Health Promotion and Community Health Program for Type 2 Diabetes

This report analyzes community-based interactions in diabetes health programs, focusing on health promotion and disease prevention. It begins by defining health promotion and wellness, then explores Type 2 diabetes (T2D), including its causes, symptoms, and global prevalence, emphasizing its preventability and impact. The report then examines strategies for community engagement, including needs assessment, empowerment, and community participation, using Laverack's ladder as a guide. Capacity building is discussed, emphasizing individual and community-level interventions, such as trust development, skill enhancement, and communication. The report also highlights the importance of a 'sense of community', effective communication, and an assets-based approach. Finally, it explores health promotion models, focusing on educational approaches to patient education and lifestyle modification, highlighting the role of information dissemination and informed decision-making. The report underscores the significance of partnership across healthcare sectors for effective T2D management.

Running head: HEALTH PROMOTION
Community health and disease prevention
Name of the Student
Name of the University
Author Note

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Introduction- According to the World Health Organisation (2019) health promotion is
an umbrella term that refers to the procedure of assisting individuals to gain complete control
over their health with the aim of improving it. In addition, the concept of health promotion
moves beyond the emphasis of behaviour or an individual towards a plethora of
environmental and social interventions. Thus, the primary objective of disease prevention and
health promotion programs is to focus on maintaining optimal health and wellbeing for all
people. In other words, health promotion programs aim to empower and engage individuals
and the wider community to make alterations and adopt healthy behaviour, which lowers
their risk of being affected by chronic disorders, and associated comorbidities (Ammendolia
et al., 2016). The concept of wellness is intricately related to disease prevention and health
promotion. Wellness is generally described as active decisions and attitudes that are made by
a person, which directly contribute to positive health outcomes. This assignment will analyse
diverse stages of community based interactions, in relation to diabetes health programs and
will also elaborate on the association between empowerment and capacity building.
Part 1- Type 2 diabetes (T2D), also referred to as adult onset diabetes refers to a
metabolic condition that is commonly characterised by an increase in blood sugar levels,
insulin resistance, and absence of insulin hormone. Some common signs and symptoms of the
condition include frequent urination, unexplained loss in body weight, and increased thirst.
The symptoms also comprise of feelings of tiredness, ulcers, and increase in appetite. The
disease generally occurs among individuals who fail to respond in an appropriate manner to
insulin hormone secretion, and with a progress in disease, there develops a deficiency of
insulin hormone (Mayer-Davis et al., 2017). Furthermore, the condition occurs due to a
combination of genetic and lifestyle factors. While some of the aforementioned factors are
controlled by an individual such as, obesity and diet, other factors like genetics, female
gender, and increase in age. T2D has been identified as a preventable health concern owing to

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the fact that when left untreated, the condition increases the risk of suffering from diabetic
retinopathy, stroke, cardiovascular complications, renal failure, diabetic foot ulcer, and even
death (Hu et al., 2015). The condition is a global health problem since the number of people
suffering from T2D has increased to 422 million from 108 million (1980-2014). Moreover,
global prevalence of T2D among adults has also demonstrated an increase from 4.7-8.5%
(1980-2014), with the increase occurring at a rapid rate in low and middle income countries.
The condition has also been found responsible for 1.6 million deaths in the year 2016, with
2.2 million death occurring due to an increase in 2012 (WHO, 2019).
Laverack defined health promotion has the procedure that permits relatively
powerless individuals to work in collaboration, with the aim of determining their health and
lives. In addition, empowerment of community health occurs when the communities and
individuals gain power over their health and wellbeing (Laverack, 2007). Time and again it
has been established that practitioners must think beyond the habitual view of a society as a
location where individuals reside. Hence, with the aim of implementing health promotion
strategies, the three strategies that will be used are namely, (i) needs assessment, (ii)
empowerment, and (iii) community participation. Needs assessment encompasses the
recognition of the demands, health needs, and preferences of the people suffering from a
particular health problem. Needs assessment generally encompasses a systematic procedure
that will help in identifying the gaps in the existing situation and will also facilitate
determination of discrepancies between the prevailing health condition, and the anticipated
health outcomes (Den Broeder et al., 2017). Furthermore, needs assessment will also act as an
effective method for clarification of health problems, and facilitate identification of the health
problem, direction of finite health dustbin, and recognition of interventions for targeting
diabetes.

