Health Promotion Funding Proposal

Project Summary

In Australia, the health disparities between indigenous (the Aboriginal and Torres Strait Islanders) and the non-indigenous people remain unacceptably wide. Some of the identified health disparities are visible in the prevalence of cardiovascular diseases, diabetes, mental disorders, and chronic respiratory diseases. Focusing on diabetes type two, the health promotion team has proposed to come up with a program, designed to support the existing Australian Diabetes Association in the fight against the disease. Educational programs have evidently been found to effectively help in the prevention and reduction of diabetes in several parts of Australia. Specific to the needs of the ATSI people, the health promotion team proposed two educational programs – knowledge-based and behavior-related tasks in the attempt to effectively launch the fight against diabetes type 2. To support the proposal, the team reviewed the previous literature to assess the success of education, literacy programs, and cultural-oriented approaches in the prevention of diabetes type 2. The proposal also defined the search strategies that were used in the literature review, followed by a detailed review of the literature. The proposal also reviewed the community needs, which was identified as the design and implementation of strategies to fight diabetes. The strengths lie in the fact that, the ATSI still observe their cultural values and introducing culturally aligned education programs can be effective in preventing diabetes. After this, the proposal adopted the five-step PRECEDE model, which provides a simple ecological approach to health promotion. Using the five steps, the proposal was able to identify social assessment and situational analysis, epidemiological assessment, educational and ecological assessment, aims and objectives, intervention alignment, administrative and policy assessment. Through the model, the team also drew up the estimated budget proposal required for the implementation of the program. Lastly, we identified the specific roles of the leader of the health promotion program.

Table of Contents

Diabetes Type 2 Education Program for Aboriginal and Torres Strait Islanders 5

Identification of health issue/project 7

Describe the Processes of Identifying the Health Issue that Needs Addressing in the Project 7

Literature Review 8

Search Strategies 8

Diabetes Education, Literacy Programmes, and Culturally Competent Education 9

Needs and Strengths 10

Project Planning using the Five Stage PRECEDE Model 10

Step 1: Determine the Population Needs through Social Assessment, Participatory Planning, and Situational Analysis 11

Step 2: Identifying the Health Determinants of these Needs 11

Step 3: Analyze the Behaviors and Environmental Determinants of Health Needs 12

Step 4: Identification of Project Aim and Objectives 12

Step 5: Project Budget and Implementation 13

My Role as a Leader in the Health Promotion Team 14

Health Promotion Funding Proposal

Diabetes Type 2 Education Program for Aboriginal and Torres Strait Islanders

The health disparities between indigenous and non-indigenous Australians remain unacceptably wide. According to Pippa, Melanie, and Rebecca (2015), indigenous people in Australia have a shorter life expectancy and worse health outcomes as compared to non-indigenous people. The health gap as Pippa et al. explained, between indigenous and non-indigenous can be explained by statistics on non-communicable disease, with cardiovascular diseases taking the lead at 23 percent, followed by diabetes at 12 percent, mental disorders at 10 percent, and chronic respiratory disease at 9 percent. Focusing on diabetes, the Aboriginal and Torres Strait Islander (ATSI) are almost four times more likely to have diabetes type 2 as compared to non-indigenous Australians. That is not all, as compared to other non-indigenous people; diabetes type 2 begins at an earlier age among the Indigenous people, which means the risk of developing complications from diabetes also starts at an early age. Additionally, the high number of people affected by type 2 diabetes is likely due to high rates of obesity, dietary changes, decreased physical activity, and an aging population. According to reports, diabetes is a lifestyle and its treatment involves lifestyle modification of weight loss, dietary change, and increasing physical activity. Among the Aboriginal and Torres Strait Islander communities successful treatment, management, and prevention of diabetes type 2 disease encompass a wider picture where economic, political, and social factors play a critically important part. More specifically, it is evident that the westernized lifestyle is one of the major contributors to the development of diabetes type 2. Research indicates that adopting a low-fat, high-fiber, a physically active lifestyle, and maintaining a healthy weight can help improve the health status of the aboriginal people and prevent diabetes type 2. 

