Diabetes Among Men In London

Introduction

The aim of this essay is to discuss the statement that health promoters have expert knowledge and their role is to empower others. In order to contextualise this question, I am going to be looking at type 2 diabetes among men, and I will also identify which part of London has the highest prevalence of type 2 diabetes. For identifying that, I am going to look at how I will apply the community health need assessment or the health profile. As a health promoter, I am going to be underpinning this with this health promotion model which is health belief model although, Ottawa chatter can also be applicable.

Background

Type 2 diabetes is a condition in which the level of sugar in the blood is too high (National Health Services, 2017). It means that, after eating food that contain more carbohydrate, chemicals in the small intestine break them down into single sugar molecules called glucose while the cells lining up in the small intestine absorb the glucose which passes into the blood stream.

Type 2 diabetes Mellitus (T2DM) is a growing issue in today society and constitute a burden on health care system globally and locally (International Diabetes Federation 2013). World Health Organisation claimed that, there were 422 million people in the world with diabetes and this number is estimated to be 642 million people living with diabetes globally by 2040 (World Health Organisation, 2018). There is a growth in the number of T2DM patients. In United Kingdom, it is found that, 3.5 million people are diagnosed to the chronic disease (Diabetes UK, 2018). With around 22, 000 people with diabetes are dying early each year in England. (Public Health England, 2018). Meanwhile, in Bromley community, T2DM has risen to 15,107 in 2018 compare to 2017 which was 14, 901. The number represent 6.92 per cent of the local populations which is higher than the England average of 6.6 percent (Public Health England, 2018).

The chronic disease side effects can be prevented if there is timely detection of the diseases. However, T2DM patients` life can be sustain only when they have better access to the healthcare facilities, right counselling, healthy lifestyle and being empowered by the health promoter. The treatment of the disease is carried on through testing of blood glucose level, exercise, insulin injection and diet control (NICE, 2017). However, people are more vulnerable to the chronic disease due to their busy schedule and lack of awareness. Based on the information from the health profile, health promoter will underpin this with health belief model.

Health promotion, as defined by Ottawa chatter from health promotion in 1988, refer to the process of enabling people to increase control over, and to improve their health (WHO, 1986). Therefore, health as described by World Health Organisation (WHO) as a state of complete physical, mental, social well-being rather than mere absences of disease or infirmary (WHO, 2018). Good health is not determined by a single factor but a variety of factors such as environment, social and economic condition have an impact on health. These factors not only impact health but also make it easier or more difficult for the people to make changes over their health. Because of this, health promotion is trying to improve health not only by targeting people and individual level to change their behaviour but by tackling a comprehensive approach, addressing a broad spectrum of the healthcare professionals, re-orienting T2DM patients and determinants of health.

It sought to aim individuals with the knowledge to make the most excellent decisions for their own health, a goal which was slowly put in place to favour the individuals thereby moving them away from the generation of personal responsibility (Baum, 2008).

The reason for this move is that assigning responsibility for poor health to make the individuals to have the mindset that it is their own fault (Victim -blaming) rather than the structural violence that are preventing them from meeting their basic needs, and health promoters to identify that forces mainly beyond the control of the individual including socioeconomic status and societal norms which has an essential role in health seeking behaviour (Goodman et al., 1996). This ideological shift formed health promoters (Beaglehole et al., 2004). The policy of the Local Government Act 2000 placed a statutory duty on local authorities to produce a community strategy for promoting environmental social and economic well-being for their community (Oliver & Pitt, 2013; Great Britain, 2000). One of the most promising, enhanced based means for diseases education at the individual and community level is an outreach model with health promoters (Perez and Martinez, 2008).

As part of the current austerity measure, public services have increasingly made T2DM individuals to be responsible for their own health. This shift of responsibility has a high impact on patients with low incomes, as austerity measure affect them more than the affluent groups and they also have the capacity to benefit most from self-management support (Glazier, et al., 2006). These have increased the burden on individuals with T2DM.

