Needs Analysis For Controlling Diabetes Mellitus

Needs Analysis Approach

Option 1: Choose a setting such as a community, health service (e.g. hospital, primary health care service) or neighbourhood you know well in Australia ( Examples (not limited to) are: 
(1)  a particular community (for example, indigenous population, women etc) 
(2)  a health service (such as hospital, primary health care service, GP practices etc) 
(3)  a neighbourhood that you know well (where you currently live in)  [Enter Subject Code and Name here] – Assessment [Enter number here] 
How to proceed with Option 1: 
STEP 1: A discussion of how you would assess different types of needs (normative, expressed, comparative, felt, etc.) and how you would prioritise the findings, justifying your choices.For this purpose, you would either know of/be in the situation in reality first. Then, you would have to undertake rigorous literature review to understand different types of needs assessment and consider alternative views to justify the choices for this context.  

STEP 2: Any potential challenges for your needs assessment and how you would address them. This could be relating to policy, contextual issues or others.  
STEP 3: A SWOT analysis, where you identify the Strengths, Weaknesses Opportunities and Threats of your organisation or program.  
STEP 4: A determination of program priorities, based upon your needs assessment In your needs assessment, you may determine multiple programs priorities – justify why you would choose the priorities you have identified. Are there any population groups that would benefit best from your program? Mention these, justify.  

AN EXAMPLE  
Let us take a GP practice in a specific growing suburb in Melbourne as a context. The waiting list seem to be increasing as many patients are approaching the GP and there are no other practices close by. It could also be that much of the population is working, and they need after hours service. If you are part of this situation (working in the practice or living in the suburb) – you would have an idea as to what type of need had risen. From that point, think about what type of needs assessment is required (via comparing few types of needs assessment from literature review), and justify your choice. Then, we are looking at potential challenges to really confirm this need, through the needs assessment.  
Subsequently, look at the SWOT analysis. There may be many GPs in the practice (Strength), but, the hours may not suit the working population in the suburb (weakness). The threat may be that due to non?suitable opening hours or waiting list, the population may begin to move to another closer suburb (where there are more GPs open late) which then (threatens) the practice. And the (opportunity) is there for this GP practice to open for more hours or have shift based GPs for different hours, keeping the practice open later.

This is a simple SWOT and there may be many more.In this situation, you would be looking at a program design that allows the GPs to open later hours or shifts, which cater to the mainly working population, young families in the new 
suburb/neighbourhood. You may prioritise working women, kids or mainly working men as population groups that would best benefit.[Enter Subject Code and Name here] – Assessment [Enter number here] 

Challenges Faced during the Need Analysis

Option 2 
Select one of the nine national health priorities  (These national health priorities have been devised via a prior needs 
assessment at a policy level. If you use one of them for your assignment, you need to take one of these areas and imagine how you would prioritize it at a service level) Imagine you have been asked to conduct a needs assessment for this setting or health priority. Describe how they would go about a needs assessment: How to proceed with.

Option 2: 
These national health priorities have been devised via a prior needs assessment at a policy level. If you use one of them for your assignment, you need to take one of these areas and imagine how you would prioritise it at a service level  
For example: Assuming that you have chosen ‘Cancer Control’. First, it is best that you break it down into the types of cancers that seem to be prevalent, looking at the incidence of these across Australia (statistics as of 2017),(do remember that you do not go into details of the health problem as such, as this is not the task. It is simply 
statistics to support this task) and review what services are already being provided across Australia in all the States and Territories as well as Federal initiatives. Your literature review needs to be highly comprehensive and up?to?date till end of 2017.Then, based on this decide on how a needs analysis can be undertaken nationally. Do remember to justify different approaches (literature review), before arriving at your final version.  

