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Prevalence of Diabetes in Indigenous Communities

Question:

Discuss about the Diabetes Management in Indigenous Community.

Diabetes is one of the most important chronic disorders that are affecting the nation at an alarming rate. The indigenous people are the most affected in comparison to the non-indigenous people and requires attention of both the government and the private sectors of healthcare and social care. Data which has been extracted from the studies of 2012 to 2013 as shown that the prevalence of diabetes in the Aboriginals and the Torres Islanders ranged from 9 to 11% which is more than 3time that of the numbers of the non-indigenous people. Studies even show that in the year 2012 to 2013, indigenous people were seen to be 4 times higher in comparison to that of the non-indigenous people who are hospitalized for the disorder of diabetes (Regan et al., 2017). Therefore, these results confirm the fact that aboriginals are not being able to manage and take care of themselves  as well as not being able to access proper health care from the urban healthcare centers like that of the non-indigenous people (Shepherd et al., 2016). Hence, it becomes extremely important for social care workers to develop a proper group by which each of the members can help in addressing each of the issues properly and help the aboriginals to develop proper quality lives.

The aboriginals and Torres Islander people had lived hunter-gatherer lifestyle until the 18th century until the arrival of the Europeans in 1788. Adverse changes in their physical activities as well as nutrition took place in the second half of the 20th century that resulted in the occurrence of diabetes in them. The researchers already state that in the present generation economic opportunity, social conditions as well as physical infrastructure play an important role in the health condition of all individuals and communities (Webster et al., 2017). In case of the aboriginals, it is also seen that the above tree aspects of better and healthy living are compromised in case of aboriginals that had become the main healthcare determinants of the occurrence of diabetes. Lack of knowledge and health literacy, proper exposure to healthy living, lack of economic stability to but healthy food and many others are the contributors to the occurrence of the disorders. Diabetes results in poor quality life of the patients as series of other different disorders are found to be intricately associated with the disorders (Leung, 2016). Circulatory complications may take place like angina, heart attack, stroke as well as peripheral vascular diseases. Renal complications mainly include diabetic neuropathy as well as chronic kidney failure. Diabetic retinopathy, cataracts as well as glaucoma also take place in the individuals. Peripheral neuropathy and autonomic neuropathy also occur in individuals. All these result in poor quality life of the cohort and increased rates of hospitalizations (Spurr et al., 2018).

Contributing Factors to Diabetes Among Indigenous Population

The group that will be formed should be such that they can successfully conduct five important aspects that are related with the issues of the diabetes management. The group would be at first taking the initiative of proper health risk assessment of the individuals. The members should make sure that proper tool as Australian type 2 diabetes risk assessment tool (AUSDRISK) is used in a culturally sensitive ways to identify the high-risk individuals and accordingly take interventions for their betterment. The second imitative would be delivering proper health education program that should be categorized accordingly to the children and adolescents and the other group of the adults (Zwar et al., 2017).  The third initiative that should be taken by the individuals is the promotion of lifestyle modification programs that will mainly focus on the changes of lifestyle habits like physical activity and weight loss systems. The last factor that should be taken is proper evaluation strategies by which the members of the groups can assess the results of the initiatives taken and accordingly try their best to help the individuals overcome the disorders. Besides, some members of the group have to take the responsibility of advocating and trying their best to manage the issues through miscellaneous social activities properly (Nguyen et al., 2016). These might include arrangement of proper medications, advocating for their needs to the local government, arranging for resources, conveying concerns of the aboriginals to the governments and so on.

The group that will be developed will have 20 members who will be addressing the different sections of the initiatives that will be taken for management of diabetes among the cohort. 5 diabetic educators would be introduced into the group out of which two of them would be mainly addressing the education of the children and adolescents. These two educators will be chosen such that they remain well knowledgeable about the communication styles and cognitive power analysis of such children and adolescents (Marley et al., 2015). The rest 3 of the educators old be mainly addressing the education plans of the adults making them develop heath literacy so that they can change required habits for better living. Four of the embers out of the 20 member team would take upon the responsibility to conduct the lifestyle modification programs. Here, they will urge all the community members to participate and help them develop knowledge about lifestyle modification through simple community programs. This would include activities like physical exercise programs, swimming sessions in the form of sports, help them learn how to measure blood glucose properly without assistance of health professionals and others (Scienerout et al., 2016). Six of the members would be mainly conducting the social activities and advocate effectively for the different necessities which would support the aboriginals to overcome the issues successfully. They would be interacting with the local authorities, governmental representatives, different public healthcare organizations and others to try their best to bring out positive outcomes on the patients. Three of the people will be mainly given the responsibility of conducting the risk assessments and evaluation of the results to understand whether any issues are occurring or further changes are required or not. Rest two members would mainly act as the coordinator who would be monitoring all the activities, conducting the meetings, developing programs and communicating necessary interventions. They would be also looking over the financial outflow and thereby conduct the financial planning as well.