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According to Tengland (2016) community empowerment comprises of the procedure
of re-negotiating power, with the aim of gaining control over health status. Furthermore, this
strategy will be able to address the cultural, social, economic, and political determinants that
underpin health outcomes of the community residents. Presence of power typically refers to
unequal associations amid individuals and the capability of some people to exert a control
over others. Thus, health empowerment will form an essential aspect of community diabetes
management since it will help in the development of capacities, tools, and opportunities that
benefit the T2D affected people, while ensuring that the health resources are accessible to all.
The third strategy of community participation in health decision-making and consultation will
focus on providing objective and balanced information to the public suffering from T2D in
order to help them understand the health problem (Fertman & Allensworth, 2016). The
strategy will also comprise of obtaining public feedback with working directly with them, and
fostering partnership in order to implement interventions for lowering the risk of T2D in the
community.
Part 2- Capacity building refers to the procedure that allows an individual to improve,
access, and retain knowledge, resources, and skills that are necessary for improved health
outcomes. In other words, it is an umbrella term that refers to workforce development and
takes into consideration the existing capabilities of people, organisations, and communities
for increasing decision making, involvement, and ownership of different issues (Palermo et
al., 2019). While talking about T2D health promotion, the concept of capacity building will
be based on the fact that healthcare strategies can be more sustainable and effective if efforts
taken by the healthcare professionals extend beyond the out-dated boundaries of health sector
(Artiga & Hinton, 2018). Furthermore, the domain of capacity building will incorporate
concepts of partnership and advocacy, which in turn are imperative for increasing awareness
of patients on the metabolic syndrome that they are suffering from (Marcus-Varwijk et al.,

4HEALTH PROMOTION
2019). Capacity building for T2D health promotion will typically begin from individual level,
followed by its dissemination across the community level.
Taking into consideration the fact that the skill potential and knowledge of a person
plays an important role in bringing about change, activities that enhance capacity building
would comprise of trust development about health interventions, diabetes self-management
skill enhancement techniques, and health communication among the community members.
Furthermore, it will also be taken into consideration that the diabetes affected groups in the
community might not have necessary infrastructure (Super et al., 2015). Hence, their
powerful collaboration will prove imperative in increasing their awareness on diabetes
management. This step would require healthcare professionals display necessary leadership
skills for helping the affected people understand the underlying factors that are responsible
for the onset and progress of T2D. Furthermore, capacity building will also focus on
identification of the competencies of healthcare professionals, which in turn will provide
them assistance in developing diabetes management programs, and will also strengthen their
capacity for providing training to the community members on different lifestyle
modifications that they need to show adherence to, for lowering their blood glucose levels
(Vaidya, 2018). Furthermore, the core domains of capacity building that will be employed for
health promotion are namely, “sense of community”, “communication”, and “assets-based
approach”.
The domain of sense of community would focus on the fact that all people affected
with diabetes in the community will realise a sense of belonging, and the basic feeling that
they are related to one another, and their healthcare needs can be easily addressed by
displaying a commitment towards enhancement of health. Sense of community is imperative
to positive health outcomes owing to the fact that it encompasses five basic attributes of
namely, emotional safety, personal investment, boundaries, and common symbol system, all

