Factors Leading to the Development of Diabetes Cases amongst the Lebanese Community in Sydney - Research Proposal Example

Application for PhD Candidature Research Proposal Working of the Thesis Impact of Diabetes among the Lebanese Community in Sydney 2. Background According to World Health Organization (WHO) report, the number of people with diabetes is rising sharply in recent years. The report found that in the year 2000 the number of people affected with the disease was about 171 million worldwide with the increase to 366 million, more than double in 2030. Though, India and China top the list of countries with maximum number of diabetes cases, the share of developing nations is certainly on the rise in the coming years as well. For example, in the African region, the diabetes cases in 2000 were about 7,020,000, but the WHO projections indicate that in the year 2030 this figure will be around 18,234,000 (WHO, 2005). The increasing cases of diabetes amongst Lebanese people are also a cause of worry. Sydney is host to a large number of Lebanese people, migrated to the country, hence the city, in search of better job opportunities living standards. There are many studies indicating increased prevalence of diabetes mellitus in these families. These have been ascribed to hereditary factors, food habits, prevalence of metabolic syndrome, and increased consanguinity over many generations (Abou-Daoud, 1969). Acculturation is a social phenomenon where family values tend to play important roles, and social and cultural factors related to the immigrant race determine the patterns of acceptance or resistance of newer cultural norms (Bhugra, 2004). This means community, family and social life will have an important impact of the disease on the family and quality of life of the individual (Dept Human Services (Vic), 2004). Diabetes in any population is associated with increased mortality, morbidity, economic, cultural, and social impacts on the person, family, relations, and the community (Zalloua, 2003). Therefore exploration into these factors can discover the qualitative indicators that are impacted with diabetes in this population which may be engineered to change these perspectives of diabetes amongst Lebanese population. Review of the Literature With the availability of such details in the public domain, a literature review can be planned out. In order to have a comprehensive literature review, we have a variety of options like, medical and health journals, findings of similar researches undertaken in the recent past, studies undertaken by reputed institutions and organizations like the WHO, Australian Health Ministry etc. In the preliminary study that has been undertaken for this research, it has been observed that while lot of data is available on the lifestyle and its impact on diabetic cases on the target population, there is a gross paucity of studies that have intended to examine the social, cultural, familial, social, economic, and community impact of having diabetes in this community specifically in Sydney. Therefore, it becomes a great challenge to create a framework for research on this topic, based on which further continuation or design of this study would be proposed. Lifestyle and its impact on Health A number of family studies have been conducted in the Lebanese population in Australia, and these indicate that they tend to retain their own cultural identity even though they have migrated to another country (Knafl and Gilliss, 2002). They would also maintain their habits and ancestral life styles in Sydney. This process tends to promote a tranquil attitude towards diabetes, obesity, metabolic syndromes, mortality, morbidity, complications and other lifestyle factors associated with this trend (Alati, 2003). Kolk (2000) contends that socially, culturally, and at familial levels the ethnic community too suffers like any other human population, but they would not aggressively attack the cause of such sufferings. With the current state of research on this area, many impacts in such areas are unknown, and an appropriate research design aimed at exploring these factors may add to the knowledge and suggest some solutions to the problem. An example may highlight this proposition. It has been observed that there are a high number of observed deaths of unknown etiology in the Lebanese population during infancy and childhood (Medlej, 2004). These deaths may be due to undiagnosed acute complications of insulin-deficient diabetes mellitus, particularly diabetic ketoacidosis, pointing to effects in the family of grief and sorrow. However, this also points out towards the need of an early diagnosis amongst the relatives of the index patient by providing adequate education to the family and the parents. Similar situations may arise due to immense comorbidity associated with diabetes and economic impacts of the disease. Deafness, blindness, neuropathy, renal failure, loss of quality of life are just to name a few (Medlej, 2004). All of these may hamper work and hence income. Added to this, the cost of treatment of diabetes mellitus may seriously jeopardize the family budget, increase expenses, affecting family relationships and social life. Neurological disorder with diabetes may impact activity and quality of life in work, sexual life, cognition and may even precipitate psychiatric disorders. These are all stressful situations for the family, relatives, society, and community. Although these can be deduced, it is not known what in reality, are the effects of this disease on social, family, cultural, and community levels in the stated Lebanese population in Sydney, since no study has been done. This makes a strong case to pursue this research. 