Type 2 diabetes mellitus needs assessment among Aboriginal Australians

Normative and Felt Needs Assessment

Normative and Felt Need Assessment

Over the last several years, the issue of Type 2 Diabetes Mellitus (T2DM) has been continually brought to the forefront. This is because an increasing number of minorities have been affected by this condition, in comparison with other population groups. In Australia, this has been having a dramatic effect upon Aborigines, who are 10 to 30% more likely to suffer from this condition than the rest of the population. (Summary 2010) As a result, growing concern is taking place among health officials, who are worried that the number of people suffering from the condition could increase. Especially when you consider the fact that six out of every 10 Aborigines are considered to be obese. To determine the overall scope of the problem: a needs assessment and felt assessment must be conducted. Where, both will concentrate on the Aborigine men and women, between the ages of 25 to 64 years old, living in Onkaparina. Once these two different examinations are complete, it will provide more insights into the overall scope of the problem.

Normative Needs Assessment

Target Group and their Local Government

To determine the actual effects of diabetes on the indigenous population, you must examine the areas where many of these individuals live. This will provide insights as to possible issues that could be contributing to the problem by: examining the policies of the local government, looking at relevant health statistics, determining fruit / vegetable consumption and looking at the different support services / infrastructure. These different elements are important, because they provide insights about how the local community could be contributing to the problem. If you can see how these factors are affecting a particular community, then the government can begin to design intervention strategies to reduce the overall effects. Once this takes place, is when you can see how this demographic of 25 to 64-year-olds can be effectively targeted for an intervention.

A description of the Local Government and relevant socio-demographic characteristics of the population.

When you look at the City of Onkaparinga, it is clear that the majority of the population would fall within the age demographic for both males and females. Evidence of this can be seen by looking no further than the number of residents that live between the ages of 24 to 54 years old, which makes up 48. 3% of the population (72, 264). Then, when you look at the total number of residents that are between 60 and 64 years old, it is obvious that the number of resident within this demographic are well over 50% of the population. As this sub-group would account for 7,514 of the community's total inhabitants. This means that the total number of people in the community within the targeted age group would be 79,778 (72,246 + 7,514 =79,778). (Age Structure 2009) The total number of Aborigines that are in this population group would be 684 people or .85%. (Indigenous Profile 2009) The weekly income for most of the community will range between: $150.00 to $799.00. Below charts illustrate the difference between the total population of the community in the targeted age group and the indigenous demographic.

(Age Structure 2009)

(Individual Incomes 2009)

What this shows is that the majority of the community is within the national population demographics of Australia. As the total number of Aborigines account for a small portion of the community

Relevant health status information including the prevalence of T2DM and related risk factors amongst this group

Within the community the total number of diabetes cases has been steadily rising between 2005 and 2008. Where, the number would increase from: 4.9% of the population to 8.3%. When you look at the total amount of obesity within the community, this number has been consistently increasing. With the rate going from: 37.4% in 2005 to 42.4% in 2008. When you compare this with the national average of 10 to 30% of Aborigines being diabetics, it means that community is seeing between 68 and 205 people affected by the condition. (Chronic Conditions 2009) Depending upon which number you are looking at, the total diabetes rates among the indigenous demographic could be slightly above the average to almost triple the diabetes rates of the community. The reason why such a broad range is given is because of the fact that many of the Aborigines do not have access to variety of health care services. This means, that large segments of the population could be affected by the condition and may not know it. The below charts illustrate the underlying trends.

(Chronic Conditions 2009)

(Chronic Conditions 2009)

(Chronic Conditions 2009)

Information on their vegetable and fruit consumption.

When you look at the food and vegetable intake with the community, it is clear that two opposite trends have been occurring. Where, the total amount of insufficient vegetable intake would increase. As this number, would rise from 86.8% of the community in 2005 to 90.7% in 2008. While the number of people not receiving the proper amount of daily fruit intake, would decrease from: 60.3% in 2005 to 56.7%. (Chronic Conditions 2009) The below charts illustrate these changes that are taking place, as far as nutritional standards are concerned.

(Chronic Conditions 2009)

(Chronic Conditions 2009)

What all of this information shows, is that the community is having a divergence in their nutritional needs. Where, the majority have been eating more fruit and fewer vegetables. While this is good start (as far as fruit is concerned) the fact that the majority of community is not consuming these different foods one a regular basis, is evidence why the obesity and diabetes rates are increasing. As result, one could infer that these two factors are having an equally devastating impact upon the indigenous community.

A profile of relevant health & community services and community infrastructure in the local government area (with a view of highlighting accessibility or gaps in services and opportunities for potential collaboration and partnerships.

