Health Promotion Program on Diabetes Type II in Kuwait

Community participation in decision making on health

Community participation in decision making for health such as planning and management of health care services and their own health is one of the fundamental goals of primary health care movement. Community participation is a concept that attempts to bring different stakeholders including the community members so that they can collectively take part in problem posing, problem solving and decision making in relation to health care needs and services within the community. Diabetes is a health problem that needs to be addressed by the whole community as several studies have shown that diabetes type II is prevalent in populations in which there is high prevalence of obesity which is the case in Kuwait. This therefore shows that community participation in decision making regirding their health and health care services will significantly impact positively in the management and prevention of diabetes type II within the community.

Community participation in decision making for health is only initiated after carrying out a community assessment and diagnosis process with the aim of determining the community’s health needs in relation to diabetes type II. The need to involve the community in decision making on health is reached after the process after which the community will be involved in a systematic way on how to participate in decision making. It is worth noting that in the history of endemic diseases, were it not for community participation in the decision making on health care services and needs identification then many people could not have accessed basic health care. Recognition of the important role that communities can make in the decisions made in relation to their health means that they will be helping even in formulation of national health policies and plans.

Community participation in decision making for health varies in extent and intensity. It is considered increasingly extensive as more people engage in and more intensive as its cost to the community in effort, money or time increases. Participation by the community in decision making for health is normally determined by the balance between benefits and costs. The intensity of participation varies inversely with the size of the community. On the contrary, the smaller the participating group, the less representative it will be. Some of the questions that must be answered carefully in community participation in decision making for health seeks are: within a given geographically defined community, which group of community members should form the representative decision making body? What information will this body perceive as necessary for valid decision making? Can a participatory process that is only consultative be sustainable or must the decision making body be given responsibility for the allocation of resources? What types of decisions should community groups make and will these decisions involve trade offs between competing priorities? And finally, Will different groups (e.g. laypeople and health workers) given the same information reach different decisions. Critical analysis and answering of these questions enables one to appropriately and efficiently implement and promote community participation in decision making for health.

Community participation in decision making for health is very important in the fight against diabetes type II. These benefits can be divided into three groups. The first group of benefits is to the individual community members and include improvement of self esteem and equipping him/her with new skills and knowledge if diabetes type II, it gives people a sense of power over the forces of that determine their own health thus empowering them. The second group is the community whereby it creates a cohesive and a united community which is armed with relevant knowledge on diabetes type II, it also promotes identification and mobilisation of untapped resources of community members and putting into effective use of citizens’ knowledge and improved planning by the proponents. The last group is the program which will benefit through gaining professional entry into social justice issues and demonstration of government commitment. The benefits are numerous but not limited to these ones.

These program, “Diabetes is preventable: Knowledge for all” will therefore incorporate community participation in decision making for health as one of the ways of ensuring that the community takes a personal initiative towards management and prevention of diabetes type II within Kuwait community.

Kuwaiti population: A prevalence study” with aim of defining the magnitude of the problem and to suggest plans for future diabetic care showed that type II diabetes is a major public health problem in Kuwait. The study further showed that obesity was a characteristic feature of the study population with a family history of diabetes type II in 63% of the diabetic individuals. In another similar study carried out by Moussa et al (2008) titled “prevalence of type 2 diabetes mellitus among Kuwait children and adolescents” with the main objective of determining the prevalence of diabetes type II among citizens aged between the ages of 6 and 18 years. The study showed that there was a prevalence of 34.9 per 100,000. The study concluded that the prevalence of type II diabetes was spreading to children and adolescents and therefore making diabetes type II an emergency public health problem. They further suggested that more preventive measures should be initiated to help curb the spread of the disease among the youth. Both studies showed that there was a difference in prevalence levels between female and males. These two studies and many more others have demonstrated that diabetes type two is a major public health problem that must be handled with a lot of seriousness and concern so that its spread can be fully controlled once and for all. Studies that have been carried out in the state of Kuwait have associated strongly diabetes type two and obesity. In this case obesity is due to poor eating habits and lack of physical exercise. These two can be effectively controlled through community screening for diabetes and positive health promotion activities.

Title of project: Diabetes is Preventable: Screening and Knowledge for all, 2009.

Objectives

The main objective of “Diabetes is Preventable: Knowledge for all” is to improve the knowledge base of Kuwaitis aged 40 years and above on diabetes type II and allowing the community to participate in decision making on health care and health care services. The specific objectives are into two categories. These are:

1. To screen community members for diabetes type II.
2. To educate the public on diabetes type two; causes risks, treatment, management, signs and symptoms, complications and prevention.
3. To Increase awareness about the importance of prevention of diabetes type two.
4. To involve the community in decision making on health in relation to diabetes type II.