Health promoter’s roles are not merely provider of service but also explanation and exhibition of how the problems that individuals / communities face in their lives, including the ones that are directly linked to health and those that arise from cultural, political, economic, social and so on that impact their conditions of lives which may be more important unit segment of analysis for illness than illness itself (Lieda et al 2008). For example, an individual’s suffering from T2DM is at greater risk of stroke, high blood pressure and death (Gerber et al., 2012).

To reduce the risk factors, attentive management of high blood pressure and blood glucose are important. For the individual to reach his goals in managing the disease, regular, continuous adherence to blood sugar test level is required. Most common factors that cause to non-adherence include lack of blood sugar test, lack of social support, low health literacy and concerns about adverse events. (Gerber et al., 2010). Therefore, health promoter is in the best position to further enhance the effectiveness of blood sugar test management for the individual because the health promoter guides the individual to discover the means of preventing stroke and high blood pressure (Gerber et al., 2010). According to Wise (1995), empowerment is an integral part of enabling the oppressed to understand how structural processes have an impact on individuals.

Health promoter help the individuals to move effectively in the right route thereby increasing the individual health knowledge. Although, the health promoter is not the person who shoulder the responsibility or solve the problem of the individuals instead, the health promoter provides the various options and every news that shows different ways of dealing with the individual / community problems (Keane et al., 2004). The individual has knowledge of type 2 diabetes because the individual is educated and can read and write. Staples (1990) proposed that, individuals empowerment has to do with the way they think about themselves and the capacities, knowledge, skills and mastery they hold.

The health promoter could have the theological knowledge like health promotion model and approaches to use on how the individuals could manage their T2DM through community health needs assessment. They have expert knowledge because they liaise with nurses and get knowledge of T2DM because diabetes specialist nurse promotes self-care management and provide effective patient care (Royal College of Nursing, 2017).

A contrary explanation is that, the person who is suffering from the disease has more knowledge because the individual has use different means to increase his knowledge that now allow the individual to better control and raise awareness of the illness (Tanabe, et al., 2010). Although, the individual knowledge does not consider the social determinants of people`s health and cannot advocate for him/her self which makes the individual not to have full expert knowledge (Wallerstein, 2006). Individual empowerment on its own has less impact when addressing health inequalities and does less to influence social change (Riger, 2002). However, the individual is the one that faced with the diagnosis of the illness and experience the health condition, and this makes the individuals to have more knowledge of the illness (Asnani et al., 2017).

As we have seen above, because the person who has T2DM has expert knowledge about the issue, the health promoter does not have the expert, but the health promoter could empower them by enabling them, informing them, advocating on their behalf as indicated in the Ottawa chatter. Empowering these group of people is for them to intervene in their own health management (Ferreira, & Castiel, 2009). In other for the health promoter to do this, the health promoter will use health belief model.

Health belief model is a practical framework use to understand health behaviour (Rimer and Glanz, 2005). Based on this model, the Bromley individuals` belief that, they are susceptible to T2DM disease, they perceive a high level of susceptibility of T2DM in their family and discuss T2DM as a condition that is inevitable for many members in their family instead of preventable disease. They explained that, their family is curse that is why many of them have T2DM. Saying that if the health promoter is one of their family members, the health promoter will have T2DM someday. According to Rappaport (1987), the aim of empowerment should be to improve the possibilities for individuals to control their own lives. Similarly viewed by Cochran (1986), that the individuals understand their own needs better than every other person and should have the power to act and define upon them.

As a health promoter, it is their duty to change these individuals’ perceptions and beliefs, by educating the individuals, telling them about the number of people that are suffering from T2DM as well as the major risks of not managing the disease. Also, informing them that the best way to manage blood sugar is to always access their GP to check blood sugar test.

Perceived severity is a social and medical consequences feeling about the severity of a disease (Janz & Becker, 1984). The participants perceive T2DM to be a deadly disease and a killer in their family. They explained that, T2DM diagnosis is viewed as a death sentence, instead of manageable condition. The participants discussed how T2DM limit everything for them including restricting their ability to work and daily activities.