3. Research Questions The era of globalisation is known for many things like liberalisation, customer focused policies, more alternatives for the customer etc. The lifestyle of all of us in general and the working professionals in particular, is also affected by this phenomenon. We tend to devote many more hours in front of computer. Late night sitting has become a rule rather than exception. Thus we forget the words of wisdom which state, ‘Early to bed and early to rise makes a man healthy, wealthy, and wise’. The routine morning walk also seems to have a thing of past while we take pride in consuming more of junk food. As a result many people suffer from diseases like diabetes. An effort is being made through this study to find out some such cases and correlate the findings to come out with factors contributing to the occurrence of this disease, particularly amongst the Lebanese community in Sydney, and how it impacts the mutual relationships. The potential research questions for this study include; 1) What are the risk factors contributing to the development of Diabetes Mellitus among the Lebanese population in Sydney, Australia? 2) What are the impact of diabetes mellitus on the social, cultural, family relationships and quality of life among these community groups? 3) What possible strategies would be necessary to raise awareness and interest of the Lebanese community in dealing with diabetes mellitus? 4) What percentage of population in general is suffering from diabetes? 5) Which are the main reasons behind the prevalence of this disease? And how the population in general is reacting to the efforts for containing the occurrence of disease? 6) How are the perceptions of migrant Lebanese community different from the internationally held beliefs about the modern way of life and if some changes are on the horizon amongst the youth segment? 7) Which are the other types of complications that a diabetic patient has to suffer and how the Lebanese community in Australia is coming to terms with the reality? 4. Rationale of the Study As the industrial activities see an upsurge on global scale, it requires the stakeholders to be more conscious about their working schedules and strenuous routines. Realising the potential danger to the health of their executives, some of the Multi-National Corporations (MNCs) maintain a schedule which also includes health related exercises ranging from couple of minutes to couple of hours. For example Sankyu, a logistics firm in Singapore, lines up its employees every morning for a workout of about 10 minutes (AsiaOne, 2009). This not only helps the individuals in gaining better health, but it also helps the company in the form of better commitment and efficiency from the individual. But, as a community in general lot of changes have come into the lifestyle of the Lebanese community in general. In addition there are some social pressures which often lead to practices amongst different communities resulting in ignorance of health issues. A disease like diabetes in effect takes dangerous proportions if the individual keeps ignoring the early warning signals, on account of a range of factors. The Lebanese community in Australia also has to undergo certain social practices which might have resulted in steps leading to increase in the diabetes cases amongst the community. Therefore, this study is an effort to figure out such factors, if present, leading to increase in diabetes cases. There might have been similar studies on a wider scale, but studying it on a micro scale within a minority society might throw some interesting light on the reasons for the occurrence of diabetes cases. 5. Limitations: Considering the nature of the subject of the study, more time and resources would be involved especially in determining the sample size and data collection. Moreover, sample respondents might be hostile in answering the questionnaires especially when the objectives of the study were not clearly defined to them. In the course of the collection of the data required by this study, the time constraints might make it difficult to follow through other possible investigations which may lead to a more in depth analysis. Much time will be spent in devising the questionnaires and agreeing with the concerned groups or individuals for administering the questionnaire. Moreover, this being a specialised subject, I might require the assistance of a qualified doctor on certain matters. The availability of such medical advice whenever required might prove to be crucial for the success of the study. In addition the researcher has to interact personally to the respondents which might, at times, also result in slightly biased opinion. 