Diabetes With South Asian Women in LA - Essay Example

?Running Head: nursing All DP- CH of the of the of the CHAPTER-2 LITERATURE REVIEW The chapter presents an overview of the rise in the numbers of South Asian women suffering from diabetes in Los Angeles County. The chapter also deals with the issues and factors pertaining to the rise of diabetes especially among South Asian women. For this purpose, the chapter will consists of critical and analytical analysis of the past published data and information in a succinct manner. The chapter also deals with the theoretical framework in order to deal with the diabetes issue among South Asian women. For this purpose, Precede Proceed Model will be discussed in length in order to form a systematic approach that will further help in identifying ways of mitigating the impact of diabetes among South Asian women in a rationale manner. There is no doubt that social, cultural, economic, and political factors affect the well being of individuals and the chapter will analyse the impact and influence of all these factors in a critical manner. This will further help in ascertaining the impact and influence of internal and external factors in a systematic manner. Data for this purpose will be collected mainly from, Nutrition journals, American Journal of Epidemiology, Diabetes Care journals, and Pub Med. The main concept for data search is based on ascertaining the rise of diabetes among South Asian women, internal and external factors affecting diabetes, socio-economic factors, cultural factors, and genetic and biological factors. The researcher believes that analyzing and assessing the above mentioned literatures will help in dealing with the research topic in a systematic and critical manner. Moreover, this will help in accomplishing the purposed major goals and objectives of the research in a significant manner. Overall, it can be believed that assessing social, demographic, cultural, and political factors through relevant literature will help in dealing with the research topic in a rationale and succinct manner. The next part of the discussion presents the theoretical framework that will further define the use of Precede Proceed Model in dealing with diabetes issue. Theoretical Framework The theory that has been used for analyzing the rise of diabetes among South Asian women is Precede Proceed Model. Precede Proceed Model is a health framework that helps policy makers, health planners, and healthcare professionals to analyze and design health care programs in an effective and efficient manner. This model helps in analyzing the quality of life and assessing healthcare needs in a rationale manner. The most important and fundamental assumption of this model is the active participation of audience in terms of defining their issues along with ascertaining short and long term solutions in a significant manner. This model states that health behaviour is determined by individual and environmental factors and thus educational and ecological diagnosis is conducted in a systematic manner. Educational diagnosis in the form of Precede includes, predisposing, reinforcing, enabling constructs, educational diagnosis, and evaluation while ecological diagnosis in the form of Proceed includes policy, regulatory, organizational constructs in educational and environmental development. The Precede framework was firstly introduced in early 70s with a view that treatment plan is dependent on the educational diagnosis of the health problem to develop intervention programs. The model is based on the notion that predisposing factors like knowledge, attitude, beliefs, self efficacy, and personal preferences in order to achieve personal desired healthcare goals and objectives. Precede Proceed Model gained immense popularity in the healthcare industry helping in developing intervention programs to deal with wide arrays of healthcare issues and problems. In the context of diabetes, it can be believed that the Precede Proceed Model has been proved as of great utility and importance in taking healthcare initiatives to deal with the diabetes issues. Diabetes issues among South Asian women has been a common problem that has been causing huge concerns requiring immediate attention and intervention to mitigate its impact in the long run. Social Diagnosis- this stage helps in identifying social problems that affect the quality of life of individuals. Health planners conduct thorough assessment of social factors influencing and affecting the individuals’ quality of life. In the context of South Asian women, it can be said that social diagnosis can be used to identify specific social factors like, beliefs, values, and traditions affecting the choices of food, living standards, and way of perceiving and believing on certain things. This will help in offering specific results to health planners and can be done through the help of surveys and interviews. Epidemiological, Behavioural, and Environmental Diagnosis- Epidemiological assessment helps in dealing and identifying health issues while behavioural and environmental assessment help in designing specific health needs. Epidemiological assessment involves the use of secondary data and research to ascertain key issues pertaining to the health issue while behavioural analysis helps in ascertaining the behaviour of individuals based on the reactions to specific influence and impact of social and other factors. On the other hand, environmental diagnosis helps in identifying the impact of the environment. In the context of South Asian women, epidemiological assessment will help in ascertaining the diabetes issue while behaviour of women in terms of eating, leading their lifestyle, physical exercise will determine their behaviour in terms of dealing with the issue. Moreover, environmental assessment in the form of availability of healthy food, availability of physical workout session, and health programs and events will help in understanding the impact and influence of