In addition, they talked about the medical outcome of T2DM, seeing many family members suffering from stroke amputation and many others. The individuals went further to say that the social consequences of T2DM are also severe among their family members. The stigma of T2DM diagnosis is extremely high and make many individuals in their family from seeking care and admitting that they have T2DM. According to Keiffer (1984), crisis often prompted people to become critically aware of their own condition. Crisis in most people culture usually create a negative connotation (Lord and Hutchison, 1993). Empower these individuals is effective to tell them the fact about the condition, the mortality and morbidity rates of T2DM, and encourage them to go for blood sugar test.

Considering Perceived benefits, under this part of the model, the individuals understand most of the self-management behaviours like blood sugar test level, exercise, reduce fat and consume more vegetables and fruits. The individuals felt about the possible benefits of T2DM self-management behaviour, although, they did not articulate the benefits of those behaviours. Some of the individuals that did not oppose the health promoter advice stated that T2DM self-management behaviour would have benefits for their family members. However, the family did not know how to they will be benefitted. In all, when the health promoter asked the individuals a question about the benefits of T2DM, the individuals were less wordy, because they have lack of understanding about T2DM management education and self- management behaviour (Anna et al., 2017).

The health promoter will educate them to see and perceived that, there are benefits involved to them personally by learning what to do to care for themselves, by taking actions for early treatment of blood sugar test that will prevent them from stroke and death.

Considering Perceived barriers, the individuals indicate a lot of obstacles that obstruct their family from practicing diabetes self-management behaviours. They talked about the structural and non-structural obstacles including lack of transportation, cultural food practice, limited access to health care, and social stigma. They identified their main obstacles to self-management as lack of access to health care services because they do not have any insurance and transportation to attend DSME classes as well doctor appointment (Ahola & Groop, et. al., 2012).

For these individuals to change their perception as to the barriers that prevent them from self-management of their T2DM, health promoter will offer guidance, alternative ideas to overcome the barriers. According to NICE guidelines for treating diabetes involve providing the person with information with T2DM to manage the condition and monitoring of possible risk complications (NICE, 2009). Informing them that by exercising will help them to control their blood glucose (Knowler et. al., 2002).

Cues to action is an action that motivates people to change their behaviour (Anna et. al., 2007). The main common theme identified by the individuals for cue to action was the T2DM diagnosis itself. The individuals explained that, once a person from Bromley borough is officially diagnosed with T2DM, it starts to have a consideration of behavioural change. While a T2DM diagnosis is the main cue to action, the shame linked with T2DM keeps many individuals from having their blood sugar tested to know if it is worst or not. Rosenstock (1996) stated that, cue to action denotes a trigger for health behaviour when appropriate beliefs are held. “One of the individuals stated that after my uncle knows that he has a T2DM, he stops taking drinks and eating food that has high quality of sugar”. As a health promoter, it is very important to come up with actions, that will motivate these individuals to change their behaviour. To achieve this, is to keep reminding, informing and providing guidance for them that having their blood sugar tested will determine if they are at high risk of blood pressure, stroke, heart disease and death. Health promoter will use external and internal cues for these individuals by organising a social gathering in every two weeks to provide information perception of T2DM symptoms, and through mass media campaign to serves as a reminder for blood sugar test.

Considering Self-efficacy, the individuals’ responses for self-efficacy was widely different. The difference was present among the individuals. The confidence in one’s ability to successfully carryout self-management behaviour is complicated by most individuals’ beliefs that it is their genetics that are the main factor that cause T2DM, which makes T2DM outside their control. The lack of self-efficacy was a reason why they did not practice self-management behaviours. Orji (2012) viewed that, people may not want to try to do something new unless they think that they can do it.

In order to use incremental goal setting strategies, individuals believe about their ability to adopt the strategy of checking their blood sugar test. Health promoter will provide culturally- tailored DSME to address misconceptions and encourage activities that will improve self-confidence in utilising recommended diabetes self-management actions. Also, get someone that was successful in the diabetes self- management to build confidence in the individuals’ abilities for managing T2DM successfully.

Conclusion

This essay has critically analysed the statement that the health promoters have expert knowledge and their role is to empower others. It has been argued that, the individuals with T2DM also have expert knowledge, they are giving reasons and examples why they are experts. Looking at the discussion above, it shows that they both have expert knowledge but in different perceptive. It has use health belief model to explain how health promoters are expert.

Continue your exploration of Devices Use in Lavel 4 Treatments with our related content.

