Diabetes is one of the chronic diseases that results either when there is the production of less insulin by the pancreas or when the insulin produced cannot be effectively used by the body. Type 2 diabetes occurs when the body ineffectively uses insulin. According to the Centers for Disease Control and Prevention (2013), diabetes type 2 is composed of 90 %of diabetic people worldwide and is mostly a result of physical inactivity and excess body weight. The disease was only occurring in adults until recently in children (American Diabetes Association 2012). The paper will use the case study in the application of the chosen policies in the design of cooking class intervention of diabetes type 2.furthermore, it will critically discuss the Caplan and Holand (1990) – traditional and humanist perspectives model of health promotion. Lastly, the paper will discuss the intervention of the cooking class evaluation.
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Cooking class intervention in diabetes type 2
Why and where the intervention was taken
I chose cooking class intervention in the prevention and management of type 2 diabetes. The main objectives of choosing cooking classes are to provide knowledge to the patients about healthier food choices and to develop skills about healthy cooking. Many reasons supported the decision to choose the cooking class intervention on type 2 diabetic patients. According to NICE (2009), one of the best approaches to diabetic care is nutrition therapy. Furthermore, diabetic people like Sally Pust in the case study have difficulty reaching the recommended cholesterol and HbA1c levels (Waltz & Strickland 2010). Lastly, ADA (2012) points out that weight loss is linked with good effects for diabetic people. The intervention program was done in a nearby community center.
The intervention program was directed exclusively to people age 40-65 years who are ailing from diabetes. The reason for choosing the audience is that almost all diabetic women aged between 45-65 years have diabetes type 2 (CDC 2001). Moreover, Williamson (2013) observed that adults over 40 years are always diagnosed with type 2 diabetes. Just like Sally Pust, this age range has a high probability of developing diabetes type 2.
Model of health promotion
Caplan and Holand (1990) – traditional and humanist perspectives
The model of the Traditional and humanist perspective developed by Caplan and Holand (1990) has been chosen to be used in this health promotion. The model is made of two cardinals. The first one outlines the theories of knowledge and how new health theories are created and the other axis looks into the society and the different influences that may affect health. Therefore, the model of traditional and humanistic perspective is made of four quadrants called radical structuralism or humanists, traditional or humanist health-related (Caplan and Holand 1990).
According to Slon et al (2009), the model applies an educational approach with the main aim of knowledge and education provision to make people make informed decisions on their health. Furthermore, its humanist approach is relevant to the educational approach which makes people maximize their skills and knowledge and make healthy lifestyle choices (Piper 2009).
NHS (2011) observes that the model covers a comprehensive health promotion as it analyses significant issues that are related to health promotion. Also, it has ideological and epistemological assumptions that explain societal beliefs and health practice
Approaches to health promotion
Naidoo and Wills (2009) explain the behavior change approach and educational approach as intervention mechanisms for diabetic patients.
Behavior change approach to type 2 diabetic patients
This approach was chosen because of its relevance to the objective of the intervention in the development of healthy cooking skills.
1.1 Aims and assumptions of Behavior change approach
According to Hayes (2009), the main aims and assumptions of the behavior change approach include the following:
- It encourages people to adopt behaviors which are healthy to improve health such as cooking skills
- It perceives health as individual properties
- Individuals choosing to change lifestyles, they can make significant improvements to their health. For instance, if sally chooses to change from taking junk foods and cook healthy food at home.
- It is the responsibility of the people to take action and care for themselves
- The approach involves attitude change followed by behavior change.
One of the methods that can be used in behavior change to the diabetic people is Campaigns aimed at persuading people to stop smoking, drinking, adopting healthy cooked food, and exercising regularly (Focus on Food 2012). It is always targeted towards individuals. Furthermore, Diabetes UK (2012) suggests that for many patients to be reached, other media forms such as mass media can be used.
According to the National Institute for Health and Clinical Excellence (2009), changing of health-related behaviors of type 2 diabetic people involves:
- Assisting them to understand the long, medium, and short term health-related behavior consequences
- Assisting them to feel positive about the value and benefits of changing their behaviors and health-enhancing behaviors.
- Recognizing how the relationships and social contexts of people may affect their behavior.
- Assisting people to plan their changes in easy and sustainable steps terms over time.
- Finding and planning for possibilities that might undermine changes they are trying to make, and organizing unique “if-then” strategies to cope and to maintain behavior changes.
However, the approach has its own limitations. Warwick-Booth (2012) explains some of the complex decisions to make are related to health. For instance, from the case study, Sally Pust has been diagnosed with type 2 diabetes that required her to take medicine regularly, commence a low fat and carbohydrate diet in addition to some physical activities. However, deciding between her family, job, and health seems to be complex for her to make. Therefore, along the way, she gets discouraged because of her, there is no free time to eat healthy food that is recommended or even to exercise.
Another limitation of the behavior change approach is that it depends on the readiness of a person to take action (Thomas 2013). Even after being diagnosed with diabetes type 2, she still has a problem in taking an action to start exercising and eat healthy food. However, after getting the education from the diabetic support group, she changed in the long run.