In response to the growing prevalence of diabetes type 2, the Australian National Diabetes Strategy outlined a national response and designed various ways in which existing limited health care resources can be utilized to prevent and reduce the prevalence of diabetes. The Australian National Diabetes Strategy 2016-2020 identified some of the most appropriate and effective interventions to minimize the impact of diabetes in the community. Among the goals proposed include enhancing access to a structured self-management education program for people with diabetes. Particular attention was proposed to be given to programmes for children with diabetes, adolescents, and older people as well as their carers. For the Aboriginal and Torres Strait Islanders, the strategy recommended the development and implementation of community-wide programmes to raise awareness and communicate the seriousness of diabetes. Unfortunately, because the proposed strategy focuses on the entire Australian community, it may not be able to cover the whole population, and especially the Aboriginal Community. Thus, we identify this as a community need and prepare a funding proposal that will focus on introducing a diabetes education program targeting the Aboriginal and Torres Strait Islanders living in New South Wales area, which is part of the region that makes up 66 percent of the Aboriginal people population. The health promotion program targets to support the educational and awareness program on diabetes type 2 raised by the Diabetes Australia. More specifically, the health promotion program will not only focus on knowledge-based teaching but will also consider behavior-related tasks. Some of the tasks the team intends to focus on include activities to help the ATSI people improve their physical exercise, arrange cooking courses targeted at helping the group make the necessary dietary changes. The funding proposal will be presented to the government for funding in a bid to support the current initiatives and to reduce the prevalence of diabetes type 2 among the Aboriginal people in Australia.

Identification of health issue/project

Describe the Processes of Identifying the Health Issue that Needs Addressing in the Project

Different factors affect the health and well-being of a community and in most cases, various entities and individuals are expected to play a role to respond to the community health needs. The health promotion team sees a requirement for a framework within the local community and proposes a need to take a comprehensive approach to maintain and improve the health status of the aboriginal people. The committee intends to accomplish this by first assessing the health needs of the community, determine the resources available and assets necessary to promote health, to help develop and implement a strategy for action to improve the community’s health status. To undertake the needs assessment, the health promotion team used four key steps. The first step was consultation, which involved talking to the people living and working in the community to gain some insight on the issues and concerns affecting the community. The team spoke to a range of people including health agencies, the public, community organizations, volunteer networks, and local healthcare professionals among others. The second step was data collection, which involved collecting data from published materials, statistical and demographic information from various organizations in relation to the health status of the Aboriginal people. After data collection, the next step involved the presentation of findings. The team provided anyone who participated in the planning and development of the program with regular updates on the data collection. The community was included in the data analysis for wider scrutiny and helped in the generation of findings. The findings were presented in a full report for presentation to the entire team and the community. The last step in the needs assessment involved determining priorities. From the consultation, it was clear that there were several issues affecting the Aboriginal community in the New South Wales area. Unfortunately, it is impossible to address all of the issues identified. A decision had to be made to prioritize one issue while involving the community and the key stakeholders to ensure the issue met the needs of the target group.  

Literature Review

Diabetes is a big health problem in Australia and one of the major causes of health disparities among the indigenous and non-indigenous people.  According to Reeve, Church, & Haas (2014), the disease and its complications contribute to various issues affecting the lives of the aboriginal people such as poor quality of life and early death. Since there is no cure for diabetes type 2, prevention is imperative. Existing literature indicates that known risks for type 2 diabetes include poor diet, obesity, lack of physical exercise, socioeconomic disadvantages, stress, advanced age, and family history. Therefore, the focus of the literature review will be placed on the Aboriginal and Torres Strait Islanders with type 2 diabetes. The literature review will be presented in an attempt to show the immense need to increase access to literacy-sensitive, effective, and culturally appropriate diabetes education for this particular community. 

Search Strategies

A literature review was carried out to evaluate the current diabetes education practices that have helped in the fight against diabetes. The search tools used included online peer-reviewed journals and government websites. Only journals published between 2008 and present were considered for review. The keyword diabetes education effectiveness was used and only research done on participants in Australia was considered to increase the relevance of the literature review. Reputable websites were used for definition and statistical data representation. 