References

• Anna, P., Hallgren, E., Henry, L.J., Ritok, M., Chutaro, J.R., & Kohlor, P. (2017). Health Beliefs of Marshallese Regarding Type 2 Diabetes. 40 (2): 248-257. Doi: 10.5993/AJHB.40.2.10. Retrieved from:
• Asnani, M.R., Gooden, A.B., Grindley, M, et al. (2017). Disease Knowledge, Illness Perceptions, and Quality of Life in Adolescent with Sickle Cell Disease: Is There a Link? Retrieved from:
• Baum F. (2008). The New Public Health. Oxford, Melbourne.
• Beaglehole R., Bonita R., Horton R., Adams O. & McKee M. (2004). Public health in the new era: improving health through collective action. The Lancet, 363, 2084–2086.
• Brucaglioni, M. (2007). Persona empowerment. Franco Angeli: 61-78.
• Diabetes.co. uk. (2018). The global diabetes community. Retrieved from:
• Feleke, D.A., Elham, S., et al. (2018). Contextualizing Ottawa Charter Frameworks for Type 2 Diabetes Prevention: A Professional Perspective as a Review. Retrieved
• Ferreira, M.S & Castiel, L.D. (2009). Which empowerment, which Health Promotion? Conceptual convergences and divergences in preventive health practices.
• Gerber, B. S., Cano, A. I., Caceres, M. L., Smith, D. E., Wilken, L. A., Michaud, J. B., Ruggiero, L. A., &Sharp, L. K., (2010). A pharmacist and health promoter team to improve medication adherence among Latinos with diabetes. 44(1):70–79.
• Gerber, B.S., Rapacki, L., Castillo, A., Tilton, J., Touchette, D.R., Mihailescu, D., Berbaum, M.L., & Sharp, L.K. (2012). Design of a trial to evaluate the impact of clinical pharmacist and community health promoters working with African-Americans and Latinos with Diabetes.
• Glazier RH, Bajcar J, Kennie NR, & Willson K. (2006). A systematic review of interventions to improve diabetes care in socially disadvantaged populations. Diabetes care. 29(7):1675–88. Retrieved from
• Goodman R., Wandersman A., Chinman M., Imm P. & Morrissey E. (1996). An ecological assessment of community-based interventions for prevention & health promotion: an approach to measuring community coalitions. American Journal of Community Psychology 24 (1), 33–61. Retrieved from:
• International Diabetes Federation. (2013). IDF diabetes atlas. Brussels, Belgium:  International Diabetes Federation. Janz, N.K & Becker M.H. (1984). The health belief model: a decade later. Health Education Behaviour. 11(1):1– 47.
• Knowler, W. C., Barrett-Connor, E., Fowler, S. E., Hamman, R. F., Lachin, J. M., & Walker, E. A. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine, 346(6), 393-403. National Institute for Health and Care Excellence. (2017). Type 2 diabetes in adult:
• Oliver, Billie & Pitt, Bob (2013). Engaging Communities and Service Users: Context, Themes and Methods., London: Palgrave Macmillan.
• Orji, et al., (2012). Towards an Effectives Health Interventions Design: An Extension of the Health Belief Model.
• Perez, L., & Martinez, J. (2008). Community health workers: Social justice and policy advocates for community health and well-being. American Journal of Public Health, 98, 11–14.
• Public Health England, (2018). Health matters: preventing Type 2 Diabetes. Retrieved
• Staples LH. (1990). Powerful ideas about empowerment Administration in Social Work. 12: 29-42.
• Tanabe P, Porter J, Creary M, et al. (2010). A qualitative analysis of best self-management practices: sickle cell disease. J Natl Med Association. 102:1033-1041.
• Wallerstein, N (2006). What is the evidence on Effectiveness of Empowerment to Improve Health? Report for the Health Evidence Network (HEN). Retrieved from:
• Wise S. (1995). Feminist ethics in practice. In: Hugman R, Smith D (eds). Ethical issues in social work. London: Routledge, 104-119.
• World Health Organization. (1986). The Ottawa charter for health promotion: first international conference on health promotion, Ottawa, 21 November. Retrieved from: