Community Health Nursing Assignment Report

Running head: COMMUNITY HEALTH NURSING
Diabetes in South Asian Immigrants in Toronto
Name of the Student
Name of the University
Author Note

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COMMUNITY HEALTH NURSING
Introduction
It is mandatory for the community health nursing professional to incorporate health
promotion and education in order to promote wellness into their professional practice
guidelines. Vollman, Anderson and MacFarlane (2017) are in accordance with this statement.
According to them, the purpose of the health promotion model is to promote comprehensive
health and wellness for all. Although significant health improvements have occurred during
the course of time among the Canadian population, sudden infiltrations of the immigrants
from, Africa and South Asian parts of the world have again increased the health related
disparities in the Canadian healthcares system. The following assignment aims to conduct
community-based health assessment o the South Asian immigrants residing in Toronto,
Canada. The health promotion will be done based on the health assessment data. Designing of
the health assessment will help in successful implementation of the public health promotion
plan and thereby helping to decrease the health-related inequalities.
Diagnosis of the target population
Issue
Diabetes is a chronic lifestyle disease and it is one of the major reasons behind
increased rate of mortality and morbidity world-wide. It is characterised by the elevated
blood glucose level that cast a serious damage to the blood vessels followed by renal
impairment, double vision and formation of deep vein thrombosis (World Health
Organisation or WHO, 2019). The most common type of diabetes prevalent among the adults
is Type 2 Diabetes Mellitus (T2DM) where as type 1 diabetes mellitus is common among the
young adults or children and thus known as juvenile diabetes. During the past few decades,
the rate of occurrence of the T2DM has increased dramatically throughout the world.

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COMMUNITY HEALTH NURSING
Approximately 422 million people scattered around the globe have T2DM. The person who
hails from the poor socio-economic determinants of health (SDH) is more vulnerable to the
disease development in comparison to the people who are from the higher SDH (WHO,
2019).
Focus
Diabetes Canada (2020) statistics highlighted that the main victims of the diabetes are
the immigrants of Canada and T2DM is more common in comparison to the type 1 diabetes.
The main victims behind the development of T2DM among the immigrants of Canada are of
South Asian immigrants they carbohydrate rich food habits and tendency of alcohol
intoxication increase their vulnerability to develop this metabolic disorder, T2DM (Diabetes
Canada, 2020). According to the Canadian Census published in the year 2006, approximately
1.26 million people from southern part of Asian migrated to Toronto, Canada. The South
Asian immigrants make 4.0% of the total population of Toronto, the provincial capital of
Ontario and one of the most populous city in Canada (Banerjee & Shah, 2018). The South
Asian immigrants are regarded as the one of the largest yet visible minority groups residing
in Canada (Statistics Canada, 2006). This South Asian population residing in Toronto,
Canada is considered as immigrants as nearly 68% of this population are born either in India,
Nepal, Sri Lanka, Pakistan and Bangladesh. The India population who majorly infiltrates in
Canada include people from Bengal, Gujarat, Tamil Nadu and Kerala (Tenkorang, 2017).
They mainly move to Canada for the search of better occupation or for business investments
(Banerjee & Shah, 2018).
Casual factors
The people who move from the South Asian parts of the country are mainly
predispose to several lifestyle diseases like diabetes, cardio-vascular disease, obesity and
hypertension and the severity of the disease increase upon their migration to the new country.

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COMMUNITY HEALTH NURSING
One of the prime lifestyle disease experienced by this group of immigrants in Canada is Type
2 Diabetes (T2DM) (Tenkorang, 2017).
Thus, conduction of the community-based health assessment among the South Asian
immigrants will help to understand the reason behind their high risk of T2DM development
and at the same time, this community based health assessment data will help in designing of
the public health promotion policies and thereby reducing the overall health-related
inequalities.
Casual factors
Diabetes Canada (2020) highlighted that the immigrants are healthier in comparison
to the natives of Canada during the initial stage of the immigration. However, racial
discrimination experienced by the immigrants of Canada along with the poor socio-economic
determinants of health under which they resides pre-disposed them to develop lifestyle
disease, T2DM. Banerjee and Shah (2018) stated that first generation South Asian
immigrants are vulnerable to T2DM. There is also a striking difference in the prevalence of
diabetes among the immigrants from the different countries of Asian. Poor dietary patterns
along with poor psycho-social health are responsible for the high prevalence of T2DM among
the South Asian immigrants (Kandola, Sandhu & Tang, 2016; Tang et al., 2018). Raising
proper awareness in the heterogeneity will help in recognising priorities for delivering
primary care that are specific for the South Asian immigrants with a diverse range of
settlement needs that also encompass the SDH.
Diagnosis
Vollman, Anderson and McFarlane (2007) highlight the process of extracting the
community-based diagnosis in detail. According to the authors the first step towards the
community-health diagnosis include classification of the collected inferences followed by