On the national level a number of different programs are funded through: Acting on Australia's Weight, Draft National Physical Activity Guidelines, Active Australia and the Obesity & Prevention Lifestyle Programs. These are used to fund various anti-obesity efforts on a local level that are targeted toward children. (OPAL 2009) (National Focus for Government Action 2009) In the City of Onkaparinga there are a number of different services that are offered to residents including: counseling services, diabetes support groups, diet / nutrition services and exercise groups. In general, most of these services are free, with the exception of the exercise group (where there is a fee that must be paid). On the surface it appears as if these different programs are providing a solid foundation for addressing the diabetes epidemic and the symptoms associated with it. Yet, when you look beneath the surface it is clear that these programs are often limited in size and the hours they are available for operation. A good example of this can be seen with the diabetes, exercise and diet / nutrition programs. Where, the diabetes program is limited as far as bookings and the total number support groups available. The exercise program only focuses on Thi Chi (a form of martial arts). While, the diet / nutrition program has limited number of courses and times that they are offered. These different areas are important, because they highlight why the obesity problem in the community is becoming worse. As the overall number and availability of various support / preventive programs are limited as far as size and the hours of operation. Then, when you look at the choices that are offered by some classes (such as the exercise class only offering Thi Chi), it is obvious that a lack of funding is taking place. This is problematic, because it is not addressing the problem with the general community, as only a limited number of resources are dedicated to the issue. Given the overall number of obesity and diabetes cases, these programs are too small in scope to make any kind of a difference. As a result, one could infer that the increase in the number of people eating fruit was the direct result of these efforts. Yet, because a large enough of resources was not dedicated to the problem, the rates of: diabetes and obesity would increase. Therefore, one could infer that until the proper amount of resources is dedicated to the problem, it will only become worse, until serious steps are taken to address the situation. (Southern Primary Health 2001)

Felt Needs Assessment

Describe the selected method for surveying the felt needs of your target group.

To determine the felt needs of the community some kind of examination be conducted of the target group. The best way to collect the data would be to use the internet and pen / paper, as a way for each of the different individuals to respond to series of different questions about how and why they do / do not consume fruit / vegetables. At the same time, there will be an emphasis on identifying why no one is engaging as much physical activity as they should. The survey can be implemented by working with: local schools, health clinics and community outreach groups. Where, you will send out invitations to these various organizations. The different groups will meet informally, where the session would begin by offering respondents something to drink such: as coffee or soda. The sample population would be divided into two different subgroups. Once this is accomplished, you would focus the survey on: the attitudes and viewpoints of the indigenous population. The best way to understand the overall attitudes about diet / exercise would be: to survey children in school and then survey different respondents at health clinics. Since the information is being collected over the internet, means that researchers will be able to categorize the different response. Once this takes place, you would communicate the results of the findings to stakeholders through an email communication (that will have a written report). At which point, the different results would allow health officials to design a customized program that will reach out to the indigenous population. Where, they can be able to target their message based upon specific factors that could be affecting perceptions, as to why someone is not eating properly or remaining active. The plan will involve what is known as sampling, this is where you will survey a small portion of the population and will make inferences about the overall issues that are occurring. The possible limitations and barriers could include: the lack of access to the internet and the ability to conduct effective follow up. To counter these issues, a written survey could be provided to the targeted group and then the different response could be entered into electronic form later. If this kind of an approach was taken for conducting the survey, it would help to accurately sample and assess the various views / attitudes, about health from the indigenous population.

Survey Tools

Tool is appropriate for target group with regards to selected method, content, layout and language used.

The survey tool that would be utilized to address community perceptions about nutrition and health will be in the form of a survey that will be given. The different questions will be targeted to address specific aspects that are relevant to diabetes and the various symptoms. For example, a general section will ask for respondents to answer lifestyle questions about how frequently they exercise and eat healthy foods. Then, a second section of the survey will ask respondents specifically their perceptions of fruit / vegetables and why they do not eat them. This will allow researchers to see specific and general factors that could be contributing to the increase in people susceptible to diabetes. Once this take place, you would then have two different groups. One group would be: the general community. While the second group, will target the indigenous community. At which point, the results from the two surveys can be compared with one another, to determine the views that are contributing to the problem and the overall severity of the situation. There would then be continuous follow up in the months / years after the survey was complete, to see the overall effect that government programs are having on both groups.

Survey questions consider individual, environmental & social factors affecting fruit and vegetable consumption

Utilizing this kind of survey tool will address the specific factors that could be contributing to the problem, by asking a variety of questions and then examining the different responses. This would include looking at: individual factors, attitudes / behaviors, environmental factors and social factors. Where, the surveys would ask both general and specific questions to determine the thoughts as well as frequency of the different patterns are occurring. Then, comparing the results of Aborigines with that of the community would help to provide an accurate assessment, as to what specific factors are contributing to the problem.

Survey questions are relevant, useful and logical

The different questions from the survey will help various health officials to know how they can begin addressing the problem, within the at risk population group. Over the course of time, this kind of survey allows communities to focus the various resources to the areas where they are most needed. This is how the community can be able to slowly reverse the rising obesity and diabetes rates.

Clearly, the issue of obesity is becoming a major factor that is affecting the underlying levels of health in the indigenous community and is contributing to the increases in diabetes cases. In the City of Onkaparinga, these issues are more of a challenge as the underlying levels of: obesity, lack of vegetable consumption and diabetes cases have been rising dramatically in the general population. Give the fact that Aborigines have higher rates for diabetes than the general public, means that the overall number of cases in this sub-group could be skyrocketing. This is because the weekly income of community is fairly low (with most salaries ranging between: $150.00 to $700.00 per week). Then, there is a lack of infrastructure to help support a healthy lifestyle. To determine how to reach out to most at risk population groups requires conducting a survey that will ask: how often respondents eat fruit / vegetables and engage in physical activity. Then, the different responses will be divided between the indigenous community and the general population of Onkaparinga. Once this takes place, it will provide specific factors that are causing the problem and the general trends that are taking place. This information will help health officials in designing an intervention program, that will reach out to the at risk groups within this population demographic.