Group-based Approach to Address Diabetes in Indigenous Communities

The members who will be the educators would develop early year education and intervention programs that will help in providing a sequential systematic approach for developing nutritional status of infants and children. Researchers suggest that if children are educated from young age, they will tend to develop better diet habits in their future. Moreover, education sessions would be arranged in the communities where adults would be guided about the importance of effective diet and weight management and how these could result in prevention of diabetes (Scheirout et al., 2016). They would be able to develop healthy body and mind along with resilience and self-regulation so that they can make effective choices. The individuals who will be conducting the lifestyle management programs would mainly guide the individuals about how to keep one fit both physically and mentally by taking up exercising activities, swimming, physical workout, yoga, meditation and others. They would be also taught about how they can measure their own activities successfully and can understand whether they are at risk or their blood glucose level is normal (Dreger et al., 2015). There would be also members who would be increasing the availability as well as access of the healthy foods, limit the advertisements of unhealthy foods, improve housing, arranging of rural healthcare campaigns once a week, advocating their issues to the concerned authorities and others. There would be members who would be conducting risk assessment of individuals to identify those who are at higher risks and should treat them on an urgent basis to help them development good quality life and lessen their sufferings. Moreover, evaluation should be done effectively to find out how the cohort is responding to the different interventions (Adams et al., 2017). Accordingly, changes would be made by the group is required.

The team members should address each of the community individually and about 3 to 4 months would be assigned for each of the communities. Within these 4 months, the coordinators will play the main role in the planning and arrangement of the meetings and conferences. The meetings would be held in the community halls after seeking permission from the community heads (Oso et al., 2016).  Every member should make sure to attend the meetings in order to discuss two important aspects – the planning of the programs of the following week and the status of the initiatives that was taken the previous week. The meetings would be help on Saturdays every week that would be held for 3 to 4 hours. The members would be requested to submit a report of the response of the target individuals and the farther planning of the interventions that the members would be providing in the coming weeks (Vasant et al., 2016). Another important aspect of the meeting would be to discuss any barriers that the embers would be facing in their respective fields. The team would try to brainstorm the issue, collaboratively find the solutions to the barriers, and proceed farther in their goals and objectives.

Role of Different Members in the Group

Aboriginal culture and their different communities are found to be widely diverse. There are different nations, tribes as well as groups living in the remote regions of Australia who have their own cultural traditions, preferences and inhibitions. Therefore, if the group applies ‘one size fits for all’ technique, the goals and objectives would never be met and the aboriginals would never be able to connect emotionally with the initiatives taken for them. Therefore, members need to tailor the ways of their working as well as their communication so that the needs of the communities can be met. Therefore, developing such a varied knowledge of the respective cultural traditions would be stressful for the members that may affect them physically and be emotionally tiring (Chung et al., 2014). Moreover, another important factor is that there are many cultural as well as historical factors that need to be acknowledged by the members, as they would be working closely with the people. Developing a vast knowledge about the background of the cohort requires huge time and dedication. It might happen that the members may not be able to develop such knowledge at one go or may not be able to be culturally sensitive due to the lack of cultural awareness and sensitivity. This may result in tensions among the members and the cohort that may lead to the failure of the project. Therefore, members should provide services, programs and interventions that align with their cultures and provides them scope in active participation and decision-making.

The member who has the responsibility to tackle the risk assessment and evaluation parts would develop a questionnaire. This questionnaire would be circulated in the communities at the end week of a particular month. The members would be surveying the aboriginals in different aspects of the programs and how they are perceiving it. The questionnaires should also note down their feelings in closed questions in the questionnaires only. These will be in the marking system of Likert five-point scale where ‘strongly disagree”, “disagree”, “neutral”, “agree” and “strongly agree” would be present. The cohort would be requested to submit their answers through interview systems and the answers would be noted. These data would then be statistically analyzed to find out the efficiency of the different interventions taken (Grigg et al., 2017). Following the statistical data, the group can reach to a conclusion about the efficiency of the projects, planning, interventions and programs. Another important method of evaluation would be the analysis of the reports that are submitted by the group members individually. The reports should show positive outcomes with increasing intensity with the passing of the number of weeks. The results of the analysis of the reports would also help in effective evaluation of the status of the projects

Culturally Sensitive Approaches to Address Diabetes in Indigenous Communities

Conclusion:

From the entire discussion, it becomes clear that diabetes is one the leading cause of suffering among the aboriginals and Torres Islanders. Therefore, it becomes important for the social acre activists to take important initiatives to help them overcome negative outcomes of diabetes on their lives. Therefore, effective teamwork is very important to help them overcome improper habits, lifestyle modification, develop health literacy and get access to proper resources according to their needs. Therefore, a twenty-member team would be developed who would have respective responsibilities to address the aspects of their health and take important initiatives to help them develop good quality lives. Cultural barriers may result but proper cultural knowledge and awareness would help in overcoming such barriers. Proper evaluation of the interventions would help in understanding the stats of the interventions and would help in achieving the goals of the team.