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identification of the inferences that help in explaining the derivation or continuation of the
problem and this will be followed by the community-based assessment and other available
strength in order to address the issues. The last step includes documentation of the data in
support of the inferences. Following this outline, the diagnosis of the health promotion
includes: Risk of developing T2DM among the South Asian immigrants who are residing in
Toronto Canada. Diagnosis will be undertaken in the domain of poor SDH and the
vulnerability of diabetes development.
Health Promotion Program
Community-based health program are based on the community-related diagnosis and
also contain specific goals, objectives and other interventions in order to achieve the desired
population health-related outcomes (Vollman, Anderson & McFarlane, 2007). The theory of
change is the foundational concept that provides an understanding of the pathways in order to
bring the change (Eldredge et al., 2016). Developing and abiding by the logic change model
during the process of creating the health-promotion program will be understand the
expectations from the health promotion program and the common understanding underlying
the program. Detail illustration of the logic change model is highlighted in the appendix
below.
Goal
The goal for this theory of change is to reduce in the rate of development of T2DM
among the South Asian immigrants and thereby helping to reduce the health-related
inequalities. Selection of clear goals helps to clearly illustrated the aim of the planned
promotional activities (Eldredge et al., 2016). The goal of a logic model is further defined by
Eldredge et al. (2016) as the as a set of goals that helps in achieving long-term health-related
outcomes.

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COMMUNITY HEALTH NURSING
In order to meet the goals, the principal human resources will include public
healthcare professionals and community-health nurses along with culturally competent
nurses. In the appendix section a detailed illustration of the community-partners is given.
Objectives of the health promotion plan
1. To increase the level of healthcare access for early screening of diabetes
2. Decrease in the level of substance abuse from the male members of the society
3. Promotion of the health-related awareness in the domain of diabetes development
Objectives for generated in a step wise manner in order to identify the hw the goals
will be met. The objectives are listed two parts in the appendix section under the column
“activities” and “outputs”. The objectives (activities) for this health promotion plan are
designed in SMART pattern (specific, measurable, achievable, realistic and time frame).
Planning partnership
Once the community has been spotted and proper planning of the partnership is
becomes other crucial aspect in order to achieve the goal. The goals of the community-health
nursing professionals might not be same as the goal that is being prioritized by the
community. Vollman, Anderson and McFarlane (2017) stated that it is crucial to validate the
community level diagnosis with the residents and the leaderships of the community members.
There are five different approaches in order to plan the partnerships. The overall success of
the health-promotion program will depend on creation of the interventions that provides
proper options for the re-inforcement of education along with proper access to care (Vollman,
Anderson & McFarlane, 2017). Brindis (2016) stated that “there is a growing need to
recognize the overall importance of the multi-dimensional array of synergistic approaches

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towards handling high rate of occurrence of T2DM among the South Asian immigrants in
Toronto, Canada while engaging the stakeholders across the communities in order to come
this health-related in-equalities.
Social Planning
Application of social planning approach in this community based health promotion
model will benefit the overall outcome through looking at the overall assessed needs at the
social level and thereby helping to recover from the poor socio-economic determinants of
health (Vollman, Anderson & McFarlane, 2017). Community-based assessment helps to
deliver the baseline information about the health-related status of the residents of the
community. It also helps to identify the opportunities for effective prevention of the disease
(in this case it would be diabetes prevention) along with providing comprehensive health-
related protection. According to Vollman, Anderson and McFarlane (2017), stated that
strengths of using social planning approach are: (i) local sharing of data occurs with the
health promotion partners before the implementation of the health promotion project and this
helps to make further changes in the plan if required. (2) Roles of the partners are also
defined and this helps in proper resource allocation. (3) Separate teams are developed for the
implementation of the plan and this helps in proper utilization of resources (4) strong
partnerships are addressed and are challenges are overcome (5) Education sessions for the
health-promotion staff provided by the Public Health Nurses helps to develop confidence and
capacity for community-based health promotion and health education program. Health
awareness and health education program are part of the mandatory health curriculum of this
health promotion project (Vollman, Anderson & McFarlane, 2017). One of the limitation of
this approach is social planning provide importance to family based participation. However,
family-based participation increase the overall cost of the health-promotion planning and

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COMMUNITY HEALTH NURSING
implementation. Moreover, social planning for health-promotion requires detail survey of
SDH and this requires a significant amount of time (Gauster et al., 2015).
Service extension
Service extension will deal with implementation of the health-promotion plan at the
Toronto based South Asian immigrants followed by extension of the implementation of the
health-promotion plan to the other immigrants in Toronto who are suffering from diabetes
related health-inequalities (Vollman et al., 2017). The strength of this approach is extension
of the service to the other groups of population help in comprehensive health and well-being
development. Other advantage include expert teaching ad this helps in improving health-
related awareness. However, service extension is also related to certain limitations. The first
limitation include requirement of large human resource for the implementation of the
extension and this further increase the overall cost of implementation. Under service
extension there is lack of community involvement and this limits the overall outcome and
development of person-centred care plan (Gauster et al., 2015).
Community Health Nurse Role
The role of the community health nurse (CHN) will be work as a health promotion
staffs, advocate the immigrants in the domain of health-related awareness, decrease in the
level of gender inequality and increasing the overall health-care access. The role of CHN will
also entails partnership with the other stakeholders of the community-based health promotion
and implementation plan and this helping to increase the provision for the collaborative
approach.. Here partnership will be done with the mental health nurses in order to overcome
the tendency of substance abuse among the male members of South Asian immigrants and
thus educing the chances of developing T2DM. During the service extension approach, the
role of the CHN will deal with proper allocation of the work to the subordinate nurses and

