The Diabetes Issue Prevailing in South Asian Indian Women - Term Paper Example

?Running Head: Diverse Population Nursing of the of the of the ment of the Problem The rise in number of diabetes cases amongst the South Asian Indian women in different parts of the United States is no more a hidden fact and mystery (Sarita, et. Al, 2005). Camarota (2001) stated that with so many immigrants coming from different parts of the world, the United States is considered as the home for many. There is no denying that South Asian Indian women often suffer from a number of health issues because of their life style and health perceptions (Sarita, et. al, 2005). Sates (Marks, (2004) stated that Obesity and diabetes are two of the most common diseases in the United. The focus of this study is on the diabetes issue prevailing in South Asian Indian women. Kanaya et. Al (2010) stated that South Asians have prevalence of diabetes despite their low body weight. This may be because of the difference in the culture that needs to be analysed. Based on the study conducted by Kanaya et al, it was found that South Asian Indians immigrants are more likely to have diabetes than other US ethnic Groups. The discussion aims at highlighting the health issue prevailing in South Asian Indian women in Los Angeles County in the United States along with developing a health care program to curtail the health issue to an extent. Gielen, Bone (2008) stated that the quality of life is often affected by these health issues along with affecting the social and economic environment in the present as well as in the future. The health problem to be assessed in this particular discussion is diabetes using Precede Proceed Model as a public health theory The study would be conducted in Los Angeles County by collecting data and information on South Asian Indian women suffering from diabetes. The use of Precede Proceed Model would further help in understanding the reasons behind the rise of diabetes in a systematic manner along with offering solutions to women suffering from it in order to curtail the impact and influence of diabetes often hampering the quality of life in a negative manner. Purpose Statement Diabetes is often considered as one of the most deadly diseases prevailing in the United States (Center for Disease Control and Prevention (2011). Wulffson (2011) stated that diabetes is the sixth leading cause of death and ninth leading cause of pre mature death in Los Angeles County. The impact of diabetes has been severe on South Asian Indian women compared to any other ethnic group in the United States as per the study conducted by Kanaya et. al (2010). The data reflected that a total of 29% of Asian Indians had diabetes, after the full research and analysis, Indians still had high cases of diabetes compared to whites and Latinos. However, diabetes cases of South Asian Indians were similar to African Americans: Indians [odds ratio (OR), 1.0], whites, 0.29; Latinos (0.34) African Americans (0.77 ;) South Asian Indians have a different lifestyle compared to other ethnic groups in terms of nutrient intakes. Chowdhury and Hitman (2000) stated that the primary cause of diabetes is obesity that increases the weight of the body along with making it defunct up to an extent in terms of performing normal usual tasks. Along with this, hypertension and proclivity towards oily and rich food often affects the body mass index of South Asian Indian Women. The most intriguing factor of this study is the reason behind the prevalence of diabetes amongst South Asian Indian Women than in any other ethnic group or community. Jafar, Chaturvedi, Pappas, and (2006), suggested that due to their genetic susceptibility, amount of abdominal fat, insulin resistance and metabolic syndrome, there are increased chances of diabetes. They follow high calorie diet combined with little physical activities that act as an impetus for insulin resistance and diabetes. This increases the overall weight that creates diabetes symptoms along with a chance of getting g influenced by it One of the most interesting facts about South Asian Indian women is their health behaviour that often allows them to go undiagnosed and as a result poorly controlled. The perception, attitude, beliefs and behaviour play an important role in shaping the health condition and its influence and in case of the South Asian Indian women; it is just a latent phase that is based on personal thinking often leading to complications. The purpose of this study is to understand and assess the increase in the number of diabetes cases amongst South Asian Indian Women along with comparing the same with other African American Women. Literature Review Diabetes has been a part of South Asians from a long period of time and as per the study conducted by Alka et al (2008) to identify the metabolic disorders and cardiovascular disease worldwide. Demographic data and lifestyle information were collected to understand its impact over the health. The study revealed that South Asian has higher prevalence of diabetes compared to other ethnic groups. The glucose level along with physical examination further revealed that men have more number of diabetes cases then women. At the same time, strong cultural beliefs and values played a major role in diabetes. The study did not reveal whether this was because of the life style or food habits but cultural beliefs may be associated with beliefs and notions pertaining to a particular culture defining the food habits. The most interesting part was the increases prevalence of diabetes amongst the South Asians in spite of high education and socio economic attainment. There is no denying that education plays a critical role in enhancing or controlling a particular life style that also controls the prevalence of diseases. However, in case