Project Plan: Diabetes Healthcare in Community Settings

This project plan focuses on addressing the healthcare issue of Type 2 Diabetes Mellitus (T2DM) among the indigenous population in community dwelling settings, emphasizing the significant health inequalities faced by this group. The project highlights the disproportionately high prevalence of diabetes, associated complications, and mortality rates within the Aboriginal and Torres Strait Islander (ATSI) population, underscoring the need for a health priority. It explores the rationale behind addressing this issue, emphasizing the role of community nurses in delivering T2DM self-management education. The plan includes a comprehensive literature review examining factors contributing to health inequalities, such as poor socio-economic status, social isolation, lack of healthcare access, and mental health issues. The project proposes specific goals and plans, including community-level health awareness programs and education on self-management skills, to improve health outcomes and reduce the overall disease burden. Learning objectives include understanding the factors leading to health-related inequalities, preventing disease outbreaks, and studying the role of healthcare professionals and government in addressing these inequalities.

Running head: PROJECT PLAN
PROJECT PLAN
Name of the Student
Name of the University
Author Note

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Topic: Diabetes among the indigenous population among the community dwelling settings
Introduction
Health-issues and the associated health-inequalities have their roots deep inside the
structure of the society and the same is been reflected in the life chances of the people of
different social classes, ethnic/racial backgrounds and other aspects of the social stratification
(Sampson et al., 2016). The following assignment is based on developing a plan and proposal
for the decision-making and other problem solving in relation to one selected healthcare
issue. The development of the proposal for the health-care issues will further help in
improving the health-related quality of life of the population and at the same time helps to
reduce disease burden and the cost of disease management. The main health-related problem
or health care issue will be Type 2 Diabetes Mellitus, a lifestyle disease that are popular
among the older adults. The conduction of this project will help to increase the overall
contribution and effectiveness of the public health towards reducing the unfair and
inequitable difference in health among the population group. A health project will help to
provide a detailed understanding and insights about the importance of the proper
implementation of the changes in the public health. Here the special focus will be given over
the health-related inequalities among the community dwelling adults.
Healthcare issue selected
Type 2 diabetes mellitus (T2DM) is a metabolic disease that is characterised by high
level of blood glucose (hyperglycemia). In T2DM, the glucose cells becomes unresponsive
towards insulin and thus preventing the re-uptake of glucose into the hepatic cells. Unhealthy
lifestyle conditions lead to the development of the disease and thus T2DM falls under the
category of lifestyle disease (Diabetes Australia, 2020).

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Why it is a healthcare priority
T2DM affects the growing international population and thus casting significant
economic and social loss. Diabetes, either undiagnosed or diagnosed is regarded as one of the
prime independent risk factors for the development of cardio-vascular disease, renal
complications, blindness and amputation. Indigenous Australians are 4 more times vulnerable
to develop T2DM and have high mortality and morbidity rate in comparison to the non-
indigenous population. T2DM is regarded as 12th largest contributors to Australia’s disease
burden during 2015 leading to 2.2% of the total disease burden. At least 11% of the
Aboriginals and Torres Strait Islander (ATSI) population (indigenous population) suffer from
diabetes (Australian Institute of Health and Welfare. (AIHW), 2019). Paul et al. (2017) stated
that screening of undetected T2DM along with effective management, is an effective
approach to prevent its complications and this opportunity is particularly important among
the high risk population (ATSI). Titmuss et al. (2019) further highlighted that metabolic
disease like T2DM and cardio-vascular disease are responsible for the gap in life-expectancy
among the indigenous and non-indigenous population. The associated high rates of
hospitalization and mortality rate and indicate health-inequality. During 2013, the rate of
hospitalization arising out of T2DM and cardio-vascular disease were 1.6 to 2.5 times higher
among the ATSI population and this percentage is dependent on age. ATSI adults are six
times likely to die from T2DM in comparison to the non-indigenous population. Indigenous
adolescents with T2DM are 10-times more likely to get hospitalised in comparison to the
non-indigenous population. The rate of hospitalizations is however, regarded as a poor
indicator for the prevalence of diabetes-related complications prevailing within the
community (Kenyon, 2013). Nevertheless, the burden of the diabetes development and rate of
diagnosis of the diabetes among the ATSI population is higher in comparison to the non-

