DIABETES - APA - Essay Example

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The discussion addresses diabetes complications with this vulnerable population. It highlights the components of cultural influence on health behavior practices. This literature was conducted by utilizing: CINHAL, Pub Med,…
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Running Head: Diabetes Diabetes of the of the of the

Table of Contents
Chapter 1
Background of the problem……………………………………………………………………….2
Statement of the problem………………………….………………………………………………3
Purpose Statement………………...………………...……………………………………………..4
Significance of the problem……….………………………………………………………………5
Goals and Objectives………………...……………………………………………………………5
Chapter 2
Theoretical framework……………….…………………………………………………………...7
Similar projects and outcomes…………………………………………………………………….8
Urban African American Using the Precede- Proceed…………………………………..8
Background of the study and research methods…………………………………………8
Outcomes of the Study………………………………………………….………………………..8
Benefits of the study…………………………………………………………………………… 10
Literature review………………………………………………………………………………....10

Chapter 1
This paper focuses on South Asian Women Population. The discussion addresses diabetes complications with this vulnerable population. It highlights the components of cultural influence on health behavior practices. This literature was conducted by utilizing: CINHAL, Pub Med, Medline, and Google Scholar. The concepts used to start the current data base from CDC, NIH, State, and County & City Websites.
(Jenum and Birkeland, 2005) stated that diabetes has emerged as one of the most common and deadliest of diseases across the world affecting the mental and physical state of an individual by weakening the body and its functions. It is most common in those people having high weight issues and family history of diabetes problem. However, South Asian Women are highly prone to diabetes because of insulin resistance, high calorie diet and lack of physical activity. South Asians are emigrants and second generation from India, Bhutan, Bangladesh, Maldives, Nepal, Pakistan and Sri Lanka. It needs to be understood that Type-2 Diabetes is quite common among Asian Women that creates Insulin resistance along with disallowing blood sugar to enter into cells and thus affecting the energy level.
Ramachandran and Vijay, (1999) believed that high weight and calorie rich diet along with genetics play an important role in increasing the chances of diabetes. There is no denying that Asian Women are on a healthier side because of high consumption of oily and rich food stuffs. Their living standard and life style also makes things difficult for them in the short as well as in the long run.
Background of the Problem
Sriskantharajah and Kai (2006) stated that people of South Asian origin have higher degree of mortality and morbidity because of diabetes and heart complications. This is mainly because of the low degree of physical activity and wellness among this group compared to European and other ethnic groups. The prime reason behind high degree of diabetes complications among South Asian Women is mainly because of issues like obesity, consumption of foods leading to obesity and low insulin and cholesterol resistance. Moreover, South Asian Women are not very much into physical activities that further affect the diabetes issues along with aggravating the issue.
Statement of the problem
Diabetes is a metabolic disorder resulting in chronic hyperglycemia and Hyper lipidemia that ultimately induces multiple system pathologies; increasing the risk for atherosclerosis, coronary heart diseases, myocardial infarction, renal disease and periodontitis. The purpose of the study is to determine factors which are instrumental for developing of diabetes and among the South Asian Women’s life style, physical activity, culture, food, education, and family unity.
Sarita, et al, (2005) believed that 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. 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. Sarita, et al, (2005) believed that 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 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 analyzed. 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 and 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 study would be conducted in Los Angeles County by collecting data and information on South Asian Women suffering from diabetes and/or pre-diabetic.
Purpose Statement
The purpose of this directed project is to educate women including their family members by providing classes on diabetes and its related complications through the following education series: There will be four classes conducted in regards to educate South Asian Women
The first class covers General Facts of Diabetes and its related complications. This will include comprehensive program of education and management which adheres to the latest standards of care for people with both types of diabetes 1 and 2 along with gestational diabetes. It also includes the prevention approach to prevent the progression of eye, kidney, and heart complications in patient with diabetes.
The second class covers Medical Nutrition Therapy.
The third class covers Exercise and Blood Glucose Monitoring.
The final class covers Special Issues and Long-Term Management.
Significance of the problem
Chowdhary, Fink, Gelberg and Brook (2003) stated that 45% of South Asian 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’s South Asian is very well educated that can be accessed 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 Women in Los Angeles County through primary and descriptive research.
In addition, 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.
Goals and Objectives
It is important to assess the impact and influence of diabetes on South Asian women by conducting a thorough analysis and research on available set of population. At the same time, it is important to take initiatives at the local, community and family level to mitigate the impact of diabetes. Goals and objectives have to be measurable in order to identify the overall benefits and influence in the long run.
Steps at the Local Level