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COMMUNITY HEALTH NURSING
this will include proper resource allocation. CHN will also deal with designing of the health-
education plan based on the language and other health needs of the target population. The
medium of the health education plan will also be selected by the CHN depending of the
overall budget of the program (Kaakinen et al. 2015).
Conclusion
Thus from the above discussion, it can be stated that the main goals of this health
promotion plan will include promotion of health related awareness by community-based
education, mental health counselling in order to reduce the level of substance abuse among
the men and working in active collaboration with the government bodies in order to raise
funds for the South Asian immigrants in order to increase their daily wages and at the same
time increase their scope of employment. The main health promotion model that will be used
include social planning and service extension in order to promote comprehensive
implementation for recovery from diabetes.

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References.
Banerjee, A. T., & Shah, B. R. (2018). Differences in prevalence of diabetes among
immigrants to Canada from South Asian countries. Diabetic Medicine, 35(7), 937-
943.
Brindis, C. D. (2016). Advancing the Field of Teenage Pregnancy Prevention Through
Diabetes Canada. (2020). Introduction. Access date: 7th April 2020. Retrieved from:
https://www.diabetes.ca/health-care-providers/clinical-practice-guidelines/chapter-1
Eldredge, L. K. B., Markham, C. M., Ruiter, R. A., Fernández, M. E., Kok, G., & Parcel, G.
S. (2016). Planning health promotion programs: an intervention mapping approach.
John Wiley & Sons.
Government of Canada. (2019). Social Determinants of Health.. Access date: 5th April 2020.
Retrieved from: https://cbpp-pcpe.phac-aspc.gc.ca/public-health-topics/social-
determinants-of-health/
Kaakinen, J.R., Coehlo, D.P., Steele, R., & Robinson, M. (2018). Family Health Care
Nursing. Philadelphia, USA: E.A. Davis Company.
Kandola, K., Sandhu, S., & Tang, T. (2016). Immigration and dietary patterns in South Asian
Canadians at risk for diabetes. Journal of Diabetes and its Complications, 30(8),
1462-1466.
Statistics Cananda. (2019). Literacy skills among Canada's immigrant population. Access
date: 5th April 2020. Retrieved
from:https://www150.statcan.gc.ca/n1/pub/81-004-x/2005005/9112-eng.htm

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Tang, T., Halani, K., Sohal, P., Bains, P., & Khan, N. (2018). Do Cultural and Psychosocial
Factors Contribute to Diabetes Risk? A Look into Canada's South Asian
Community. A Look into Canada's South Asian Community (July 22, 2018).
Tenkorang, E.Y., 2017. Early onset of type 2 diabetes among visible minority and immigrant
populations in Canada. Ethnicity & health, 22(3), pp.266-284.
Vollman, A. R., Anderson, E. T., & McFarlane, J. M. (2017). Canadian community as
partner: Theory & multidisciplinary practice. Lippincott Williams & Wilkins.
World Health Organisation. (WHO). (2019). Diabetes. Access date: 6th April 2020. Retrieved
from: https://www.who.int/health-topics/diabetes#tab=tab_1

Running head: COMMUNITY HEALTH NURSING
GOAL: DECREASE IN THE HEALTH-RELATED INEQUALITY OF DIABETES DEVELOPMENT AMONG THE SOUTH ASIAN IMMIGRANTS OF
TORONTO, CANADA
Situation
The risk of
developing T2DM
among the target
population is higher
due to poor income,
lack of proper
healthcare access and
gender
discrimination. Other
factors include poor
SDH, poor dietary
habits and poor
psycho-social health
make the South Asian
immigrants high risk
towards developing
T2DM in comparison
to Canadian natives
Inputs
Funding
Community
Health Nurses
Community-
Based health
Camps
Canadian
Government
Statics
Activities
Education of the
South Asian
immigrants about the
progression of
diabetes mellitus and
thus increasing health
awareness
Reducing alcohol
abuse among the
male members of
immigrants by
mental health
counseling
Fund raising under
active government
support in order t
increase the daily
wages of the South
Asian immigrants
and thus increasing
the healthcare
access
Audience
The adult male
and female of
the South Asian
immigrants in
Toronto, Canada
Outcomes
Increase in the
level of the
health related
awareness
Decrease in the
level of alcohol
abuse and
gender
inequality and
thus reducing
high diabetes
rates among the
men
Increase in the
level of
financial wages
and thus
increasing
healthcare
access
Outputs
Presence of
Mental
health nurses
for mental
health
counseling
Increase
hours in the
community-
based health
education