of South Asians, it can be assumed that cultural issues like food habits and life style played a major role in aggravating diabetes in the short as well as in the long run. This particular study did not state cultural values and beliefs that might have played a crucial role in diabetes. There is a need to assess cultural aspects at a broader level to deal with the issue in a logical manner. The present study focuses on identifying the reasons behind the prevalence of diabetes in South Asian Indian Women along with analyzing cultural aspects and beliefs through a number of interventions including nurse care manager, community health workers, group discussion and usual care. This will help in identifying and assessing the issue in an easy and more impactful manner along with achieving the goal of the program. Significance of the Problem As per the research conducted by Chowdhary, Fink, Gelberg and Brook (2003), 45% of South Asian Indian had an annual income of >$ 80,000 and 42% had a master degree. This clearly shows that their demographic factors are quite strong and can be used to combat diabetes issue and problem. These women speak Hindi, Tamil, Guajarati and English along with other languages. Chowdhury,( 2003) stated that there is no denying that Asian Indians are very well educated that can be assessed through their life style. However, in spite of all these positive factors, they tend to avoid health issues especially diabetes and obesity The research aims at collecting data and information from South Asian Indian Women in Los Angeles County through primary and descriptive research. The quality of life of South Asian Indian Women living in Los Angeles County has been ascertained based on their demographics. The demographics clearly suggest that most of these women belong to a well to do family along with possessing good education and knowledge. Majority of the women prefer following their culture rooted deep inside their mind and heart through natural upbringing. Bajaj, Banerji, (2004) stated that in spite of living in a developed country; they prefer following their own beliefs and perceptions rather than following modern trends helping in combating different health issues This can also be the reason behind their health problems along with social values and perceptions. Ameredia (2009) stated that the social environment has played a major role in aggravating the health problem like diabetes but mental barriers like switching to a healthy life style and common attitude pertaining to food habits has also played a significant role in demeaning what would have been a life time gift from the nature; the quality of life. The next part of the study explains the theoretical framework of Precede Proceed Model along with comparing the same with the African Americans. Theoretical Framework of Precede Proceed Model (Daniel, Green, (1995) stated that Precede Proceed Model is an effective framework helping policy makers, health planners and health communities to assess health problems along with offering solutions for them in an effective and analytical manner This model requires active participation of people targeted for the study in order to assess the health problem along with finding solutions for it. Precede Proceed Model has been selected for this particular study as it follows a systematic approach of addressing problem along with effective analysis offering solutions. The importance of this model has been assessed by referring to the project of the Department of Epidemiology, The Johns Hopkins Medical Institutions that evaluated the effect of nurse case manager and community health care interventions on risk factors for diabetes related complications in Urban African American using the Precede Proceed Model. The Social Diagnosis analyzed the demographics along with identifying reasons for diabetes. The use of nurse case manager and community health care interventions helped in detecting diabetes problems along taking further initiatives to address the issue. The epidemiological study helped in garnering data over the diabetes issue. The behavioral patterns highlighted the food habits and common attitude and perception of African Americans pertaining to health issues, food habits and local environment. The environmental diagnosis helped in analyzing the environmental factors like access to health care, healthy food, water facilities and other factors. Overall, these steps helped in analyzing the reason behind the prevalence of diabetes in African Americans. Background of the Study and Research Methods Gary et al (2003) found that African American suffers from diabetes problem but very few steps have been taken to identify the key reasons behind it along with identifying ways to improve diabetic control in this population. A total of 186 African American were identified suffering from diabetes and were categorized under four heads. The below mentioned data highlight the mode of study in an illustrative manner. Usual Care Only Usual care + Nurse Case Manager Usual Care + Community Health Worker Usual Care + Nurse Case Manager+ Community Health Worker The two year follow up visit was completed by 149 individuals that were around 84% of the total respondents. Compared to the usual care group, the nurse care manager group and community health worker group has modest decline in HbA (1c) that is the amount of sugar in the body over the period of two years. The decline in the level of HbA (1c) was 0.3 and 0.3% respectively. On the other hand the combined nurse care manager and community health worker group had more decline in HbA (1c). The percentage in decline was about 0.8 that can be considered as quite good. This study showed that the nurse care manager and community health worker intervention helps in dealing with diabetes issue along with