Diabetes Education, Literacy Programmes, and Culturally Competent Education

Up until the late 18th century, the Aboriginal and Torres Strait Islanders maintained a hunter-gatherer lifestyle (Burrow, Ride, & Australian Indigenous HealthInfoNet, 2016). However, with the arrival of the Europeans in 1788, the Aboriginal went through major lifestyle transformations. The changes in diet and physical activities played a key role in the development of diabetes among the ATSI people, particularly during the second half of the 20th century. Currently, there is no known cure for diabetes type 2 except the administration of insulin to lower down or boost a patient’s blood sugar. Similarly, unlike diabetes type 1, where there is no known way to prevent it, prevention of diabetes type 2 is a critical component in diabetes care. In Australia, diabetes educators provide self-management education for people with diabetes as a way of promoting optimal health and wellbeing. The educators work under an umbrella group tagged the Australian Diabetes Educators Association (ADEA), which was founded in 1981 (King, Nancarrow, & Grace, 2017). The workforce is diverse drawing professionals from various groups such as nurses, dietitians, and pediatrics among others. Among the Aboriginal and Torres Strait Islanders, evidence indicates that diabetes type 2 short-term health lifestyle programs can have positive health effects and more effective if initiated by the community.  Additionally, culturally appropriate care services and education programs have been proven effective in improving diabetes care and prevention. A research carried out to analyze the experience of the ATSI people who attended urban community courses in 2002 to 20017 indicate that the course helped them to adjust their diet (Abbott, Davison, & Moore, 2012). Thus, a focus on behavior-related tasks, as opposed to knowledge-based learning, increases the success of diabetes and nutrition education. Along with that, the success of the study indicates that practical classes such as the cooking course are better placed to promote dietary behavior adjustment and are more useful to the groups.

Needs and Strengths

Before the arrival of the Europeans in 1788, the Aboriginal and Torres Strait Islanders maintained a hunter-gather lifestyle. However, after 1788, they underwent a major change in lifestyle. The traditional activities associated with finding renewable food and resources changed. The community also experienced adverse physical activity and nutrition changes, which played an important role in the prevalence of diabetes among the ATSI people. The factors associated with the high rates of diabetes among the ATSI people is a combination of historical, social, economic, and cultural determinants. Nonetheless, despite these transformations, the ATSI people still hold strongly to their cultures. This means, introducing culturally appropriate and locally supported education programs has a high probability to be successful and help in the fight against diabetes type 2. 

Project Planning using the Five Stage PRECEDE Model

The prevalence of diabetes among the ATSI people constitutes a significant health disparity in Australia. Efforts have been made to develop and evaluate various strategies to improve the diabetes health status of the Aboriginal and Torres Strait Islanders with moderate success. Evidence shows that the most effective educational programs are theory-based and take patterns from changing behavioral patterns (Moshki, Dehnoalian, & Alami, 2017). However, planning, designing and evaluating a health promotion program based on changing the behavioral patterns of a community to impact diabetes health status can be a challenging and time-consuming exercise. The PRECEDE model is one of the models used for programming behavioral changes and usually adopts a five-step process, which provides a simple ecological approach to health promotion (Curley, & Vitale, 2012). Consistently, this health promotion program sought to apply the five-stage PRECEDE model on the preventive behaviors for type 2 diabetes mellitus. 

Step 1: Determine the Population Needs through Social Assessment, Participatory Planning, and Situational Analysis

The prevalence of diabetes among the ATSI people is significantly high as compared to the non-indigenous people in Australia. The health promotion team noted that because diabetes is a lifestyle disease, changing the dietary behavior of the ATSI people and increasing their participation in physical activities can help prevent and reduce the incidence of diabetes type 2. Thus, to be able to define the social needs, the team started by collecting the demographic data, which was designed to assess the prevalence of diabetes type 2 among the ATSI people in New South Wales area. The team used community surveys, focus groups, face-to-face interviews with the community administrators and healthcare professionals, and questionnaires in public places. 

Step 2: Identifying the Health Determinants of these Needs

In this phase, the team looked for issues or factors that might cause or influence the outcome identified in the first step and select the most important that can be influenced by an intervention. Diabetes is often defined as a lifestyle disease, which requires people to change their dietary behavior and adopt a physically active life. In this case, it was identified that among other factors, unhealthy dietary behaviors and lack of enough physical activities were the major causes of diabetes type 2 among the ATSI. It was further identified that lack of awareness on the proper diet, importance of physical activities, and health literacy on the risks of diabetes were some of the major contributors to the prevalence of diabetes type 2.

Step 3: Analyze the Behaviors and Environmental Determinants of Health Needs

The predisposing factors are emotional and intellectual factors that influence individuals to adopt a risky behavior or lifestyle. Some of these factors can be influenced by educational interventions. In this case, the lack of knowledge on the dangers posed by unhealthy dietary behaviors can be influenced by introducing educational programs to raise awareness on the risks and recommend dietary changes. The enabling factors are internal and external conditions that influence people to adopt and maintain healthy or unhealthy behaviors. Among the ATSI people, the community has been marginalized for a very long time. Most probably the lack of enough resources in form of capital to buy healthy foods may be one of the factors influencing their bad dietary decisions. The reinforcing factors include the community attitudes or the people who support or make it hard to adopt healthy behaviors. These are largely the attitudes from influential people such as teachers, employers, peers, and family among others.  Some of the reinforcing factors identified include whether the family supported and encouraged people to change their diet and do exercise. Has the community education providers been encouraging the public to participate in diabetes type 2 prevention programs?