Specifically, In this example:  
Step 1: What is the best needs analysis approach for ‘cancer control service?’ Can this be national or state level – and why (justify via literature).  
Step 2: What are the challenges that you will face in undertaking the needs analysis? Look at policy, inter?disciplinary and generic levels.  
Step 3: SWOT – From literature that exists until 2017. This can include what is being done (for example, screening), weakness (do not cover all population), threats (many people resist undertaking scanning), opportunity (making screening mandatory).  
Step 4: Program priorities–identify priorities for a potential program based on the above that can be provided at grass root level via state/local councils. (Keep in mind that designing a program as such is not the primary objective ? you are only outlining it at this stage) 

Assessment Criteria (Please see Learning Rubric On Following Pages)  
• Demonstrates knowledge and understanding of different types of need, the process of conducting a needs analysis and SWOT analysis and the steps required (25%)  
• Demonstrates understanding of different approaches and methods for needs analysis and ability to choose the most appropriate for their selected area (25%)  
• Demonstrates ability to synthesise information for a review of relevant literature and to form a coherent rationale for the needs prioritised (20%)  
• Critically analyses the methods and population group chosen and potential challenges to the needs assessment. (20%)  

• General assessment criteria (10%):  
? Provides a lucid introduction  
? Shows a sophisticated understanding of the key issues  
? Shows ability to interpret relevant information and literature in relation to chosen topic  
? Demonstrates a capacity to explain and apply relevant concepts 
? Shows evidence of reading beyond the required readings  
? Justifies any conclusions reached with well?formed arguments and not merely assertions  
? Provides a conclusion or summary  
? Correctly uses academic writing, presentation and grammar:  
1. Complies with academic standards of legibility, referencing and bibliographical details (including reference list)  
2. Writes clearly, with accurate spelling and grammar as well as proper sentence and paragraph construction  
3. Uses appropriate APA style for citing and referencing research .

Needs Analysis Approach

Diabetes is among the nine national health priorities. Diabetes consists of a group of diseases that have got different causes but with similar manifestation. Among the common feature is a high level of glucose within the patient’s body. This is caused by the lack of the hormone insulin or even the incapability of a person to respond to insulin. Despite that it is difficult to cure diabetes, it is observed that it can be clinically controlled and managed. Additionally, there is a lot that individuals with diabetes can do to improve their personal health.

A needs analysis is part of a planning process that is used to identify and determine the gaps that exist between the present conditions and the desired conditions. The purpose of this report is to conduct a needs analysis on people living with diabetes mellitus through identification of the best needs analysis approach, challenges faced during the needs analysis, conducting a SWOT analysis, and identifying the program priorities. The realist review approach will be used in carrying out the needs analysis.

Needs Analysis Approach

Realist review approach is among the best needs analysis approach for diabetes mellitus control. Diabetes control should be done at the national level since the disease is an important public health issue, and it has got negative impacts on the economy. According to the Ontario Ministry of Health and Long-Term Care Reports, Diabetes is among the leading cause of death globally. However, the number of deaths that are as a result of diabetes are substantially underestimated specifically because of the methods used to record deaths (Becker, 2015). This is because individuals who suffer from diabetes normally die due to diabetic complications that include heart attack, which is mostly recorded as the cause of death rather than diabetes itself. Additionally, the disease has got health system costs that translate to the increased economic burden that is as a result of diabetes treatment and its complications.

According to Malone, et al (2012), realist analysis has become a popular approach in reviewing and synthesizing evidence by focusing on and understanding the mechanisms by which an intervention works or does not work. This approach entails the identification of the underlying causal mechanisms as well as exploring how they function under what conditions. The approach involves four stages that include defining the review’s scope, searching and analyzing the evidence, extracting and synthesizing, along with developing the narrative (Bray & Popkin, 2014).

This needs analysis approach is thus useful in developing an explanatory or a program theory regarding what works best and what does not work during the process of controlling and managing diabetes mellitus and to what extents. Applying the approach, the context-mechanism-outcome configuration can then be developed iteratively by means of data collection, theorizing, including engaging the stakeholders (Cain, Orionzi, O’Brien & Trahan, 2017). The people that may be included in this needs analysis include the people living in the community, a care home or even other long-term settings.

