Together with local stakeholders, health systems may incorporate community-based services that are efficient across the continuity of care to strengthen patient-centred results, promote patient acceptance, and eventually contribute to the increased patient involvement and satisfaction. Chronic diseases like diabetes impact an extremely significant portion of the Australian population (Harrison et al., 2013). Rises in diabetes cases reflect a variety of causes which include longer life expectancy, aging population, rigorous screening procedures, and marked rises in obesity and associated risk factors for behaviour. Diabetes management and treatment consume a huge amount of expenditures from any country’s health care funds (Yesudian et al., 2014). Thus, there is a growing need to establish low-cost, efficient, preventive, and therapeutic approaches, and also strategies that delay the progression of diabetes, side effects, and correlated functional deterioration in diabetes patients. This paper will discuss a few successful, cultural competence community-based programs and important aspects required to implement projects at a healthcare system level or community level.
Diabetes affects an extremely large segment of the Australian population. The Laverack community-based engagement ladder offers a well-accepted structure for community and primary care home improvement in diabetes and chronic disease treatment. This approach has been adopted into their systems by a variety of community-based diabetes initiatives (Laverack, 2007). Diabetes services must provide accessible population-wide resources and knowledge and execute in a way that is comprehended regardless of education and socioeconomic status. Understanding the community context is essential for tailoring prevention strategies of diabetes and ensuring community involvement (Philis-Tsimikas & Gallo, 2014).
Community engagement is one of the concept which offers a forum for public health planners and program managers to prepare, assess, adapt, and extend their approaches to community engagement. When projects are being developed, it can be used as a resource for internal communication and can be especially useful as a catalyst for conversations about what approaches to use and how to handle expectations, explain roles and categorize group obligations to tackle diabetes. The framework for discussion with community members on how to increase their participation and jointly determine which strategies will be most appropriate in reducing cases of diabetes to achieve a specific public health goal (Tol et al., 2015). The government is obliged to direct the community to act and adhere to predefined, standardized procedures for safety. However, experience has also shown that the community is more inclined to follow health care directives during an urgent situation if they are involved in developing these procedures and have a chance to develop a sense of trust with the public health department through such a process.
Moreover, the creation, implementation, and evaluation of health services are generally believed to be beneficial to Community participation. Yet many challenges remain to the sustainable and successful involvement of the community. At the individual level, the community and people can work to cure diabetes. Comprehending the value of self-care in health services to combat diabetes within-group engagement rates and models (Alcántara-Aragón, 2019). Community members can focus on health benefits as well as compliance that emphasize the participation of individuals in health programs and the decision-making power of individuals that might be inclined to a partnership between health care professionals and individuals. Indeed, self-care will provide the community as a whole with the ability to bring about sustainable change at all levels, individual and community to achieve and maintain optimal health. Especially those who tolerate the greatest burden of chronic illness such as diabetes could benefit. Self-care can increase people's intentions to practice preventive behaviours, which can encourage early diabetes monitoring (Hood et al., 2015).
Australian health policy centuries ago and refer to as 'capacity building' either as a strategy for achieving a healthy society or as a goal for itself. Although the capacity building has been extended to initiatives aimed at bringing about a sustainable shift in diabetes from person to entire nations, organizations are usually an essential part of capacity building for health (Hacker et al., 2012). There are four key solutions, and a variety of methods may appear to have the potential for capacity building in diabetes prevention and cure. The four approaches recognized are: (i) changing policies and making better policies for diabetes; (ii) staff skills improvement in taking care of the diabetic patient; (iii) strengthening partnerships among organizations working towards the disease; and (iv) involving individual members of the community in self-care and management (Hacker et al., 2012).
Considering the importance of core domains of capacity-building, "learning opportunities and development of skills" would be expected in attempts to build community capacity and strengthen teams that can work for the diabetic cure. It is necessary to ensure that people involved in the delivery of the diabetes prevention program are properly trained. The fundamental principles of team-based treatment should be familiar to doctors, health system management workers, and community members participating in the diabetes cure program. Staff in the production and implementation of the health care plan should be trained in the specifications of basic procedures, job responsibilities, and expertise to fulfil their role. Staff should be aware of the community practices and provide service delivery training and patient care materials that are suitable for the health and culture of the community (Liberato et al., 2011).
"Resource mobilization" is very important, always with the term including attaining funds but also concerning drawing on individuals, structures and processes. Identifying community support resources that will help diabetic patients achieve their medical and developmental goals is critical since these systems may be easier for patients in their community area to access (Tung, & Peek, 2015). Local community health centres, county health resources, senior centres, and YMCAs are included in the community resources.