6. Methodology Research approaches and methods radically influence research content and, consequently, the policies designed in response to that content. Research philosophy is a belief about the way in which data about a phenomenon should be gathered, analysed and used. This thesis will make use of both qualitative and quantitative techniques in arriving at the conclusion. The qualitative case study will focus on an analysis on increasing number of diabetes cases amongst the Lebanese community in Sydney. The discussion on the background dictates that this study would involve the families and the population in the community. The qualitative approach allows exploring even the traits like attitudes, perceptions or beliefs. On the other hand the quantitative study requires us to quantify the data. It will help us in quantifying the data and then generalizing the results from the sample to the population of interest. Quantitative approach is basically a structured approach and makes use of statistical tools for data analysis. Therefore this research activity requires in-depth study of the subject. The nature of this study requires that besides finding out the numbers of people affected, we need to do a broader analysis of the factors leading to development of such symptoms. Therefore we’ll have to depend more on qualitative analysis and take the help of secondary sources in good measure. In order to determine the overall impact on the Lebanese community and the implications and significance of social and cultural beliefs on the people lifestyles and hence on the increasing number of diabetes cases, a comprehensive interview questionnaire shall be prepared which will seek answers from the respondents accordingly. Part A of the questionnaire will contain the demographic characteristics of the respondents and will serve as the profile of the respondents. This will include their gender, age, employment, and affiliations profile. Part B will determine the behavior and attitudes of the respondents as to how they perceive the importance of a healthy lifestyle and what could be the possible hindrances that they might be facing to adopt such lifestyles. The questionnaire itself would comprise of: Open-ended questions Scaling questions. Checklists Subsequently a thematic analysis of the content of these interview transcripts would be carried out which will help us in understanding and an in-depth analysis of the feelings, experiences, and perspectives of the population in question. Primary data would be collected from a target group of about 50 people comprising both male and female members of the society. These people can be in the age group of 40-55 years who have developed the symptoms of diabetes in the stated Sydney community. It is worthwhile here to mention that to gain responses from 50 people, we might have to approach more number of people as some people might decline to participate in the research study. 7. Ethical Considerations Whilst this study requires participation of human subjects, consent and confidentiality happens to be a significant issue. A sincere effort would therefore be made to communicate the aims and objective of the study to the participants through the covering letter accompanying the questionnaires. The covering letter will also list the contact information of the researchers and other details. By providing this relevant information, they will be made aware about the study prior to completing or sharing any information. Acquiring informed consent is vital to a researcher. Such a consent document serves as protection both for participants and for the researchers involved. 8. Timeline and Plan Efforts would be made to complete the different modules of the project leading to the completion of the project as per the following timeline. 1st year:      Refine research proposal and commence literature review. 2nd year:     Complete literature review and obtain relevant Ethics Committee approvals. 3rd year:     Data collection and commencement of writing. 4th year:     Completion of thesis writing. Six Literature Reviews 1. Wan, Q., M.; F. Harris, G. P. Davies, U. W. Jayasinghe, J. Flack, A. Georgiou, J. R. Burns, D. L. Penn (2007). ‘Cardiovascular risk management and its impact in Australian general practice patients with type 2 diabetes in urban and rural areas’. International Journal of Clinical Practice. Blackwell Publishing Ltd, January 2008, 62, 1, 53–58. This paper in general talks about the prevalence of cardiovascular disease (CVD) amongst the people with type 2 diabetes in rural as well as urban areas in Australia. The paper goes to analyse how efforts are made by the healthcare services and the government to managing the risk of CVD amongst diabetic people. The study has been carried out by analysing the cases during the period between 2000 and 2002. The study has been carried out in a very comprehensive manner by analysing the records of 6305 patients during the period of study. The records of diabetes type 2 patients were extracted from registers from 16 divisions of General Practice (250 practices) across Australia. Previous studies have found out that cardiovascular disease (CVD) and diabetes are the major causes of morbidity and mortality in Australia. The Australian government is aware of the danger posed by the increase in diabetes cases and it has undertaken a number of programs to contain the disease. Healthcare programs like the National Integrated Diabetes Program (NIDP) which includes the Practice Incentives Program (PIP) and Service Incentive Payment (SIP) started in 2001. The More Allied Health Services (MAHS) programme was started off in 2000for providing better access to care by allied health professionals in rural communities. The study found out that in preventing CVD occurrences the blood lipids and blood pressure play a crucial role. Controlling these two factors helps the patients. The study also found out that no significant difference is there in lipid and blood pressure management between urban and rural areas. 