Naidoo and Wills (2009) suggest that the complex relationship between environmental and social factors and behavior of the individual pose as another limitation to the approach. This comes out clearly when she has inadequate eating time and therefore during her short breaks, she takes chocolate and biscuits. Additionally, she rarely has regular lunch because of a lack of available time to prepare meals. She also eats snacks and fast foods frequently on her way to work. All these hinder her from taking healthy food. Therefore, change of behavior is hindered by the environmental conditions existing in her workplace. Besides, her job is stressful, tiring, and monotonous but cannot change because she dropped out of school early with no good qualifications.
Behavior sometimes can be a response to the living conditions of a person which may be beyond the control of the individual (Gellman & Turner 2013). Sally is a divorcee with four young children and her ex-husband does not support her. Furthermore, her mother is diabetic and obese, her father hypertensive and her grandmother who died the previous year from acute myocardial infarction had diabetes for thirty years. This shows the living conditions beyond Sally’s control and they are overwhelming her.
This approach was also chosen because it is related to the objective of knowledge provision on healthier food choices in the intervention.
2.1 Aims and values of educational approach
According to Amdam (2011), the aims and values of the educational approach include the following:
- To enable people to make choices that are informed about their health behavior by providing information and knowledge and developing the necessary skills. This will give the patients the necessary skills for identifying the recommended healthy foods because they will be knowledgeable.
- Does not try to motivate or persuade a one direction change
- The outcome is the voluntary choice of the client which may be totally different from the one the health promoter prefers.
2.2 Assumptions and limitations of educational approach
The educational approach assumes that an increase in knowledge will lead to attitude change and finally change of behavior (Shumaker 2009). This comes out clearly when sally joins the diabetes support group with her community. Her knowledge increased and her attitude also changed after spending some time with the diabetic support group. This helped her very much in adapting to treatment challenges and in choosing the type of healthy food she is supposed to eat in addition to doing physical activity. For instance, she decided to alight from the bus some two bus stops before on her way back home to walk for 30 minutes daily.
On the other hand, the limitations of educational behavior are that the voluntary change of behavior may be restricted by economic and social factors. Additionally, health-related decisions are very complex (Hayes 2009).
Learning aspects in educational approach
Cognitive aspect –information provision on health-related behaviors effects and causes of especially on type 2 diabetes. These may consist of one on one advice, leaflet and booklet provision, and the visual display. These can create additional information and help in changing the attitude of the patient. (Thomas 2013).
Affective aspect– clients are provided with explorative opportunities and even share their attitudes and their feelings. These may take the form of group discussions, one to one counseling. This has proven helpful to Sally who is diabetic when she joined the diabetic support group (Warwick-Booth 2012). By being counseled and attending the group discussions, her knowledge of exercising and choosing healthy foods increased.
Behavioral aspect– clients are assisted in the development of decision-making skills that are important for living a healthy lifestyle. These include circumstances of real-life exploration situations and role play. For instance how one should react or behave when offered a cigarette, drink, or drugs (Naidoo and Wills 2009).
Evaluation is always done on a program to test its effectiveness. This is important in the identification of areas to be improved during the execution of the program (Jackson & Furnham 2010). An evaluation of the cooking class intervention, an open and closed questionnaire with relevant questions was distributed to each participant before and after the program to fill in.
The questionnaires were used in the evaluation of the intervention because it is useful in measuring the opinions, attitudes, and motives of people with different behaviors and to measure the behaviors of the past to be used in future action predictions (Morrow 2011). Furthermore, questionnaires are the most suitable because they are cost-effective, less likely to alter the participant’s behavior, are adaptable to the surrounding, are simple to complete by the respondents with complete anonymity, and lastly reliable and valid (Jackson & Furnham 2010). However, Morrow (2011) adds that a questionnaire designed for a specific intervention must examine certain factors of duration, complexity, respondent’s intellectual capacity, age groups, the activity being surveyed, and the participant’s financial constraints.
One of the importance of closed questionnaires as observed by Jackson & Furnham (2010) is that the respondents are kept to the topic in addition to easy analysis of the responses. However, the respondents are subjected to giving simple answers. This is contrary to open questionnaires where the respondents have the freedom to express themselves in detail but greater efforts, thinking, and time are required (Morrow 2011).
The questionnaires used in the evaluations also have limitations. Some of the questions in the questionnaires have pre-coded nature that deters the respondents or makes respondents’ misinterpret the question asked (Jackson & Furnham, 2010). Moreover, it can create bias in the evaluation of the results by imposing answer structures that portray the reflection of the researcher’s reasoning and not the respondent. Morrow (2011) points out that truth in the answers cannot also be tested evasiveness and reluctance of the respondents cannot be reflected.
In conclusion, a cooking class can be a good intervention for diabetic people as it enhances the taking of healthy food. Furthermore, educational and behavioral change approaches steer a person to the right healthy path.
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