in 2015 (Lee et al. 2013). It is due to comorbidities associated with the chronic condition such as associated cardiovascular disease, decrease in life expectancy, anxiety and depression (Huo et al. 2016).
The rate of type 1 and type 2 diabetes have increased by 10% and 85% respectively and is attributable to poor health literacy and lack of empowerment (Tran et al. 2014). Additional factors contributing to this chronic illness are the sedentary lifestyle and low educational attainment. This chronic illness is the major health priority in current health system to decrease mortality and morbidity. Therefore, the aim of the health promotion plan for diabetes is to empower, encourage and develop communities to become healthier.
The aim of the health promotion plan is to promote healthy management of diabetes among those affected and promote healthy lifestyle modifications among those diagnosed and at risk of diabetes. The health promotion program aims to improve the health and well-being of the young adults and older adults in Australian Aboriginal communities.
Aims and objectives
The objectives of the health promotion program are:
- To modify the health related behaviours of the individuals through education- Health education will help people in better understanding of the illness and ways to cope up with the complications. Health literacy was found to be effective in modifying the lifestyle choices of patients (Rockette-Wagner et al. 2015).
- To focus on self-efficacy and self-directed learning to manage the chronic illness
- To train the health professionals and the community health workers-to deliver the strategies efficiently
There are various ideas and theories in literature, which, support the health promotion program. The theories may guide the approach to the health promotion plan. However, the success of the program depends on the “focus of change of behaviour” the program works on. For tackling diabetes, and to promote healthy management of the illnesses the following theories may be helpful.
According to Bandura (2004), health promotion by the social cognitive means is a comprehensive approach. This approach posits a multifaceted causal structure that focus on self-efficacy beliefs. In this approach, the regulators of human motivation, behavioral change and well-being such as goals, expectation of outcomes, environmental barriers and facilitators operate together with self-efficacy beliefs. It means that if an individual beliefs in the necessity of change then they will surely maintain the healthy habits. According to Rimer and Glanz (2005) the learning theory, communication theory, diffusion of innovation theory well inform the behavioural interventions specially when promoting the healthy food choices. Healthy eating is also an important part of the diabetes management program. The policy theory may help in understanding how to influence the political processes for instance convincing the council to establish free services for diabetes management such a counselling services. The community development theory facilitates the understanding of the barriers of the people in maintaining the healthy lifestyle choices (Rimer and Glanz 2005).
The stages of the change model explain the readiness and willingness of the patients in a given community to change towards health promotion. The health belief model is an effective guide in the health promotion programme. The health behaviours that the people are more likely to undertake are predicted and explained by the health belief model (Rimer and Glanz 2005). For the purpose of the health promotion for diabetes patients, the health belief model is chosen as conceptual framework.
The Health Belief Model is a conceptual framework selected for the health promotion program. This model emphasises on the beliefs of the patients related to their health condition and determines their behaviours. The model supposes that a person can avoid a negative action when he/she beliefs positive results would emerge. It will consequently, make them belief that taking the recommended steps will help them gain a healthy life. This model will also help in decreasing the cost of the Australian health care system for all types of the health problems. Using this model, the short term and the long-term health goals for the health promotion program will be designed. There are five stages to using this model. The first step is to gather information by assessing the community for their health needs. The second step is the sharing of information on health consequences of diabetes to this community. The third step involves recommending the health promoting strategies. The fourth step is to remove barriers in effective implementation of action. The fifth step is demonstration of the actions together with self efficacy and self directed learning to successful behaviour modification (Rimer and Glanz 2005).
Theories and models
The success of the model depends on the range of factors including the perceived severity, barriers and facilitators of actions, perceived susceptibility to high-risk condition among the people and self-efficacy and self-directed learning among the targeted population which in this case is Indigenous population among Australia. The rationale for selecting only this community for health promotion for diabetes is to ensure the feasibility of the plan. It will be implemented in broader community if successful. Using the model, the health promotion plan will be developed in a manner that will focus on the individual behaviour, beliefs towards diabetes. It will focus on motivating people and empowering them to engage in self-management program. The other discussed theories will be used for developing strategies to health promotion for diabetes.