References:

Adams, K., Liebzeit, A., Browne, J., & Atkinson, P. (2017). How’s Your Sugar? Evaluation of a Website for Aboriginal People With Diabetes. JMIR Diabetes, Vol 2(1), pp e6. Retrieved from: https://diabetes.jmir.org/2017/1/e6/

Chung, F., Herceg, A., & Bookallil, M. (2014). Diabetes clinic attendance improves diabetes management in an urban Aboriginal and Torres Strait Islander population. Australian family physician, Vol 43(11), pp 797 retrieved from https://search.informit.com.au/documentSummary;dn=748589436438389;res=IELHEA

Dreger, L. C., Mackenzie, C., & McLeod, B. (2015). Acceptability and suitability of mindfulness training for diabetes Management in an Indigenous Community. Mindfulness, Vol 6(4), 885-898. https://doi.org/10.1007/s12671-014-0332-0

Dreger, L. C., Mackenzie, C., & McLeod, B. (2015). Feasibility of a mindfulness-based intervention for Aboriginal adults with type 2 diabetes. Mindfulness, Vol 6(2), pp 264-280 DOIhttps://doi.org/10.1007/s12671-013-0257-z

Grigg, A., Thommasen, H. V., Tildesley, H., & Michalos, A. C. (2017). Comparing Self-rated Health, Satisfaction and Quality of Life Scores Between Diabetics and Others Living in the Bella Coola Valley. In Connecting the Quality of Life Theory to Health, Well-being and Education (pp. 137-150). Springer, Cham. https://doi.org/10.1007/978-3-319-51161-0_6

Iso, K., Mukai, K., Kakumae, Y., Ishi, K., & Ohuchi, H. (2016). The relationship between CVR-R and 2-year glycemic control in type 2 diabetic patients. Diabetes Research and Clinical Practice, 120, S150. DOI: https://doi.org/10.1016/S0168-8227(16)3 pp 1314-6

Leung, L. (2016). Diabetes mellitus and the Aboriginal diabetic initiative in Canada: An update review. Journal of family medicine and primary care, Vol 5(2), pp 259. doi:  10.4103/2249-4863.192362

Marley, J. V., Oh, M. S., Hadgraft, N., Singleton, S., Isaacs, K., & Atkinson, D. (2015). Cross-sectional comparison of point-of-care with laboratory HbA1c in detecting diabetes in real-world remote Aboriginal settings. BMJ open, Vol 5(3), e006277. https://dx.doi.org/10.1136/bmjopen-2014-006277

Nguyen, H. D., Chitturi, S., & Maple?Brown, L. J. (2016). Management of diabetes in Indigenous communities: lessons from the Australian Aboriginal population. Internal medicine journal, Vol 46(11), pp 1252-1259. https://doi.org/10.1111/imj.13123

Regan, T., Paul, C., Ishiguchi, P., D’Este, C., Koller, C., Forshaw, K., ... & Eades, S. (2017). Comparison of Two Sources of Clinical Audit Data to Assess the Delivery of Diabetes Care in Aboriginal Communities. International journal of environmental research and public health, Vol 14(10), pp 1236.  doi:10.3390/ijerph14101236

Schierhout, G., Matthews, V., Connors, C., Thompson, S., Kwedza, R., Kennedy, C., & Bailie, R. (2016). Improvement in delivery of type 2 diabetes services differs by mode of care: a retrospective longitudinal analysis in the Aboriginal and Torres Strait Islander primary health care setting. BMC health services research, Vol 16(1), pp 560. https://doi.org/10.1186/s12913-016-1812-9

Shephard, M., O’Brien, C., Burgoyne, A., Croft, J., Garlett, T., Barancek, K., ... & Shephard, A. (2016). Review of the cultural safety of a national Indigenous point-of-care testing program for diabetes management. Australian journal of primary health, Vol 22(4), pp 368-374. https://doi.org/10.1071/PY15050

Spurr, S., Bullin, C., Bally, J., Trinder, K., & Khan, S. (2018). Nurse-led diabetic retinopathy screening: a pilot study to evaluate a new approach to vision care for Canadian Aboriginal peoples. International journal of circumpolar health, Vol 77(1), pp 1422670. https://doi.org/10.1080/22423982.2017.1422670

Vasant, B. R., Matthews, V., Burgess, C. P., Connors, C. M., & Bailie, R. S. (2016). Wide variation in absolute cardiovascular risk assessment in Aboriginal and Torres Strait Islander people with Type 2 diabetes. Frontiers in public health, Vol 4, 37. ttps://doi.org/10.3389/fpubh.2016.00037

Webster, E., Johnson, C., Kemp, B., Smith, V., Johnson, M., & Townsend, B. (2017). Theory that explains an Aboriginal perspective of learning to understand and manage diabetes. Australian and New Zealand journal of public health, Vol 41(1), pp 27-31. https://doi.org/10.1111/1753-6405.12605

Zwar, N., Harris, M., Griffiths, R., Roland, M., Dennis, S., Powell Davies, G., & Hasan, I. (2017). A systematic review of chronic disease management. retrieved from https://openresearch repository.anu.edu.au/bitstream/1885/119226/3/final_25_zwar_pdf_85791.pdf

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