Managing Diabetes in Older Indigenous People - Term Paper Example

Managing Diabetes in Older Indigenous People Promoting health literacy and medication adherence using principles of community nursing Name of Student: [Pick the date] Student No: Introduction This essay will examine the challenges experienced by health professionals as they attempt to manage diabetes in rural populations of indigenous people. It will begin by attempting to define health literacy and then examining various models that have been used to attempt to transfer custody of health management to the rural indigenous populations. It will then look at the challenges faced in bringing about good health in these populations and finally what has been learned both by the health professional and the community they are attempting to serve. The definition of health literacy is the cognitive and social skills which establish the drive and capability of people to gain access to the comprehension and utilisation of information in ways in which encourage and uphold good health (Nutbeam, 2000). Health literacy is about more than imparting information. It involves empowerment of the populace in their capacity to utilize health literacy effectively(Nutbeam, 1998). When it is looked at in this way, health literacy becomes a concept not just of health education or individual behavior but also other factors such as environmental, political and social which are instrumental in determining good health (Kickbusch, 2000). In this way, health education influences not only the individual lifestyle choices but also those of raises awareness of health determinants. Health education is therefore achieved not only through diffusion of information but also interaction, critical analysis and participation (WHO, 2009). As a nurse working in an indigenous community, the importance of family and community to the Aborigines is an important point to note. This premise is supported by literature review which emphasises the role and responsibility of family and community in dealing with issues such as diabetes (Boston et al, 1997). Issue: Personal Skills A study done on The Chronic Disease Self Management (CDSM) strategy designed for Aboriginal people on Eyre Peninsula, in Southern Australia was developed to provide program tools and processes for setting goals, fostering change in behaviour and diabetes self management. This was a pilot project that aimed to put to trial a plethora of CDSM processes and procedures among indigenous peoples. This involved participation of sixty type two diabetics from the aborigine community in two remote regional centres representing 25% of all known diabetic populations within those areas (Lynall and Jordan, 2009). In order to engage participants, a community development approach was utilised with four community Aboriginal Health Workers (AHW) trained in setting goals and self management strategies so they could run the program. The AHWs divided their communities into small groups, working with these to build understanding of their health problems, create particular goals for managing their conditions and using person-centred solutions. This process was facilitated by the concerns the community had on managing prevalence and mortality brought about by Diabetes. Certain barriers were identified by participants as hindrances to achieving these goals. These barriers included family and social dysfunction, access to services, exercise and nutrition. The hindrances identified by the Aboriginal Health Workers were a dearth of preventative health services, social problems and the pressure of time on the staff (Kit et al, 2003). This program resulted in improved self management scores in five of six domains although QOL scores did not show a major change. Problem solving improved by 12%, goals by 26% and the mean HbA1c decreased from 8.74-8.09. this led to the conclusion a diabetes self management program facilitated by Aboriginal Health Workers works well in the community and enhances self-management. The Aboriginal communities find it useful especially if alterations are made to the programme that would make them more culturally inclusive to the indigenous populations. This would make them an effective strategy in improvement of self management skills as well as behaviours related to the health of chronically ill patients. The CDSM pilot study precipitated refinement of the tools and processes that are utilised for chronic illness self management programmes in indigenous people, and led to a higher acceptance rate for these processes in the concerned communities. This is enabled by the concern the community has on the prevalence and mortality of diabetes (Battersby et al, 2008). Health Literacy The population of Australia has taken in a growing mix of cultural populations, languages and beliefs in recent years (Kinfu & Taylor, 2002). This brings with it its own challenges as pertains to lifestyle behaviour, literacy, expectations of health and wellness and how various cultures and peoples own their lifestyle choices. Chronic disease is estimated to constitute 70% of the national burden of disease and this is slated to rise to 80% by the year 2020 should there be no change in present health care trends (Department of Health and Aged Care, 2000). There is an unacceptably low life expectancy among indigenous peoples. In order to reverse this or at least slow it down, the effects of chronic diseases such as diabetes on the mortality and morbidity of the indigenous peoples must be addressed (National Public Health Partnership, 2001). Australia has several formal and informal self management models in use, the most prevalent being the Lorig “Stanford Model” or the Chronic Disease Management Program. Primary health workers in a specific large regional community health service reported that the Stanford Model was unsuccessful among their clients. This occurred for various reasons including lack of client engagement in attending courses, high failure rates in attendance of the primary booked session and a high drop out rate in subsequent sessions as well as constant negative feedback from clients (Lynall and Jordan, 2009). Issue: Disability and ageing afflicts the Aboriginal and Torres Strait Islander people at an earlier age than the non-indigenous Australian. This means that services for the aged are pegged at fifty years amongst these populations as opposed to seventy and over for the rest of Australia. The indigenous peoples have access to conventional services provided under the Aged Care Act as well as those provided under the National Aboriginal and Torres Strait Islander Flexible Aged Care Program. This program aims to provide an estimated 750 flexible places through 30 services located for the most part in rural and remote areas. This gives the indigenous population access to culturally appropriate cares services in close proximity to their communities. Participation by the community is facilitated in every aspect of the service provision, from planning through to operations. The type of services provided range from residential to community aged care services and these services do vary as the requirements of the aged community do. As the approach to funding is flexible, modification of the type of aged services provided according to the needs of the ageing population in the local communities is possible. However, it is recognised that service providers face challenges in these remote or very remote communities and therefore supplementary practical assistance is available. This assistance consists of peer and professional support services, as well as emergency support services and capital funding for unforeseen