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indigenous population and thus clearly indicating the requirement for health priority (Pauly et
al., 2013).
Rationale behind addressing this priority
According Diabetes Australia, improving the lives of the ATSI population residing in
communities is the prime health-care priority as this will help to reduce the overall disease
burden and health inequality (Kenyon, 2013). Kenyon (2013) stated that reduction in the rate
of occurrence of T2DM at disproportionate rate among the indigenous population will help to
reduce the overall disease burden over the ATSI population. Reduction in the disease burden
over the ATSI population will help to improve the overall socio-economic status of the ATSI
population and thus helping to reduce the socio-economic health-inequality and health-related
inequality. The public health leaders have long identified the importance of improving the
health-related quality of life of the population at large, with a special focus over the
indigenous population. In future, the improvements in health of the population will be
achieved through promoting health-related equity by taking action on the social determinants
of health (Sampson et al., 2016).
The specialty area of nursing practice
The main specialty area of the nursing practice that will be focused in this paper is
community nurses. Egbujie et al. (2018) stated that I Australia the number of reported cases
of T2DM is increasing and this is in accordance with the global scenario. In Australia, the
conditions are more severe among the indigenous population. In association with the
escalating number of the diabetic population, there is also an escalating need for the
community health nurses. Community health nurses mainly help to deliver the T2DM self-
management education and thus helping to improve the overall clinical outcome. The main
self-management skills promoted by the community health nurses include structured

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education, health-related awareness and therapy adherence. The community health nurses
also help in promoting advocacy to the patient in order to participate in the decision-making
skills. Preparing and coordination the community healthcare nursing professionals for the
effective management of the community dwelling diabetes mellitus among the indigenous
population will require further research on role strengthening (Egbujie et al., 2018).
Literature Review
Poor socio-economic status and diabetes development
Mutyambizi et al. (2019) stated that the inequalities in diabetes are widely prevalent
among the ATSI population and other population that resides under the poor socio-economic
group. Mutyambizi et al. (2019) conduced a cross-sectional study in order to examine the
underlying reasons behind the health-related inequalities among the ATSI population. The
analysis of the self-reported data showed that the level of occurrence of diabetes is higher
among the people who reside among the poor socio-economic. ATSI population resides
under the poor socio-economic group and thus increasing their vulnerability. The report also
showed that the extent of the inequality is worse over the total diabetic outcome in
comparison to the self-reported diabetes outcome. In comparison to the other determinants of
health, the overall contribution of the lifestyle factors was found to be modest and these
contributions are important for the development of the policy planning and at the same time
addressing the socio-economic inequalities. The cross-sectional study conducted by Moody
et al. (2016) over the population of England showed that the people from the lower ethnic
group are victims of the hyperglycemia and other anthropometric risk factors for the diabetes
development. Lack of proper healthcare awareness and information about the disease
prognosis, further increases the tendency of developing hyperglycemia. The longitudinal
study conducted over the population of Demark also indicated the role of the poor socio-

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economic determinants of health behind the development of Type 2 Diabetes Mellitus. Sortsø
et al. (2017) highlighted some of the poor socio-economic determinants of health associated
with the development of the diabetes mellitus. This includes lack of proper employment, lack
of proper education and financial setup, lack of proper social support and sanitation along
with substance abuse.
Other factors associated to diabetes development
The other factor that leads to the development of diabetes and subsequent health-
related inequality among the ATSI population is social isolation (Steve et al., 2016). de Wit et
al. (2020) stated that ATSI population are victims of social discrimination, and racism even in
their professional field. Lack of proper employment gives rise to financial crisis and
hampering the comprehensive health-care access. The lack of health-care access, leads to the
development of undiagnosed cases of T2DM. This in turn increases the health-related
inequality and severity of the disease. Taylor et al. (2017) stated that there is a significant
association of diabetes with the mental health (depression) leading to poor health-related
outcome and increase in the level of mortality. Interview conducted over 73 men and 115
ATSI women showed that people residing in the remote areas are more likely to suffer from
high level of depression and thus increasing the vulnerability of the disease development. The
severity of depression is not however related to the glycaemic control. Increase in the level of
expression and other physical activity helped to reduce the depression score and thus
indicating an opportunity for successful health promotion. Le Grande et al. (2019) conducted
a systematic review and meta-analysis that highlighted that in comparison to the non-
indigenous people, indigenous population suffer from poor mental health condition and lack
proper employment increase psychological distress and depression. This increases the rate of
diabetes development and cardio-vascular disease. Xu et al. (2019) showed that the health-
related behaviours of the indigenous population residing in the remote areas are poor. There

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are women who consume alcohol, high risk drinkers, likely dependent drinkers along with
lack of proper physical activity. This poor lifestyle habits increase the risk of developing
diabetes among indigenous population in comparison to the non-indigenous population.
Lack of healthcare access in remote areas
The semi-structured interview conducted over the 31 service providers showed that
the healthcare access in the rural and in the remote areas of Australia is poor. This lack of
health-care access increases the chances of un-reported or undiagnosed cases of diabetes
among the indigenous population leading to the health-inequality (Reifels et al., 2018). Ralph
et al. (2017) study showed that low uptake of the aboriginal interpreters under the healthcare
setup decrease the healthcare access among the aboriginals as they are from the culturally and
linguistically diverse (CLAD) population. The lack of the properly trained aboriginal
healthcare nursing professionals further decrease the level of the uptake of the healthcare
service and increasing the health-inequality.
Learning objectives
Thus from the above analysis of the review of literature, it can be stated that the main
barriers towards increase in the health-inequality among the indigenous population in
Australia toward the development of the T2DM is poor social determinants of health along
with poor psychological state of mind and lack of aboriginal healthcare workers. Lack of
proper healthcare access in the rural and the remote areas of Australia is another reason
behind the high rate of diabetes occurrence and health-inequality. Thus in order to reduce this
T2DM related health inequality among the ATSI at the community level healthcare setting, it
is important to increase to undertake the below mentioned learning objective.
 Focus on the factors leading to the development of health-related inequality