The diabetes prevention and management in Aboriginal community can be initiated using the whole system approach that is derived from the World Health Organization (WHO) and Ottawa Charter (Thorlindsson 2011). It is build on the elements of capacity building, community participation, partnership, community empowerment and equity. This system incorporates multidisciplinary and holistic approach towards risk factors. It includes three core elements of health promotion within the circle. The outer circle represents the public health policies, round spot that enables enabling, mediating and advocacy applied in health promotion areas (Jackson et al. 2006). Therefore, the following strategies are prioritized for this health promotion programme.
Health literacy- is the effective strategy to help patients understand the diabetic complication engages in optimal management, regular monitoring and health screening activities. The theory guiding the approach is empowerment theory. Health literacy can be achieved by educating the patient using various strategies. Using empowerment philosophy interactive teaching strategy will be implemented to assist patient in problem solving. Group educational programs will best strategy for increasing the health literacy of the Aboriginal community (Funnell and Anderson 2004).
Self-management-The philosophy of empowerment will be used for increasing the self-management skills among the patients through patient centred activities and change of pre-existing beliefs and feelings. Self-management education program will teach self-care activities include participating exercises, blood glucose monitoring and others. The benefits of the providers include achievement of the recommended standards of care and improved outcomes (Funnell and Anderson 2004).
Self-efficacy and self-directed learning- patients will undertake the behaviour change model seriously if it is operated together with the self-efficacy (Maibach and Murphy 1995). It will push people in participating in the screening and disease management activities. It will also lead to targeting, planning and reporting of the early detection in the primary healthcare services and take initiative for further health education (Merriam 2001). There are five steps to empowerment. It starts from sharing information to community people about the diabetes and lifestyle modifications. It is followed by comprehending and apprehending the problem and ascertaining the belief system of the target people. The next step, which will follow this, is to develop short term goals for behaviour change and evaluation of change (Whiteside et al., 2014).
Conceptual framework
Communication strategies- in order to influence and motivate people to change their health behaviour, health communication is important. An effective communication strategy is required to make patient understand about the relationship between the literacy and the glycemic control in diabetes disease management. For this purpose, a tailored health communication strategy including the “persuasion and message effects” will be used (Rimer and Kreuter 2006). In this strategy any combination of the “information and the behaviour change strategies” can be used to reach a person. The behaviour change takes place by reception of message, acceptance, yielding (exposure to different message sources) and finally the impact (increase in health literacy and decrease in sedentary activities). The communication medium selected for this purpose is social media, telephone, television, radio, brochure, and internet. Using this medium of communication patients will be educated to create awareness on nutrition and physical activities required (Robroek et al., 2012).
Capacity building and training- It includes regular training for community workers participating in the health promotion plan on diabetes care and prevention. Training for health professionals on diabetes and funding for multi-disciplinary team that provides expertise on physical activity, nutrition, and diabetes is essential for success of health promotion. These strategies will be followed by mobilisation of knowledge. It will be undertaken by the Australian health research group including, surveillance, communication and evaluation, monitoring, support in collecting data and disseminating of information.
The implementation plan involves the elements- partnership coalitions, activities, development of budget and setting timeframe (Eldredge et al. 2016).