2. Colagiuri, Stephen and Waiker, Agnes E. (2008). ‘Using an Economic Model of Diabetes to Evaluate Prevention and Care Strategies in Australia.’ Health Affairs 27, no. 1 (2008): 256-268; 10.137. Taking a cue from the statistics brought out by the WHO and International Diabetes Federation (IDF) the study goes to find out a cost effective economic model of diabetes for preparing a better health care strategy in Australia. IDF projections of 380 million people getting affected with diabetes by 2025 are quite worrisome for the world community in general. The type 2 diabetes is being stated to be of particular concern because of its latent nature if it remains undiagnosed for longer durations. In this research paper the Diabetes Cost-Benefit Model tries to figure out the incidences and progression of diabetes cases amongst Australian population. An effort has been made to figure out the distinctive parameters based on Age, sex, diabetes status, and treatment costs. The model further tries to correlate the costs of treatment with the period required to carry out the treatment. The economic model made use of fifteen stages of diabetes and its complications. Subsequently the study found out with the help of the discounted intervention and treatment cost streams that, the initial costs happened to be higher. However the scenario treatment costs gradually decreased as fewer complications were reported in those under observation. The research also carried out nine sensitivity analyses and compared the outcome with the ‘default’ scenario. Underlining the strengths and weaknesses of the model, the authors state that its strengths are based on robust full population data and on recent Australian data on prevalence of diabetes and IGT/IFG and cost. Also, the outcomes of the simulations are based on randomized controlled trials of diabetes prevention programs in countries with health patterns similar to Australias. The lack of definitive data on some aspects of the model, the difficulties surrounding quantification of health outcomes, and the uncertainties in predictions of future events are termed as some of the weaknesses of the model. 3. Davis, W. A.; M. W. Knuiman; D. Hendrie and T. M. E. Davis (2006). ‘The obesity-driven rising costs of type 2 diabetes in Australia: projections from the Fremantle Diabetes Study’. Internal Medicine Journal 36 (2006) 155–161. This particular study is an effort to estimate the cost of treatment for type 2 diabetes for an individual and the society. The high costs often prove very devastating for people living with meagre income levels. For, example, the Lebanese migrant community living in Australia, though living for many decades in the country, is not counted amongst the well off communities. Therefore such communities are the worst affected when the cost of treatment proved to be out of bound. Analysing the data of over 19 years between 1981 and 2000, the study points out that overweight and physical inactivity are the most common reasons for the type 2 diabetes. The study finds out that the total prevalence of type 2 diabetes in adults of 25 years and above was 3.6 percent in 2000 with total direct health-care cost of A$636 million. The study also points out that the treatment of oldest age group women required the highest costs, while for men the cost was at its peak at 65-74 years. Projecting the results for the year 2051 the study adds a note of cautions that the cost of treating type-2 diabetes could quadruple by 2051 if adequate precautions are not taken by the authorities. It has also been pointed out that the incidences of type 2 diabetes are bound to be more if the lifestyle is not changed. 4. King, Meri; Rebecca Munt; Angela Eastwood (2007). ‘The impact of a postgraduate diabetes course on the perceptions Aboriginal health workers and supervisors in South Australia’. Contemporary Nurse. Volume 25, Issue 1–2, May–June 2007. This research paper is unique in nature as it tries to analyse the effectiveness of the training being provided to healthcare professionals and diabetes educators. Fourteen sites in South Australia have been monitored for the study. Stated objective of the study is ‘to identify the perceptions of the course held by the health workers who had undertaken the course and the supervisors whose responsibility it was to oversee their clinical activities.’ This paper also takes a leaf from the fact that type 2 diabetes is a major cause for morbidity and premature mortality amongst the aboriginal population. Quoting the findings of Australian Institute of Health and Welfare, the study points out that aboriginal people with diabetes die between 19-21 years earlier than non-indigenous individuals. The Canberra based Australian Diabetes Educators Association (ADEA) has been promoting the education on the subject for several years. It is significant to note here that the critical ethnography was adopted as the preferred approach during this study, as one of the objectives was to enlighten and empower the survey respondents, which in turn would help in bringing about social change. The research study was carried out in seven rural, remote and one metropolitan regions of South Australia. Nine Aboriginal Community Controlled Health Services (ACCHS) and five mainstream health providers of Aboriginal diabetes health care were involved in the study, which in fact helped in making a comprehensive study. 