Step 4: Identification of Project Aim and Objectives

Diabetes education programs have been widely implemented in Australia and evidence indicates that they have been successful. The objective of this health promotion proposal is to propose an educational program for the Aboriginal and Torres Strait Islanders on diabetes type 2. Type 2 diabetes is a serious public health problem in Australia and mostly among the ATSI people. The prevalence of diabetes among the indigenous people is also significantly high as compared to the non-indigenous people. The proposal is aimed at implementing educational programs designed to offer both knowledge-based and practical-based educational programs to the affected community. More specifically, the program goals include prevention and reduction of diabetes type 2 by introducing awareness education programs and campaigns. Organize cooking courses and physical activities, where the community can participate in to get firsthand knowledge of the healthy dietary behaviors and physical activities they should adopt.  

Step 5: Project Budget and Implementation

The development of a detailed budget includes identifying the needs, costs, and resources required to implement the health promotion plan. The budget shall include a budget range of all the options required for the successful implementation of the diabetes education program. The exact budget includes the following:

Personnel

Program Coordinator 30,000

Administrative Assistant 6,500

Supplies

Educational/ Outreach 2,500

Office Supplies 1,500

Food Supplies for Wellness Programs 3,500

Contractual

Consulting Medical Doctor 16,500

Registered Dietitian/ Diabetes Educator 18,600

Exercise Therapist 23,500

Equipment

Laptop Computer 800

LCD Projector 1,100

Kitchen Appliances and Equipment 2,500

Total Budget Estimate 107,000

My Role as a Leader in the Health Promotion Team

The position is responsible for the leadership of the planning, implementation, and evaluation of the health promotion program. My primary role involves managing, leading, and providing the necessary professional oversight for the entire team. In my position, I will also play a critically significant role in identifying new health promotion initiatives and provide professional advice and support within the current health promotion initiatives. Along with that, the position also expected me to engage and provide strategic level support to relevant stakeholders to enable the success of the health promotion program. Other roles that I am expected to undertake to include ensuring appropriate monitoring and reporting is observed including analyzing variations, completing monthly reports, and completing as well as submitting all ministry of health reporting and information requests. Support the delivery of health promotion outcomes including managing staffs, financials, and other resources to ensure they remain within proposed budgets. I will also be responsible for engaging with and maintaining key relationships with the local communities while ensuring cultural competency and address ethical issues. Understandably, this is a hard task and in order to maintain cultural competency, I will be required to conduct a cultural audit to understand the native language, the spiritual or religious beliefs, social and economic status, and other characteristics specific to the group.

References

Abbott, P. A., Davison, J. E., Moore, L. F., & Rubinstein, R. (2012). Effective Nutrition Education for Aboriginal Australians: Lessons from a Diabetes Cooking Course. Journal of Nutrition Education and Behavior, 44(1), 55-59.

Burrow, S., Ride, K., Australian Indigenous HealthInfoNet, & Edith Cowan University. (2016). Review of diabetes among Aboriginal and Torres Strait Islander people. Mt Lawley, W.A. Australian Indigenous HealthInfoNet.

Curley, A. L. C., & Vitale, P. A. (2012). Population-based nursing: Concepts and competencies for advanced practice. New York, NY: Springer Pub. Co.

King, O., Nancarrow, S., Grace, S., & Borthwick, A. (2017). Diabetes educator role boundaries in Australia: a documentary analysis. Journal of Foot and Ankle Research, 10(1), 1-11.

Moshki, M., Dehnoalian, A., & Alami, A. (2017). Effect of precede-proceed model on preventive behaviors for type 2 diabetes mellitus in high-risk individuals. Clinical Nursing Research, 26(2), 241-253.

Pippa, W., Melanie, P., Rebecca, B., James, D., & Michael, R. (2015). Factors Influencing the Health Behaviour of Indigenous Australians: Perspectives from Support People. Plos One, 10(11), 1-17.

Reeve, R., Church, J., Haas, M., Bradford, W., & Viney, R. (2014). Factors that drive the gap in diabetes rates between Aboriginal and non-Aboriginal people in non-remote NSW. Australian and New Zealand Journal of Public Health, 38(5), 459-465.