"Partnership/linkages/networking" is important in terms of more equitable relations but also in terms of "connection and networking" within and through the communities. Daily meetings should be held to address any organizational and clinical concerns of diabetes, review results, and maintain bidirectional communication for feedback and continuing progress with all of the program's participants including community leaders and diabetic patients. Moreover, "Leadership" has been essential to motivate communities to participate in a goal, to negotiate conflicts and to overcome obstacles. Community members will have supervisory responsibilities on the progress of the diabetic plan, recruitment of staff, location of the health care centre, integration with existing community and health system services, tracking reports of the patients and communication among staff, health care system, community and patients (Powers et al., 2016). To ensure a smooth program operations community in-charge can take care of underlying support services may be needed from human resources, finance, and information technology. Leadership by community members can help in determining what kind of personnel mix is needed for the diabetic centres such as dietitians, wellness coaches, nurses or educators would be required in their area.
Additionally, "Participatory decision-making" was commonly viewed parallel to governance in communicating with a range of prospective audiences to identify areas of concern and ways to address them. To create and maintain an active organization, a community-based organization needs to provide clinical and organizational leadership. A member from the community or health professional who is knowledgeable about diabetes care and other standards can assume the position of leader. The community participation provides support and guidance for the tools for supporting clinical decision making and as a backup to complicated clinical situations which arise in diabetic patients (Wilkinson, Nathan, & Huang, 2013). Also, accredited diabetes educators can monitor the quality of clinical treatments and the programs in self-management education.
There are different models and approaches which can be utilised to achieve health promotion, one of which is the health belief model. It's a theoretical model that can be used to guide diabetes programs for disease prevention and health promotion. This model explains and predicts the changes in individual health behaviours. It can be used to understand the health behaviours of diabetic patients. The main factors affecting health behaviours according to this model are as the perceived vulnerability to disease (perceived susceptibility), the belief in effect (perceived severity), benefits of action (perceived benefits), perceived obstacles to action, exposure to stimuli triggering action (cues to action), and ability to achieve (self-efficacy) (Jones et al., 2015). The benefit of this model is that it focuses on key components of individual health conditions by making the beliefs stronger of the patient by predicting behavioural patterns related to health. The downside is that by controlling for individual variations in views and behaviours it helps to anticipate health-related behaviours. However, it does not account for other factors influencing health behaviours like smoking and alcohol consumption in case of diabetes (Kumar & Preetha, 2012).
Another approach is the medical approach. It centres on intervention aimed at reducing morbidity and premature mortality. Intervention is aimed at whole communities or groups at high risk of diabetes. The goal of this approach of health promotion is to increase medical treatments that prevent the disease and premature death caused by diabetes (Farre, & Rapley, 2017). The medical approach is often described as involving three levels including primary prevention, where the causes of the onset of diabetes can be found out and the onset of the disease can be prevented or it can be reduced through awareness and secondary prevention, which is to avoid diabetic progression through screening and detection methods. The last one is tertiary prevention which is achieved by further reducing the disability and suffering who got diabetes; prevent the recurrence of a disease, such as rehabilitation, patient education, and self-care. This approach is quite informative and educative in prevention and onset of the disease’s conditions. But the approach fails to the people of lower literacy and the people who do not have access to the early health care facilities.
Another approach is the educational approach which aims towards having information and awareness about diabetes, and to build the skills necessary to allow people to choices about their health condition. Training, however, is intended to produce a result. The educational approach is made up of a series of assumptions about the relationship between knowledge and behaviour. The assumption that there would be a shift in behaviour that may lead to positive changed behaviour, through educating the patient about diabetes. The purpose of this approach is to make an educated decision that can seem unambiguous and the diabetic patient agrees (Janssen, Van Regenmortel, & Abma, 2014). Yet this ignores not only the very real limitations that social and economic forces impose on changing voluntary behaviour but also the complexity of decision-making related to health. The disadvantage of this approach is that it is not designed to convince or inspire progress in a specific direction. This will be the voluntary decision of the patient; it might not be the one that the healthcare professional would prefer. The advantage of this approach is that educating the patient to help them to make choices about the condition and give positive health outcomes.
There is another strategy which focuses on behaviour change for health promotion. This strategy is meant to inspire people to follow healthier habits, which are seen as the path to better health. Health-related decisions are a dynamic process and it is unlikely that they will be successful unless an individual is ready to take action. This approach is common, as it considers wellbeing to be the property of a person. It is fair then to conclude that people could make real changes to their wellbeing by deciding to change their way of life. It also presumes that if people don't act responsibly to take care of themselves then they are to criticize for the implications (Chauhan et al., 2017).
The paper concludes that a globally growing population requires information to access diabetes control and prevention programs. People should be able to gather information and endorse across the community making it available to all and presented in a form that is comprehended, irrespective of socioeconomic status and literacy. This can make a difference in reducing the rate of development of diabetes and improving control of existing diseases. The Laverack’s ladder provides a framework for the establishment and implementation of community-based programs. The Australian Association of Health Care offers additional guidelines and recommendations to help manage diabetes. Strategies and approaches are used for ultimate objective for diabetic patients; identification and acknowledging the health conditions, or cultural differences to care; incorporating evidence-based guidelines and medical data into care for the disease; and combining the care management teams of nurses, pharmacists, and other health care services to improve disease such as diabetes, have been demonstrated.
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