controlling the sugar level to an extent. The usual care has the slightest decline in the HbA (1c) that proved that usual care is not the right approach to fight with diabetes issue and at one point of the time needs assistance and support from the nurse case manager and community health workers. The below mentioned data will offer a good amount of idea on the study conducted. Interventions Decline in the HbA (1c) Usual Care Very less Nurse Health Care 0.3% Community Health Worker 0.3% Nurse Health Care + Community Health Worker 0.8% Benefits of the Study The study revealed that combined nurse care manager and community health care interventions may help in improving diabetic control in African American Population. However, the study lacks statistical significance but to an extent helped in understanding that these interventions may be of great benefit in diabetic control in the short as well as in the long run. The same approach can be used for controlling diabetes amongst South Asian Indian Women by categorizing them under casual usual care, nurse care manager, community health care workers and nurse care manager +community health care workers. This will help in addressing the issue in a clear manner and may assist in analyzing the impact and influence of these interventions in the short as well as in the long run. It needs to be understood that in the long run, initiatives need to be taken pertaining to diabetic control other than usual care and practices to deal with the issue in a judicious manner. Future Initiatives Apart from including the selected population in the intervention program, there is a need to include other interventions also to deal with the issue. The implemented program aims at offering long term benefits and thus quarterly assessment will be done to analyze the overall improvement along with adding value to the existing program through new and innovative interventions like motivational classes and public classes. Conclusion The study helped in addressing key problems along with identifying reasons behind the emergence of diabetes. Overall, the study has been impactful and result oriented in terms of benefits and advantages. It is going to be an ongoing program so more results and findings can be added in the present as well as in the future making the whole process, a successful effort. The key findings of the project of the Department of Epidemiology, The Johns Hopkins Medical Institutions also helped in identifying some benefits that can be used in the present study to make it all the more compact and result oriented References Ameredia (2009). Indian American Demographics (South Asian). Retrieved on November 15, 2011 from http://www.ameredia.com/resources/demographics/south_asian.html Alka M. Kanaya, Deepika Mathur, Vishal Ranpura, Christina Wassel FYR, San Francisco, CA (2008), South Asians and Diabetes: Higher Risk with Traditional Beliefs, Retrieved on December 05, 2011 from http://professional.diabetes.org/Abstracts_Display.aspx?TYP=1&CID=70023 Bajaj M, Banerji MA (2004). Type 2 diabetes in South Asians: a patho-physiologic focus on the Asian-Indian epidemic. Curr Diab Rep.; 4:213-218. Chowdhury TA (2003). Preventing diabetes in South Asians. BMJ;327:1059-1060. Center for Disease Control and Prevention (2011). Chronic Disease Prevention and Health Promotion. Retrieved on December 05, 2011 from http://www.cdc.gov/chronicdisease/resources/publications/AAG/ddt.htm Daniel, M., & Green, L. W. (1995). Application of the Precede-Proceed model in prevention and control of diabetes: Diabetes Spectrum 8, 80-123. Green, L. & Kreuter, M. (1991). Health Promotion Planning. (2nded.). Mountain View: Mayfield Publishing Co Gielen, A.C., Bone, L.R. (2008). Using the PRECEDE/PROCEED Model to Apply Health Behavior Theories. 4th edition, pp. 407-433. San Francisco: Jossey-Bass Gary TL, Bone LR, Hill MN, Levine DM, McGuire M, Saudek C, Brancati FL (2003).Randomized controlled trial of the effects of nurse case manager and community health worker interventions on risk factors for diabetes-related complications in urban African Americans. Retrieved on Dec 05 from http://www.ncbi.nlm.nih.gov/pubmed/12799126 Jafar TH, Chaturvedi N, Pappas G (2006). Prevalence of overweight and obesity and their association with hypertension and diabetes mellitus in an Indo-Asian population. CMAJ; 175:1071-1077 Jennifer B. Marks, (2004). Obesity in America: It’s Getting Worse. Retrieved on December 05, 2011 from http://clinical.diabetesjournals.org/content/22/1/1.full Kanaya AM, Wassel CL, Mathur D, Stewart A, Herrington D, Budoff MJ, Ranpura V, Liu K, (2010). Prevalence and correlates of diabetes in South Asian Indians in the United States, Retrieved on December 05, 2011 from http://www.ncbi.nlm.nih.gov/pubmed/19943798 Robin Wulffson (2011), New study on risk factors for gestational diabetes. Retrieved on December 05, 2011 from http://www.examiner.com/women-s-health-in-los-angeles/new-study-on-risk-factors-for-gestational-diabetes S. Chaudhry, a Fink, L Gelberg and R Brook, (2003). Utilization of Papanicolaou Smears by South Asian Women Living in the United States. Retrieved on November 15, 2011 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1494856/ Sarita A Mohanty, MD, MPH,1 Steffie Woolhandler, MD, MPH,2 David U Himmelstein, MD,2 and David H Bor (2005). Diabetes and Cardiovascular Disease Among Asian Indians in the United States. Retrieved on December 05, 2011 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1490101/ Steven A. Camarota (2001). Immigrants in the United States. Retrieved on December 05, 2011 from http://www.cis.org/articles/2001/back101.html Tahseen A Chowdhury and Graham A Hitman (2000). Why is Diabetes More Common in South Asians? Retrieved on December 05, 2011 from http://www.medscape.com/viewarticle/569265_3 Read More