the environment. Educational and Ecological Analysis- Educational and ecological factors are also known as pre-disposing factors signifying the beliefs, values, and perceptions of individuals. Knowledge, skills, and attitude often help in shaping perception and thus can be considered as an important part of ascertaining individuals’ behaviour. In the context of South Asian women, it will be used to ascertain their education and skills affecting their beliefs, values and ideas pertaining to the dealing of diabetes. Administrative and Policy Diagnosis- Administrative and policy diagnosis often play a crucial role in determining the impact and influence of healthcare initiatives. As a matter of fact, health planners have to design healthcare needs and programs as per the goals and objectives of their program. Moreover, they have a certain budget to fulfill the goals and objectives of the program. At the same time, policies of the healthcare programs need to be associated with the goals and objectives of the program in order to derive useful and relevant results. In the context of South Asian women diabetes case, it will be used to assess polices against the goals and objectives of the program along with deriving key and specific results. Implementation of the Program- After assessing social, demographic, administrative, and other relevant factors, the program is implemented in the social environment. The implementation of the program can be considered as an important activity in terms of taking a step in fulfilling the goals and objectives of the program. The healthcare program for South Asian women pertaining to diabetes will be implemented in Los Angeles County and will continue for at least 10 months to seek benefits and advantages. Process Evaluation- this phase helps in analyzing where the processes are initiated as per the objectives and goals of the programs or not. This also helps in determining whether the goals and objectives of the programs will be met or not. Impact Evaluation- this phase helps in determining the impact and effectiveness of the program by assessing and evaluating the benefits and values created by the program in an honest and critical manner. The performance of South Asian women in terms of participation and values extracted will be determined in a systematic manner. Outcome Evaluation- this phase helps in ascertaining the overall outcomes in terms of changes in the quality of life in regard to the proposed goals and objectives of the program. Moreover, this phase also helps in ascertaining the key outcomes and results pertaining to the initiated program. Definition of Diabetes Diabetes has been defined as a metabolic disease where the blood sugar increases mainly because the pancreases do not produce enough insulin or the body cells do not respond to the produced insulin (Barnes, et al, 2002). Diabetes is further defined as a situation where the blood sugar either increases or decreases to an extent that affects the overall functioning of the body in a critical manner. Diabetes has been categorised into Type-1 and Type-2 forms where Type-1 diabetes is defined as a loss of insulin producing beta cells in the pancreas mainly because of the insulin deficiency (Das, 2002). This form of diabetes is often dangerous as the immunity system gets affected in a critical manner. On the other hand, Type-2 diabetes can be defined a process where the body does not react to the insulin becoming insulin resistant. The reduced insulin secretion further affects the proper functioning of the body and thus affecting the overall movement of the body in a significant manner (Barnes, et al, 2002). Type-2 diabetes has emerged as one of the most common forms of diabetes in majority of people across the world. Like the other form of diabetes; this cannot be treated fully but can only be managed and controlled through health intervention programs and strict diet helping in maintaining a balanced insulin level within the body (Das, 2002). Diabetes Pathophysiology Diabetes Pathophysiology can be understood by analyzing the relationship between carbohydrate metabolism and insulin action. When carbohydrates are consumed, they are broken into glucose enzymes (Egede and Dagogo-Jack, 2005). Glucose is consumed into the bloodstream elevating the level of blood glucose. Insulin is required by all the cells of the body in order to function properly. However, increase in the insulin secretion can lower the blood glucose level and lower glucose level results in low insulin secretion. The diabetes pathophysiolgy is based on the fact that glucose needs to be maintained at a balanced level in order to facilitate the proper functioning of the body and for that; diet plays a major role. Complication of Diabetes Diabetes has a number of health complications that affect the body and mind in a direct manner and thus affecting the quality of life in a significant manner. Diabetes affects the insulin and immunity resistance level that weakens the body and its functioning (Hossain, 2007). Moreover, diabetes leads to weakening of joints and obesity that further raises concerns over the quality of healthy life. Diabetes also affects the cardiovascular functioning and thus increasing the chances for heart diseases and complications in the long run (Das, 2002) Diabetes can also lead to tiredness and extreme trauma that further affect the overall wellbeing. In the context of women, diabetes affects them more compared to men resulting in severe health complications like osteoporosis, cardiovascular complications, and weak immunity system. In order to mitigate the complications of diabetes, it is important to control it using health and diet intervention programs in a systematic and dedicated manner leading to the overall betterment (Das, 2002). Diabetes in South Asian Women Research has shown that Asians and Africans are largely affected by diabetes in the Los Angeles County. Furthermore, it was found that diabetes is pretty common and high