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of which will allow T2D affected individuals to development an enthusiasm for participating
in health promotion activities (Liberato et al., 2011). The domain of communication will also
enable concerned health professionals to disseminate essential diabetes related information,
diabetes management advice, and guidance to the affected people in an effective manner. In
addition, strategic communication will also ensure easy accomplishment of strategic health
promotion goals, which most often necessitate intentional and deliberate action. In contrast,
use of assets-based approach for diabetes health promotion will form an essential component
of community health development since it will facilitate all people affected with the
metabolic condition to collaborate and accomplish positive changes in their own health
literacy, awareness, lived experiences and skills for diabetes management (Betsch et al.,
2016). Furthermore, it will also enable identification of protective factors that will support an
enhanced wellbeing of the community residents (Roy, 2017).
The capacity building strategy used by Lee et al. (2014) was Health Promoting
Hospitals (HPH) initiative. This initiative had been formulated and enforced during the 90s,
with the aim of expanding and developing health services on a global scale, which in turn
would help in enhanced promotion of population health. The major dimensions of this
initiative that were taken into consideration by the authors for capacity building were namely,
leadership, mission and strategy, management practice external environments, system,
structure, organization culture, and staff participation. It was found that HPH initiative
created a positive impact on the hospital, with an increase in leadership assistance, fine-
tuning of mission, adherence to physical activities, improved management, increased staff
participation, and development of a supportive structure. However, several barriers were
encountered by the hospital, during the implementation of transactional leadership, when
compared to transformational leadership.

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Part 3- Time and again it has been found that if T2D is poorly controlled, the
condition results in heart attack, stroke, amputation, or renal failure. There is compelling
evidence for the fact that the prevalence rate of T2D is increasing at an alarming rate on a
worldwide basis. In addition, it has also been found from clinical trials that patient education
on lifestyle modification and self-monitoring can minimise the risks of suffering from T2D,
thereby reducing the rates of mortality and morbidity (Chen et al., 2015). Health promotion
strategies and models for effective management of T2D might comprise of one or a plethora
of programs that are able to specifically target dietary and health education, psychological
support and self-management, Furthermore, the primary objective of health promotion would
be to increase partnership across different healthcare sectors. Taking into consideration the
fact that patient education encompasses the process by which responsible healthcare
professionals impart necessary evidence to patients and their family members in a manner
that is able to improve their health status and alter their health behaviour, the educational
approach of health promotion will prove most effective for addressing this health concern.
The primary objective of the educational purpose is to provide necessary information
and knowledge, which in turn is concomitant with development of necessary expertise and
skills such that the affected people are able to make informed decisions about their health and
lifestyle behaviour. Implementation of the educational approach is different from the
behaviour change approach in that the former does not intend to motivate or persuade change
in a definite direction. In contrast, the education approach is intended to bring about a
positive health outcome, which in turn will be based on the voluntary choice of the diabetes
patients. The educational approach will be based on providing information to the diabetes
affected people through the dissemination of booklets, leaflets, one-to-one advice, and visual
displays. The basic advantage of educational approach is that it enables individuals for
making informed decisions about diabetes related health behaviour by providing them

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adequate information, which will allow the patients to develop necessary behaviour
modifications for reducing their blood glucose levels (Reisi et al., 2016). The educational
approach will help in accomplishment of optimal health outcomes based on the voluntary
choice of the people affected with diabetes, owing to the fact that it will increase their
awareness and familiarity with the procedures of diabetes self-monitoring, dietary changes,
and adherence to physical exercise (Pan et al., 2015). This approach would ensure that the
patients are well-informed about diabetes, its risk factors, treatment, and prognosis. In
addition, the approach also provides the advantage of building trust with the diabetes patients,
which in turn will reduce their anxiety and stress. However, the approach takes into
assumption the fact that voluntary behaviour alteration might face restrictions by economic
and social factors.
Conclusion- To conclude, with the aim of reaching a state of comprehensive mental,
physical, and social well-being, a person or group must be competent to classify and to
comprehend aspirations, and cope with the changing environment. Therefore, health
promotion is generally observed as a major resource for regular life. Diabetes is a global
health concern that increases risk of mortality and morbidity among individuals. Thus, the
education approach will be used for diabetes related health promotion in the community.