Program Area Coverage

The program will be implemented in the state of which has a high prevalence of Diabetes type II with large numbers of population not aware of their diabetic status and have knowledge deficit on diabetes type II. According to a censure carried out in 2001, total population was found to be 2.25 million with life expectancy of 73.8 years (State of Kuwait, 2009).

Target Population

The target population for this program will be citizens of the state of Kuwait with special focus on adults aged 40 years and above as they are affected with the increasing prevalence of diabetes type two in one way or another and they will also be very instrumental in the prevention of diabetes type two.

Methods/strategies/interventions

This health promotion program was purposely chosen due to the fact that community screening for diabetes type II and health promotion has been shown to be an effective intervention in the prevention of behaviour related disease and illnesses such as obesity which is highly associated with diabetes type two. The will be carried out in the communities and in diabetic clinics. In the communities, the days of will coincide with days when community meetings are held and those days that the local leaders will convene the community members. Door to door campaigns will also be carried out with the aim of reaching a large group of clientele. Diabetic clinics will also be used in delivery of the health education and awareness campaigns.

Lack of awareness of a person’s diabetic status and knowledge on diabetes type two has also been known to be a contributing factor in the spread of the disease. Health promotion whose main objective is to help individuals improve their own health through empowerment will therefore ensure that people are knowledgeable on all issues related to diabetes type two, this will consequently lead to a change in behaviour and attitude that will help in reducing greatly the prevalence of diabetes type two in the state of Kuwait.

One of the best ways that has proven effective and efficient in prevention of diabetes type II is community diabetes screening. According to Wilkey (2008) and Jakal (2007) community diabetes screening is basically a systematic way in which community members who are at high risk of developing diabetes or those who already are diabetic but are not aware or have not been diagnosed. The main aim of community screening for diabetes is to link those at high risk and those that are newly diagnosed to effective prevention and treatment programs. Community screening for diabetes helps health care professionals to identify people at high risk of developing diabetes after which they hare referred to health care institutions in which proper diagnosis is done and a follow up is initiated to ensure that care is given to them, community screening has also been shown to help in creating community awareness on diabetes type II risk factors, causes, treatment, management, and when to seek medical assistance. This is normally done through health education and promotion activities aimed at improving the knowledge base on diabetes of the community. Knowledge on diabetes is therefore an integral part of community screening for diabetes (Baobarb, 2006). Another importance of community screening for diabetes is that it enables the community members to identify diabetes resources within the community and hence put them into good use (Okoth, 2003). This program will involve health education and promotion with the aim of eliminating knowledge deficit on diabetes and will include: diet counselling, importance of prevention of obesity and how the high risk patients can prevent developing diabetes type II. Community screening for diabetes type II will involve physical examination, taking of blood samples for laboratory tests to determine blood sugar levels, cholesterol levels, and taking of vital signs such as blood pressure. Individuals who will show physical signs of diabetes such as polyuria, polydypsia, blurred vision and weight loss which may occur with polyphagia will be referred to a medical facility for further tests in order to make accurate diagnosis (American Diabetes Association, 1998a). Other parameters to be used are lipid abnormalities, obesity, high cholesterol levels. According to the American Diabetes Association (ADA) (1998b), those that are at high risk of developing diabetes type II are: “Individuals previously identified as having impaired glucose tolerance, diagnosed as having hypertension, with an HDL-cholesterol level < 35mg/dl and/or a triglyceride level >250 mg/dl, women who have a history of gestational diabetes mellitus or have delivered a baby weighing over 9 pounds”. ADA has also identified major high risk factors for diabetes type II as being family history of diabetes, obesity (more than twenty percent of ideal body weight) and age above 40 year with any of the above listed risk factors. This program will involve the following stages: preparing for community diabetes screening, identifying people at risk of developing diabetes, raising awareness about diabetes, educating community about diabetes and implementing improvements throughout the health care system in the state of Kuwait.

Permission and Ethical issues

Letters of approval will be obtained from the university; lecturer and head of research, ministry of health and directors of health in the six regions. Professional code of practices and code of conduct will be followed strictly by each and every individual.

Personnel

Qualified nursing staff will be enlisted in the “Diabetes is Preventable: Knowledge for all.” Those nurses who are employed by the government and are working in fields related to health promotion will also be invited to help in the program as part of their national duty in health promotion. Due to the nature and work load of this program, nursing students from local nursing schools and universities will also be enlisted in the program where they will help in health education and creating awareness on diabetes type II. Nutritionists will also be involved.