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 To describe the factors that can help to prevent this health-inequality and gamut
disease outbreak among ATSI population
 To study the role of the healthcare professionals to overcome this health-inequality
 To understand the role of the government in order to prevent the health-related
inequality
Proposed Goals and plans of the project
Goals of the project Projected Plan to Achieve the goal Intended outcome
To improve the health-
related awareness in
the domain of the
prognosis and
effective management
of diabetes mellitus
this goes in accordance
with the priority areas
highlighted by the
Australian National
Diabetes Strategy
2016-2020
1. Setting-up community level health-
awareness program under the presence of
the community level health-care nursing
professionals. Under the health-care
awareness program, the main resources
apart from the nursing professionals will
include colourful posters and power-point
presentations as a tool for promoting
health-care education.
2. Education from the nursing professionals
about self-management skills of diabetes
Note: The community based health
education program for the promotion of the
diabetes awareness must be done under the
presence of both community-based nursing
professionals and aboriginal yet culturally
competent nurses in order to increase the
level of participation in the healthcare
educational programme. Moreover, in order
Increase in the level of health-
awareness and increase in the
level of health-care access
2. Powers et al. (2017) have
stated that educating the
population about the self-
management skills of diabetes
help to increase the disease
awareness and the same time
ensuring timely screening of
the disease

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to increase the level of participation among
the ATSI people in the health-awareness
and health education program it is
important to channelize the daily incentive
structures. Clough et al. (2018) stated that
since the ATSI population mainly resides
under poor socio-economic status, it is wise
to circulate daily financial incentives and
this will help to retain a constant footfall at
the community-level health-awareness
campaign.
Increasing the level
health care service
access among the
ATSI population along
with screening for type
2 DM
Increasing the level of Aboriginal
healthcare workers and other allied
healthcare staffs in the community based
healthcare and screening settings in order
to increase the level of healthcare access.
This would however, take time as the
recruitment of the trained yet aboriginal
healthcare worker needs proper funding
along with interventions coming from the
Nursing and the Midwifery Board of
Australia.
Improving the overall level of the rural
healthcare set-up for the proper screening
of the diabetes. Here the main resources
include glucometer for the detection of the
blood glucose level and weight machine for
Ralph et al. (2017) stated that
the presence of the aboriginal
healthcare worker helps to
overcome the language
barrier and thus helping to
increase the healthcare access.
Increase in the healthcare
access will help in the early
detection of the disease and
thus helping to reduce the
negative health outcomes.

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ascertaining height and weight and
calculate the BMI
Promotion of
comprehensive health
and well-being
1. Improvement in the mental health status
of the ATSI population by increasing their
social participations like community-based
health-care activities
2. Decrease in the level of substance abuse
among the ATSI population by conducting
mental health counselling under the
presence of the community level mental
health nurses
() stated that the improvement
in the mental health status
helps to reduce the substance
abuse and the level of
depression and thereby
improving the overall health
and reduction in diabetes.
According to the Closing the
Policy improvement in the
mental health helps to reduce
the vulnerability of diabetes
development
Evaluation of the outcomes
At the end, I would like to highlight that the overall evaluation of the outcome will be
a lengthy yet time consuming process. However, in order to ascertain the decrease in the level
of the diabetes occurrence, the epidemiological data for the concerned community will be
take post three months of the implementation of the goals outlined in the project followed by
the comparison of the same with the previous data.
Conclusion
Thus from the above discussion, it can be conclude that the health-related in-equality
in the domain of the diabetes development among the ATSI population is attributed to poor
SDH or poor socio-economic status. Proper health-awareness program at the community

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level might help to improve the overall scenario. At the end, it can further be stated that the
local health, health awareness services, health councils and other supporting bodies must
work under active collaboration in order to promote sustainable reduction in the diabetes
development by improving the social determinants of health and improving the lifestyle
habits.

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References
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25th March 2020. Retrieved from: https://www.aihw.gov.au/reports-data/health-
conditions-disability-deaths/diabetes/overview
Clough, A. R., Grant, K., Robertson, J., Wrigley, M., Nichols, N., & Fitzgibbon, T. (2018).
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