Challenges Faced during the Need Analysis

Challenges Faced during the Need Analysis

During the process of carrying out the needs analysis, multiple small obstacles were faced and they ranged from policy, inter-disciplinary and the generic levels. These challenges have a negative impact when conducting a needs analysis, and this may even lead to termination of the process. At the policy level, there were restrictions as to the specific time when assessors could get in touch with patients who were in care homes (Krämer, Green, Pollard & Tugendreich, 2013). As a result, there was a limitation to the number of diabetic patients who were involved in the analysis due to restricted interaction periods with the patients. Staffing in these care homes was largely done by the residents. This resulted in lack of patient continuity over time, every resident attended only a few patients, and the competing clinical, as well as educational demands limited the research participation.

At the generic level, there were several challenges that related to the patients who were to be included during the needs analysis for diabetes control. It was noted that most of the diabetes patients were unaware of the possibility of engaging in a needs analysis and if they were aware of this opportunity, it was difficult for them to locate the needs analysists (Miller & Maloney, 2013).

Most of the patients resided very far from the study centers. As a result, there was difficulty in coming to the clinics to participate in the diabetes control needs analysis. Nonetheless, there were poor show rates including confusion pertaining to the purpose of the analysis, despite the multiple reminders (Nicolucci, et al., 2013). At the inter-disciplinary level, the need analysis was faced with the challenge of making sure that there is fairness and ethics during the process of data collection such that only facts are collected and not statements which are emotionally charged or any other types of judgments that deviate from the acceptable evidence.

SWOT

Among the current strengths in the control of diabetes is screening which includes a hemoglobin A1C test as well as the fasting plasma glucose test. Screening helps in early detection and treatment of diabetes hence help in keeping diabetic people healthy (Pennel, McLeroy, Burdine & Cascante, 2015). Screening also helps in minimizing the risks that result from serious complications that include blindness, kidney failure, stroke, or even limb amputations.

Weaknesses associated with the control of diabetes is that it does not cover all the population. This is because very few people are involved in the screening process, since they are not aware that early detection of the disease could likely save each person an approximate of $1,415 per year (Paul, Street, Wheeler & Singh, 2015). Some of the factors that cause diabetes screening not to include all the population is due to clinic separation and the remoteness of the community-based outpatient clinics, as well as the different capabilities and the support services at every community-based outpatient clinic.

The opportunity associated with diabetes control is making diabetes screening mandatory for everybody. The Australian government should launch a fresh bid in overcoming the condition, pushing for national, and developing a comprehensive early detection program across the country. Emergency rooms along with the GP clinics should be supported to carry out more routine screening. Also, there are opportunities for improving diabetes outcomes, enhancing self-management in diabetes care, and organizing a systematic method for diabetes screening and reassessment.

SWOT

 However, diabetes control is faced with certain threats such as the resistance of many people to undergo a diabetes screening. Among the reasons for this is that many people who are aware of the disease are afraid of screening themselves since they fear that they may test positive. Resistance may also be as a result of lack of exposure, thus some people lack necessary information that relates to the disease.

Program Priorities

Legal and regulatory interventions, unlike medical interventions, are rarely assessed during a needs analysis. As a result, priorities should be identified based on well-recognized criteria such as political feasibility, cost impact, along with effectiveness. These priorities should be provided at the grass root level via the state or the local councils (Kuehnert, Graber & Stone, 2014). First, the government should put in place a mandatory front-of-pack-labeling scheme. This is because if individuals are to take responsibility for their health, they should have clear and consistent nutritional information pertaining to the foods they purchase (Reisner, et al., 2016).

According to the Australian law, it is a requirement that manufacturers disclose on the food packages the nutrition information as well as the ingredient list. Since it may be time-consuming to read and interpret the information, a front-of-pack labels translate this information into simple visual images regarding the food’s quality and nutrition.

Second, children should be restricted from exposures related to junk food advertising. Dietary habits, as well as food choices, are affected by food advertisements. In 2008, the Australian Government had given consideration to this priority but later decided against regulating junk food advertising to children. Rather, the food industry signed two voluntary code of conducts. Empirical evidence shows that the signed voluntary codes have done little in minimizing the exposure of children to junk food advertising (Reed & Fleming, 2014).

Thus, this priority should be implemented at the grass root by putting in place comprehensive and preferable statutory measures that comprise of clearly defining the media and the audience, sanctions for non-compliance, and monitoring of compliance. Other priorities that can be provided at the grass root level include having stronger co-regulatory structures for food reformulation as well as imposing heavy taxes on sugar-sweetened carbonated beverages.

Conclusion

A needs analysis helps determine the existing discrepancy between current and expected expectations. This analysis is effective in clarifying a problem and identifying the necessary solutions or interventions. In this case, the realist review approach has been used to conduct a diabetes mellitus needs analysis. This approach is effective since it reviews and synthesizes evidence by focusing on and understanding the mechanisms by which an intervention works or does not work. Some of the challenges faced in the analysis include schedule limitations as to when to interact with patients in care homes. Among the strengths in the control of diabetes include screening, the weakness is that the whole population is not covered, the opportunity includes making diabetes screening mandatory while the threat is that there is resistance in screening for diabetes. Some of the program priorities include restricting children from exposures related to junk food advertising.

References

Becker, K. L. (2015). Conducting community health needs assessments in rural communities: lessons learned. Health promotion practice, 16(1), 15-19.

Bray, G. A., & Popkin, B. M. (2014). Dietary sugar and body weight: have we reached a crisis in the epidemic of obesity and diabetes?: health be damned! Pour on the sugar. Diabetes care, 37(4), 950-956.

Cain, C. L., Orionzi, D., O’Brien, M., & Trahan, L. (2017). The power of community voices for enhancing community health needs assessments. Health promotion practice, 18(3), 437-443.

Krämer, A., Green, J., Pollard Jr, J., & Tugendreich, S. (2013). Causal analysis approaches in ingenuity pathway analysis. Bioinformatics, 30(4), 523-530.

Kuehnert, P., Graber, J., & Stone, D. (2014). Using a Web-based tool to evaluate a collaborative community health needs assessment. Journal of Public Health Management and Practice, 20(2), 175-187.

Miller, J., & Maloney, C. (2013). Practitioner compliance with risk/needs assessment tools: A theoretical and empirical assessment. Criminal Justice and Behavior, 40(7), 716-736.

Nicolucci, A., Kovacs Burns, K., Holt, R. I., Comaschi, M., Hermanns, N., Ishii, H., ... & Tarkun, I. (2013). Diabetes Attitudes, Wishes and Needs second study (DAWN2™): Cross?national benchmarking of diabetes?related psychosocial outcomes for people with diabetes. Diabetic medicine, 30(7), 767-777.

Paul, M., Street, C., Wheeler, N., & Singh, S. P. (2015). Transition to adult services for young people with mental health needs: A systematic review. Clinical child psychology and psychiatry, 20(3), 436-457.

Pennel, C. L., McLeroy, K. R., Burdine, J. N., & Matarrita-Cascante, D. (2015). Nonprofit hospitals’ approach to community health needs assessment. American journal of public health, 105(3), e103-e113.

Reed, J. F., & Fleming, E. (2014). Using community health needs assessments to improve population health. North Carolina medical journal, 75(6), 403-406.

Reisner, S. L., Poteat, T., Keatley, J., Cabral, M., Mothopeng, T., Dunham, E., ... & Baral, S. D. (2016). Global health burden and needs of transgender populations: a review. The Lancet, 388(10042), 412-436.

Vasilakou, D., Karagiannis, T., Athanasiadou, E., Mainou, M., Liakos, A., Bekiari, E., ... & Tsapas, A. (2013). Sodium–glucose cotransporter 2 inhibitors for type 2 diabetes: a systematic review and meta-analysis. Annals of internal medicine, 159(4), 262-274.