At the local level, it is important to identify South Asian Indian women suffering from diabetes by conducting surveys or collecting details from the local healthcare authorities. At the same time, these women need to be surveyed to assess demographic, social and economic factors leading to diabetes. This will help in identifying a particular sample size that will further help in creating awareness and offering education on diabetes.
Steps at the Community Level
It is important to have the details of initiatives being undertaken by the authorized community pertaining to healthcare. Moreover, community members can be educated on issues of diabetes along with lending a helping hand to women suffering from diabetes through counseling, medication and proper healthcare checkups.
Steps at the Family Level
At the family level, it is important to educate South Asian Indian women on healthy life style and eating habits helping in reducing weight along with taking initiatives in fighting with diabetes. At the same time, other members in the family can be educated on the importance of healthy lifestyle so that they can help women in their family for a healthy life style. Overall, it can be said that all these steps taken at the local, community and family level will help in achieving the purposed goals and objectives.
Chapter 2
Theoretical framework
This paper used Precede Proceed Model because it is a particularly useful, widely applied, and easy-to-follow. The Precede Proceed Model (PPM) is very much an ecological approach to health promotion. The PPM is actually quite simple to understand once one realizes that it embodies two key aspects of intervention: a) planning, and (b) evaluation. The PPM guides the program planner to think logically about the desired end point and work "backwards" to achieve that goal (Chowdhury, 2003).
For implementing Diabetes Prevention and Health Promotion, the Precede-Proceed model of planning and evaluation is applied. This model helps to explain, design, influence and evaluate the health-related behaviors and environments and their consequences. The precede-proceed model, which is based on the disciplines of health administration, epidemiology and the social, behavioral, and educational sciences, is used in this health initiative and it emphasize that diabetes and its associated risks are caused by multiple factors and efforts to effect behavioral, environmental and social change of the diabetes patients should be multidimensional and participatory. This model requires multi-level planning, as it involves eight phases. Precede, the diagnostic part of the model focuses on the desired goals of the intervention and set the structure and targets for the planning and design of intervention. Proceed is the treatment part of the model and it involves the implementation and evaluation of the intervention. Precede-proceed model also helps to revise the plan as per the results of various evaluations (Gielen, et al (2008)
The Precede- proceed model has been applied to more than 960 published studies in communities, schools and clinical and workplace settings over the last decade ((Gielen, et al (2008). Green and Kreuter, (1991) stated that Precede Proceed Model is a framework that enables policy planners, health care professionals and evaluators to assess health programs along with assessing the health and quality of life of individuals and communities in an effective manner. The most interesting and arguably the most logical part of this model is including participants in the discussion along with defining, assessing, and sharing health related problems. There is no denying that health factors are driven by individual and environmental factors and thus it is important to analyze both in a critical manner.
Similar projects and outcomes
Urban African American Using the Precede- Proceed Model
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
Outcomes of the Study
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.
Decline in the HbA (1c)
Usual Care
Very less
Nurse Health Care
Community Health Worker
Nurse Health Care + Community Health Worker
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 (Sriskantharajah and Kai (2006) 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.
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 (Sriskantharajah, Kai (2006)
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 (Sriskantharajah, Kai, 2006)
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.
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.
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
Ameredia (2009). Indian American Demographics (South Asian). Retrieved on November 15, 2011 from
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.
County of Los Angeles Public Health (2007) Diabetes on the Rise in Los Angeles County, LA Health
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
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
Gielen, A.C., McDonald and Bone, L.R. (2008). Using the PRECEDE/PROCEED Model to Apply Health Behavior Theories. 4th edition, pp. 407-433. San Francisco: Jossey-Bass
Green, L. & Kreuter, M. (1991). Health Promotion Planning. (2nded.). Mountain View: Mayfield Publishing Co
Green, L., Kreuter, M. (1991). Health promotion planning: An educational and environmental approach. 2nd edition. Mountain View, CA: Mayfield Publishing Company
Janani Sriskantharajah and Joe Kai (2006) Promoting physical activity among South Asian women with coronary heart disease and diabetes: what might help? Retrieved from
Jennifer B. Marks, (2004). Obesity in America: It’s Getting Worse. Retrieved on December 05, 2011 from
Jenum AK, Birkeland KI (2005). Ethnicity and sex are strong determinants of diabetes in an urban Western society: implications for prevention. Diabetologica 2005; 48: 435-9.06
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
Ramachandran A, Vijay V. (1999). Impacts of urbanisation on the lifestyle and on the prevalence of diabetes in native Asian Indian population. Diabetes Res Clin Pract 1999:44 (3); 207-13
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
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
Sriskantharajah, J, Kai, J (2006) Promoting physical activity among South Asian women with coronary heart disease and diabetes: what might help? Accessed on October, 24, 2012 from
Steven A. Camarota (2001). Immigrants in the United States. Retrieved on December 05, 2011 from Read More
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