5. London, Shane (2005). ‘Modern diets converging: the move to low GI/GR diets’. Nutrition & Food Science. Vol. 35 No. 5, 2005. pp. 320-323 As the title of research itself suggests, the study is being carried out to study the food habits and the fast changing life style. The study makes use of Atkins diet machine, the Glycaemic Index (GI) and the Glycaemic Response (GR). While the GI measures the blood glucose profile of a standard amount of ‘available carbohydrate’ in the test food, the GR takes into entire food to measure its impact on blood glucose. During the study after measuring GI the blood samples were taken to measure glucose content over the next two to three hours, which helped in establishing a relationship for the particular individual. It was found out that food with high GI releases glucose rapidly into the blood stream, while foods with a low GI value release at a slower rate. Citing a number of recent instances, in which some retail MNCs have started out with their own GI guide, to attract even the health conscious customers, the study points out that health care professionals need to play a proactive role in raising the awareness levels of general population. It has been pointed out that; Low glycaemic foods provides health benefits, in particular for diabetes; Low glycaemic foods may also improve satiety and help in weight control; GI is just one of the means of assessing the value of a food; Glycaemic Response (GR) of the entire food may be more beneficial than GI for assessing the impact of resistant starch and dietary fibre added to foods on glucose release; The GI can vary when consumed as part of a mixed meal. 6. Wong, Julia; Shirley Wong; Swarna Weerasinghe; Lydia Makrides and Thelma Coward-Ince (2006). ‘Building community partnerships for diabetes primary prevention: lessons learned’. Clinical Governance: An International Journal. Vol. 10 No. 1, 2005. pp. 6-14. This research paper highlights the importance of community partnership in implementing healthcare policies and persuading the people to go for a healthy lifestyle. Citing the The Ottawa Charter for Health Promotion the paper states, “To reach a state of complete physical, mental and social well-being, an individual or group must be able to realize aspirations, to satisfy needs, and to change and cope with the environment”. Pointing out that the task of community partnership is indeed very challenging for the health professionals and officials, as they have to step down from their dominant positions in order to reach out to different sections of the society, the study calls upon the respective authorities to take up the issue with due sincerity. The project was carried out with the help of key informants from amongst the participant communities, having no known diabetes symptoms. Thereafter a questionnaire was distributed amongst the sample group to capture a broader view of diabetes primary prevention programming needs from the community. After carrying out a comprehensive study the research concluded that; Partnership and community building are difficult to articulate. Developing this partnership proved to be more challenging than was originally anticipated, and required a respectful, preserving approach Reference List Abou-Daoud, K.T. (1969). Diabetes mellitus in a Lebanese Population Group. American Journal of Epidemiology; 89: 644 - 650. ABS (2005) Migration, Australia. ABS Cat No 3412.0. Australian Bureau of Statistics, Canberra. Alati, R. (2003) Changes in mental health status amongst children of migrants to Australia: A longitudinal study. Sociology of Health & Illness, 25(7): 866-88. AsiaOne (2009). Health and work are inseparable at logistics firm Sankyu. Retrieved March 20, 2009 from http://www.asiaone.com/Business/Office/Rest%2BAnd%2BRelax/Story/A1Story 20090115-114920.html Bhugra, D. (2004) Migration and mental health. Acta Psychiatrica Scandinavia 109: 243–58. Dept Human Services (Vic) (2004) Cultural Diversity Guide: Planning and Delivering Culturally Appropriate Human Services. Department of Human Services, Melbourne. Kristensen, J.K., Bak, J.F., Wittrup, I. and Lauritzen, T. (2007). Diabetes prevalence and quality of diabetes care among Lebanese or Turkish immigrants compared to a native Danish population. Primary Care Diabetes; 1(3): 159-65. Knafl, KA. and Gilliss, CL., (2002). Families and Chronic Illness: A Synthesis of Current Research. Journal of Family Nursing; 8: 178 - 198. Kolk, AM., Schipper, JL., Hanewald, GJFP., Casari, EF., and Fantino, AG., (2000). The Impact-on-Family Scale: A Test of Invariance Across Culture. Journal of Pediatric Psychology; 25: 323 - 329. Medlej, R.,Wasson, J., Baz, P., Azar, S., Salti, I., Loiselet, J., Permutt, A. and Halaby, G. (2004). Diabetes Mellitus and Optic Atrophy: A Study of Wolfram Syndrome in the Lebanese Population. Journal of Clinical Endocrinology and Metabolism; 89: 1656 - 1661. WHO (2005). A rising global burden. Retrieved February 20, 2009 from http://www.who.int/diabetes/BOOKLET_HTML/en/index5.html WHO (2009). Country and regional data. Retrieved February 20, 2009 from http://www.who.int/diabetes/facts/world_figures/en/ Zalloua, P.A., Terwedow, H., Shbaklo, H., Halaby, G., Xu, X. and Azar, S.T. (2003). Host and environmental factors defining the epidemiology of type 1 diabetes mellitus in a group of Lebanese children and young adults. Journal of Pediatric Endocrinology and Metabolism; 16(5): 759-69. Read More