Evaluation

Evaluation of the project will be done in between the program and at the end of the program which will be after one of implementation of the program. Evaluations helps in checking if the program is success and whether there is any positive impact and if interventions put in place had desired results (Parahoo, 1997). Evaluation also helps in knowing if the set goals and objectives were met, determining success or failure of the problem and to put corrective measure into place (Elaine, 2005; Jorsen, 1999). Evaluation of this program will be done through carrying out studies to determine prevalence of diabetes type two among the populations in which the program will be implemented and also from health records from the ministry of health regarding new diabetes cases recorded during and after the implementation of the program. The program will be considered a success if prevalence decreases. Assessment on knowledge levels on diabetes type two in relation to causes, at risk groups, prevention, disease process, management and treatment will be carried out using structured questionnaires that will be issued at the end of the program.

Timeline for the Program

References

1. Abdella, N., et al. (1996). Known type 2 diabetes mellitus among the Kuwaiti population: A prevalence study. Acta Diabetol, 33(2):145-9. Web.
2. American Diabetes Association. (1998a). Position Statement Clinical Practice Recommendations: Screening for Type 2 Diabetes. Diabetes Care, 21(suppl.1):20-22.
3. American Diabetes Association. (1998b). Diabetes Alert.
4. Aravjo R.B., I dos Santos,(1999). Assessment of diabetic patient management at primary health care level. Rev. Saude. Pulica, 33: 24-32.
5. Baobarb K. M. et al (2006). Community assessment, screening and diagnosis of diabetes type II. Macmillan Publishers.
6. Carol, T., (2005). Fundamentals of nursing: The art and science of nursing care. Philadelphia: Williams and Williams.
7. Clark, M. J., (2003). Community Health Nursing; Caring for populations. 4^th Edition. New Jersey: Pearson Education Inc.
8. Delaune, S.C. et al (2006).Fundamentals of nursing (3^rd.ed).Louisiana; Thomson Delmar learning.
9. Elaine, M. M., (2005). Health Bulletin – Promoting Healthy Behaviors. Washington DC: Population Reference Bureau.
10. Jakal G. H. (2007). Community assessment: Diabetes screening. Lagos, Nigeria: Abagbu Publishers.
11. Jorsen, D. (1999). History and Trends of Professional Nursing. Washington DC: Mosby Company.
12. Jorum, K. L. (2008). Health education and promotion on diabetes. Nairobi, Kenya: Upendo Publishers.
13. Lantion-Ang L.C., (2000). Epidemiology of Diabetes Mellitus in Western Pacific region: focus on Philippines, Diabetes Res. Clinical Practice, 50 suppl. 2: S 29-34.
14. Lorenz R. A., et al (1986). Impact of Organizational Interventions on the Delivery of Patient Education in a Diabetes Clinic. Patient Edu. Couns., 8:115-23.
15. Moussa, M. A., et al. (2008). Prevalence of type 2 diabetes mellitus among Kuwaiti children and adolescents. Med Princ Pract, 17(4):270-5. Web.
16. Murray C.J.L., A.D. Lopez, (1996). The global burden of disease. Geneva: World Health Organization
17. Nutrition Sub-Committee of the British Diabetic Association’s Medical Advisory Committee, (1982). The Role of Dietitian in the Management of Diabetes. A Policy Statement by the British Diabetic Association. Human Nutrition: Applied Nutrition, 36A: 395-400.
18. Okoth, J. M. et al (2003). Prevalence of diabetes type II in Sub Saharan Africa. Nairobi, Kenya: Upendo Publishers.
19. Parahoo K. (1997). Nursing Research: Principles, Process and Issues. Macmillan
20. Sally, K., & Rosamund B., (2004). Primary Health Care Research and development. London: Arnold, Hodder Headline Group.
21. Sony Anthony, William Kelly, and Tina Odgers, (2004) Health promotion and health education about diabetes mellitus. Journal of the Royal Society for the Promotion of Health, Vol. 124, No. 2, 70-73
22. State of Kuwait, (2009). General information about Kuwait.
23. Wilkey N. K. et al (2008). Community screening for diabetes. New York: McGraw Hill.
24. World Health Organization, (1986). Ottawa charter for health promotion, Journal of Health Promotion, 1: 1-4.
25. Zerwekh,J.(2003).Nursing today; transitions and trends(4^th ed.).Dallas, Saunders.