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References
Ammendolia, C., Côté, P., Cancelliere, C., Cassidy, J. D., Hartvigsen, J., Boyle, E., ... &
Amick, B. (2016). Healthy and productive workers: using intervention mapping to
design a workplace health promotion and wellness program to improve
presenteeism. BMC Public Health, 16(1), 1190.
Artiga, S., & Hinton, E. (2018). Beyond health care: the role of social determinants in
promoting health and health equity. Health, 20, 1-10.
Betsch, C., Böhm, R., Airhihenbuwa, C. O., Butler, R., Chapman, G. B., Haase, N., ... &
Nurm, Ü. K. (2016). Improving medical decision making and health promotion
through culture-sensitive health communication: an agenda for science and
practice. Medical decision making, 36(7), 811-833.
Chen, L., Pei, J. H., Kuang, J., Chen, H. M., Chen, Z., Li, Z. W., & Yang, H. Z. (2015).
Effect of lifestyle intervention in patients with type 2 diabetes: a meta-
analysis. Metabolism, 64(2), 338-347.
Den Broeder, L., Uiters, E., Ten Have, W., Wagemakers, A., & Schuit, A. J. (2017).
Community participation in Health Impact Assessment. A scoping review of the
literature. Environmental Impact Assessment Review, 66, 33-42.
Fertman, C. I., & Allensworth, D. D. (Eds.). (2016). Health promotion programs: from
theory to practice. John Wiley & Sons.
Hu, H., Sawhney, M., Shi, L., Duan, S., Yu, Y., Wu, Z., ... & Dong, H. (2015). A
systematic review of the direct economic burden of type 2 diabetes in
china. Diabetes Therapy, 6(1), 7-16.
Laverack, G. (2007). Health promotion practice: building empowered communities.
McGraw-Hill Education (UK).

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Lee, C. B., Chen, M. S., Chien, S. H., Pelikan, J. M., Wang, Y. W., & Chu, C. M. Y.
(2014). Strengthening health promotion in hospitals with capacity building: a
Taiwanese case study. Health promotion international, 30(3), 625-636.
Liberato, S. C., Brimblecombe, J., Ritchie, J., Ferguson, M., & Coveney, J. (2011).
Measuring capacity building in communities: a review of the literature. BMC
public health, 11(1), 850.
Marcus-Varwijk, A. E., Madjdian, D. S., de Vet, E., Mensen, M. W., Visscher, T. L.,
Ranchor, A. V., ... & Smits, C. H. (2019). Experiences and views of older people
on their participation in a nurse-led health promotion intervention:“Community
Health Consultation Offices for Seniors”. PloS one, 14(5), e0216494.
Mayer-Davis, E. J., Lawrence, J. M., Dabelea, D., Divers, J., Isom, S., Dolan, L., ... &
Pihoker, C. (2017). Incidence trends of type 1 and type 2 diabetes among youths,
2002–2012. New England Journal of Medicine, 376(15), 1419-1429.
Palermo, C., van Herwerden, L., Maugeri, I., McKenzie-Lewis, F., & Hughes, R. (2019).
Evaluation of health promotion capacity gains in a state-wide rural food literacy
intervention. Australian journal of primary health.
Pan, A., Wang, Y., Talaei, M., Hu, F. B., & Wu, T. (2015). Relation of active, passive,
and quitting smoking with incident type 2 diabetes: a systematic review and meta-
analysis. The lancet Diabetes & endocrinology, 3(12), 958-967.
Reisi, M., Mostafavi, F., Javadzade, H., Mahaki, B., Tavassoli, E., & Sharifirad, G.
(2016). Impact of health literacy, self-efficacy, and outcome expectations on
adherence to self-care behaviors in Iranians with type 2 diabetes. Oman medical
journal, 31(1), 52.

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Roy, M. J. (2017). The assets-based approach: furthering a neoliberal agenda or
rediscovering the old public health? A critical examination of practitioner
discourses. Critical public health, 27(4), 455-464.
Super, S., Wagemakers, M. A. E., Picavet, H. S. J., Verkooijen, K. T., & Koelen, M. A.
(2015). Strengthening sense of coherence: opportunities for theory building in
health promotion. Health promotion international, 31(4), 869-878.
Tengland, P. A. (2016). Behavior change or empowerment: On the ethics of health-
promotion goals. Health Care Analysis, 24(1), 24-46.
Vaidya, A. (2018). Capacity building: A missing piece in Nepal’s plan for prevention and
control of non-communicable diseases. Journal of Kathmandu Medical
College, 7(4), 131-133.
World Health Organization. (2019). Diabetes. Retrieved from https://www.who.int/news-
room/fact-sheets/detail/diabetes
World Health Organization. (2019). Health promotion. Retrieved from
https://www.who.int/healthpromotion/en/