among South Asian women (Hossain, 2007). It was further found that erratic lifestyle and unhealthy eating patterns have been the main reasons behind the prevalence of diabetes in South Asian women (Viswanathan, et al, 2006). Viswanathan, et al, (2006), conducted research on the Urban-rural differences in the prevalence of foot complications in South-Indian diabetic patients and found that South Asians have the tendency to put on weight mainly because of the high calorie diet and unsystematic life style leading to the rise of diabetes. As per the research conducted by Los Angeles County Department of Public Health (2011), it was found that, South Asians are the second-largest visible minority in United States of America and a fastest growing population of the immigrants. These people are mainly affected by diabetes and other cardiovascular diseases mainly because of the genetic and cultural issues. The research also found that South Asians have more chances of developing diabetes complications compared to the white population as their genetics and culture play an important and decisive role in it. As per the research conducted by the County of Los Angeles Public Health (2008), it was found that diabetes is one of the most influencing health complications in the Los Angeles County and large numbers of Asians have been suffering from it. It affects the general functioning of the body along with making it weak in the long run. It was found that the rate of obesity has increased from 14.3% in 1996 to 22.2% in 2007 in South Asian women. This can be considered as an alarming situation as increase in the weight can lead to more diabetes complications and thus weight reduction should be the top most criteria to deal with the diabetes issue in the long run. All these researches have been based on the diabetes complications among South Asian women showing high prevalence to the point where health intervention programs have been of little use and benefit. As per the research conducted by Chowdhary, et al (2003) on demographics of South Asians and Diabetes, it was found that South Asians have a higher level of income and education stating the fact that demographic factors have been pretty strong and favourable but still lack of discipline and control over the lifestyle has often affected their quality of life in the long run. The research also showed that South Asian women tend to follow their culture and values that do not allow too much of physical exertion resulting in higher degree of obesity and thus causing diabetes complications. Abourizk et al (1994) in his research on “An outpatient model of integrated diabetes treatment and education: functional, metabolic, and knowledge outcomes”, found that self education and management plays an important and crucial role in mitigating the impact of diabetes but lack of awareness among South Asian women has resulted in severe diabetes complications. Based on the analysis, it can be believed that diabetes in South Asian women is quite common requiring self awareness and management and at times can be dealt using wide arrays of systematic and planned health related programs and activities. Factors Related to Diabetes in South Asian Women A number of factors affect the diabetes in South Asian women. Factors pertaining to diet, lifestyle, environment, family, and healthcare top the list (Mather and Keen, 1985). Detailed analyses of all these factors have been presented as follow: Lifestyle- South Asian women tend to live an erratic lifestyle suggesting the lack of physical exercise, proper diet, and irregular approach towards addressing the diabetes issue. Though, lifestyle pattern can be enhanced but there are not many evidences of it suggesting that intervention programs may be of great help in enhancing the lifestyle (Mather and Keen, 1985) Diet- Diet plays an important and crucial role in mitigating the impact and influence of diabetes. However, in the case of South Asian women, it was found that, majority of them follow high calorie rich diet that increases the fact level and thus causing more issues pertaining to diabetes complications in the long run (Ramachandran and Snehalatha, 2010). Environment- Environment can have a significant impact and influence on the mindset and behaviour of individuals. Though, the environment is driven by the values and beliefs of people existing there; in the context of Los Angeles County, it can be said that the environment is quite supportive but lacks goals and objectives (Raymond, et al, 2009). Family- Family also plays an important and crucial role in mitigating the impact and influence of diabetes. However, when the women of the families are least interested in mitigating the impact of diabetes; the family members play an insignificant role in convincing their family members to follow a strict diet and program (Raymond, et al, 2009). Healthcare- It has been found that healthcare programs play an important and significant role in controlling and managing diabetes. There have been a number of intervention programs helping in educating women to deal with diabetes issues and can be considered as of great utility and importance in dealing with the diabetes issue (Ramachandran and Snehalatha, 2010). Sex Differences As per the Los Angeles County Department of Public Health (2011), it was found that the rate of diabetes has increased from 6.6% in 1997 to 9.1% in 2007. Moreover, it was also found that the numbers of women suffering from diabetes are much more compared to men in Los Angeles County. This suggests that gender may play an important role in determining the level of diabetes. Women suffer more from diabetes mainly because of the genetic and diet issues compared to men. It was further found that the rate of obesity has increased from 14.3% in 1996 to 22.2% in 2007 in South Asian women clearly suggesting that the prevalence of diabetes is much more in women (Los Angeles County Department of Public Health (2011). Ethnic Differences It was