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Data collection and tracking of the data |
Staffing |
Developmental stages |
Activities |
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Ø Track and report the elements such as blood glucose levels- to assess the population at risk and identify the individuals susceptible to complications of diabetes |
Ø Recruitment of competent community health workers for this community based interventions. Nurses, dieticians, health coaches, would be decided by the program manager through staff mix Ø Partnerships for funding and support include- community service organizations, local hospitals, government organizations, local and state health departments, multicultural alliances, volunteer groups from the colleges and universities and public health organizations |
Ø Certified diabetic educator: to provide education on self management of diabetes Ø Physician: Guide people in clinical decision making Ø Program manager: responsible for delegation of tasks to the staff, communication and tracking of program success Ø Integration of health systems- effective communication with stakeholders to share information and communicate plans Ø Community resources to support people through health program: local community health centres, local hospitals, and other community health resources. Seek support from the local and state government. Ø Communication between the parties: for policy considerations, to discuss and resolve the clinical and operational issues, plan and develop the community-based health promotion initiatives such as legislative advocacy, taxation, fiscal measures, and regulatory oversight (Gruen et al. 2008) |
Ø Teaching basic concept of diabetes- prevention, blood glucose monitoring, complication Ø Teaching physical activity, healthy eating via community kitchens Ø Awareness campaigns for enhancing health literacy and self management of illness Ø Workshops for- teaching how to cook healthy meal in traditional style Ø Develop reports for evidence and recommend policy changes and ban on marketing of fast food with high fatty acid content. Ø Training: the participants of the program needs to be trained on diabetes care and prevention. They need knowledge on the cultural aspects when dealing the target community such as ethnicity, traditions and languages |
The evaluation of the health promotion plan is vital prior to its implementation to ensure that the program will achieve the desired goals and objectives. This evaluation is important due to failure of previous initiatives in this context. For instance, unsuccessful attempts of FWB previously mandates health promotion through effective empowerment and health literacy. For the evolution of the health promotion program for diabetes, the six-step evaluation framework highlighted by Round et al. (2005) will be used with some modification. The evacuation plan will be developed simultaneously with the implementation plan. The six steps of evaluations are-
- Describe the program-It includes detailed vision of the health promotion program and understanding how it will address the problem of unhealthy management of disease.
- Evaluation preview- In this process the stakeholders will be engaged and they will be clarified about the purpose of the evaluation. In this process, the key questions of the stakeholders and the community health workers will be identified. It also includes identifying the resources for removing the barriers of the diabetes health promotion program by having weekly meetings with stakeholders. The data is well preserved for future reference. In this step, performance and outcomes are monitored for evaluation and incorporated in the routine practice (Lichfield, Kettle and Whitbread 2016).
- Focus the evaluation design- In order to ensure that the information collected gives maximum value, effective data collection instrument will be chosen. It refers to tracking of the implementation of the staff training programme, diabetes duration, nutrition and physical activities. This step is followed by the review of the percentage of the stakeholders involved.
- Data collection- Evidence related to the health promotion activities are collected. In this case, close ended questionnaire appears to be reliable and valid instrument. Both the process and the outcomes (improvement in health literacy, decreased sedentary behaviour etc.) will be evaluated using this instrument.
- Data analysis and interpretation-Using the reports, gaps and strengths will be identified and compared with the ongoing trends in the community to track the reach of the target
- Dissemination of information gained- Based on the data analysis, a mix of the disseminating strategies will be used to disseminate the findings to the stakeholders and the funding body to create a strong evidence for the health promotion programme. It is necessary for arrangement of funds and fulfilling the training needs.
Conclusion
The public health agencies in Australia and the research institutes have implemented various activities for the prevention and the control of diabetes. For instance, the “Family well-being empowerment and leadership programme or FWB” for Aboriginals. However, these initiatives were not successful in combating the problem due to lack of coordination in activities, which is central to the success of the health promotion strategy. The FWB mainly focused on the empowerment than on health education (Laliberté et al., 2012). There is a little direction on how diabetes activities work to support each other. Due to weak management practices, these initiatives were unable to achieve the desired goals. There was no plan for evaluating the impact of the diabetes initiatives on the well-being of the people who are diagnosed with diabetes and who are at risk of developing the disease. The forums meant for seeking diabetes advice from the experts and other partnership programs are partly in place, which is cumulatively hampering the process of tracking the nature and extent of Aboriginal diabetes and to determine the impact of the diabetes programs it promotes and funds for Aboriginal peoples. Therefore, a health promotion plan is developed for diabetes using the Health Belief Model as a framework and it is expected to increase healthy management of diabetes and reduce the health complications of Aboriginals in Australia. It is expected to be successful because it is derived from the whole system approach of WHO and Ottawa Charter. Unlike the previous initiatives, this promotion programme consists of monitoring and evaluation system to track the changes and modify accordingly. It strength is that the plan aims to overcome the limitations of the previous initiatives in Australia.
Key strategies
References
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