circumstances. These include failure of essential services or major building damage (Department of Health and Ageing, 2008). STG: The current health status of the indigenous populations is a matter that encompasses many aspects of their environment, from social to political and environmental. Diseases related to nutrition such as heart disease and diabetes and the resultant complications form the main cause of excess morbidity and mortality among indigenous populations. Between the years 1995 and 1997, the main causes of death in these communities were from cardiovascular diseases such as heart attack and stroke, injury, respiratory disease, neoplasms and endocrine diseases such as diabetes. This cluster accounted for 75% of all deaths with 25% of these deaths stemming from diseases of the circulatory system (ABS & AIHW, 1999). The Torres Strait area experienced a majority of deaths from diabetes and heart disease from 1989 to 1994. Data taken on prevalence of diabetes in indigenous populations have shown an overall prevalence rate of 10-30% which amounts to twice to four times the rates in non-indigenous populations. Campbell et al (2004) did a review on interventions to improve the health of Aboriginals and they indentified an approach known as community development and empowerment. This approach involves programs that emphasise community assistance, using specific terms of identity, geography or issue in order to find solutions to their problems. Health initiatives such as those used in control of diabetes utilise community participation in order to make sure they cooperate with health programs. They would also result in empowerment facilitation and responsibility in terms of achieving a means as well as an end. Community empowerment is defined as a social action that encourages individuals, organisations and communities to participate in taking control of their lives both internally within the community and in the larger society. It is a process that is a continuing progression that is constantly in flux consisting of individual empowerment in small groups, organisations in the community, partnerships and political action (Campbell et al, 2004). Personal Skills – Negative Attitude One major risk factor for many chronic illnesses including diabetes (Non-Insulin Dependent Diabetes Melitus) and cardiovascular disease, there is urgent need to address the overweight issues among indigenous populations through prevention and management (Condon et al, 2004). The NHMRC report (1997) pegged overweight and obesity to be at 60% for Aboriginal and Torres Strait men and 58% of women. This means that any health literacy carried out among these populations must include an aspect on exercise and proper nutrition, began at an earlier age so as to preclude these ills. Poor nutrition tends to be clustered with smoking, lack of physical activity and socioeconomic factors within these populations which presents as an intricate web of nutrition related issues that need to be addressed across the life cycle (Morgan et,al. 1997). There are higher death rates among disadvantaged socio-economic groups stemming from diabetes, coronary heart disease and cerebrovascular disease among others. The National Health Survey carried out in 1989-1990 showed higher morbidity rates for lower income groups, with low education or socio-economic status (National Health Strategy, 1992). Smoking and obesity is also more prevalent in lower socio-economic groups increasing their risk for both CVS diseases and diabetes (Australian Institute of Health and Welfare, 2003a). This therefore labels the Aboriginal and Torres Strait Islanders as a group ‘at risk’ because of their lower income and education when compared to other non-indigenous populations. Information on education and employment of these populations show that a principle source of income for the Aboriginal and Torres Strait Islander populations is from government benefits such as unemployment benefits, the dole and government pensions (Department of Human Services, 2003). Community Participation The National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan outlines various ways in which the community can be engaged to address some of the issues that contribute to diabetes prevalence in the community. These strategies include self-determination and community control given to the indigenous populations to handle their issues in a way that is culturally appropriate. There must be open consultation and a continuous commitment to work together in terms of transference of skills and expertise in both directions. The indigenous community will more fully be in control of health initiatives while enabling a greater cross-cultural understanding and response to their needs. The Aboriginal and Torres Strait Islanders value community and family relationships and the behaviour of individuals is strongly influenced and bolstered by family and community life. The dynamic environment in which they operate is a key factor in determining healthy family patterns of eating and therefore proper nutrition needs to be taught within the context of this dynamic. The National Aboriginal Health Strategy (1989) which encourages holistic health care approach takes into account the Aboriginal and Torres Strait Islander’s concept of health. This involves not only physical health of the person but also the social, emotional and cultural health of the entire community. This is a holistic view of life and involves the cyclical idea of life-death-life (NAHS, 1989). Social Policy: Inequitable Social Policies The health of indigenous peoples is an all encompassing life concept, therefore in order to address any health issue including diabetes, it is necessary to utilise community development strategies that involve ownership by the community and participation by them (Durie, 2003). This means respecting the idea that health is not just a physical concept but involves the dignity of physical environment, self-esteem of the community and justice. Conclusion In management of diabetes and other chronic diseases among the aged, the patient’s source of strength is key to maintenance of good health. Sources of strength may include availability of a source of cultural and traditional knowledge; drawing from their own life experiences in order to come up with ways to deal with negative elements of their disease; drawing strength from family and community which means maintenance of contact with the same as well as regular access to primary health care; it is also important for them to have access to the AMS whether or not they have a long wait to do so (Jowsey et al, 2011). Having these strengths with them assists them to deal with a number of challenges faced in their situation such as poor access to health services that are culturally appropriate; restricted support systems from a cultural perspective; racism; poor communication between them and health care providers; poverty; difficulties in transportation; family history of diabetes; co-morbidity of health challenges; staying motivated to continue with self management (Saggers and Grey 1991). All of these factors must be incorporated in health literacy in order to ensure its effectiveness. References Australian Institute of Health and Welfare (2003a). Health and Community Services Labour Force 2001,AIHW , Canberra. Battersby, M.W., Kit,J. A., Prideaux, C. Harvey,P. W., Collins, J. P. Mills, P.D. (2008). Research Implementing the Flinders Model of Self-management Support with Aboriginal People who have Diabetes: Findings from a Pilot Study, Australian Journal of Primary Health 14(1) 66 – 74. 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