found that South Asians have more chances of developing diabetes complications compared to the white population as their genetics and culture play an important and decisive role in it. Ethnic issues like genetics, culture, values, and beliefs play a decisive role in determining the impact and influence of diabetes among women (Viswanathan, et al, 2006). White population do not suffer much from diabetes mainly because of the genetics and lifestyle measures being taken while the same lacks in South Asian women suggesting that ethnic plays an important and major role in the prevalence of diabetes among South Asian women. Socio-Economic Status Research conducted by Chowdhary, et al (2003) on demographics of South Asians and Diabetes found that South Asians have a higher level of income and education stating the fact that demographic factors have been pretty strong and favourable but still lack of discipline and control over the lifestyle has often affected their quality of life in the long run. This reveals the fact that in spite of having a strong socio-economic background, South Asian women suffer from the severity of diabetes affecting their well being and quality of life in the short as well as in the long run (The Asian population (2000) Financial Burden on the Society There is no doubt that any health complication affecting the society has a direct impact and influence on the society. At times, it acts as a financial burden on the society where lack of finance can actually affect the wellbeing of the masses (Viswanathan, et al, 2006). The healthcare communities are often funded by the government but when the numbers of healthcare complications are much more than the expectation; there is an increased pressure on the society and healthcare communities to fulfill the needs and demands of the masses. The financial burden may affect the awareness process and thus not catering to the needs and demands of all individuals and thus affecting the useful healthcare needs and demands in a critical manner. Management Programs for Mitigating the Burden on the Society There is no doubt that the government is responsible for managing the healthcare needs and demands of individuals who need them the most. However, the government allocate fixed fund to the healthcare communities to fulfill the healthcare needs and demands and thus, it becomes important for the health planners and professionals to cater to the healthcare needs of individuals who need them the most rather than forming a uniform approach that may not serve the cause (Raymond, et al, 2009). Poor people need to be look after first and also older people to create a balance in the society. This will help in dealing with the issue in a rationale manner along with managing and controlling the cases of diabetes in a systematic manner. Programs Available in Los Angeles County There are a number of programs available in Los Angeles County helping in mitigating the impact and influence of diabetes. The American Diabetes Association Office in Los Angeles County is committed towards educating people suffering from diabetes. Moreover, awareness and healthcare programs are designed and planned very frequently to support those living with the disease. At the same time, there are other healthcare communities helping people to understand the complications of diabetes along with ascertaining ways to deal with it. Summary The chapter presented detailed information over the prevalence of diabetes among South Asian women by analyzing and discussing relevant literatures. It was found that diabetes is quite common disease among South Asian women that affects their well being in a critical manner. Diabetes is mainly affected by the lifestyle and diet issues that need to be taken care of in order to mitigate the impact and influence of diabetes in the long run. The chapter assessed the role and impact of diet, lifestyle, gender, genetics, socio-economic factors, and the environment in dealing with diabetes. Overall, it was found that diabetes can be controlled through a dedicated and systematic approach but requires high level of awareness especially among South Asian women to avoid the severe complications of diabetes in the long run. References Abourizk NN, O’Connor PJ, Crabtree BF, Schnatz D. (1994) An outpatient model of integrated diabetes treatment and education: functional, metabolic, and knowledge outcomes. Diabetes Educ, Vol. 20(5): pp. 416-21 Barnes PM, Adams PF, Powell-Griner E. (2008) Health characteristics of Asian adult population: United States, 2004-2006 Adv Data; Vol. 394, pp.1-22. County of Los Angeles Public Health (2008). Trends in Diabetes. Los Angeles Health. Retrieved fro http://publichealth.lacounty.gov/wwwfiles/ph/hae/ha/Diabetes_2010_6pg_Sfinal.pdf Centers for Disease Control and Prevention (2011) National diabetes fact sheet, 2011 [Internet]. Atlanta (GA): CDC; Available at: http://www.cdc.gov/ diabetes/pubs/pdf/ndfs_2011.pdf on 3rd January 2012. Das, U.N (2002). Nutritional deficiencies and the prevalence of syndrome X in South Asians. Nutrition, 18 (3), 282-282 Egede LE, Dagogo-Jack S. (2005) Epidemiology of type 2 diabetes: focus on ethnic minorities. Med Clin North Am. Vol. 89: pp.949-975 Forouhi, N and Sattar, N. (2006). CVD risk factors and ethnicity- A homogeneous relationship? Atherosclerosis Supplements, 7 (1), 11-19 Hossain, P. (2007) Obesity and Diabetes in the Developing World—A growing challenges. N Engl J Med; Vol. 356 (3): pp. 213-15 Hamman RF, Marshall JA, Baxter J, Kahn LB, Mayer EJ, Orleans M, Murphy JR, Lezotte DC. (1989) Methods and Prevalence of Non-Insulin-Dependent Diabetes- Mellitus Ina Biethnic Colorado Population - the San-Luis-Valley Diabetes Study. American Journal of Epidemiology; Vol. 129: pp. 295-311 Los Angeles County Department of Public Health. (2011) LA Health: trends in diabetes: a reversible public health crisis [Internet]. 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Diabetes Care; Vol. 29(3):pp. 701–703. Read More