Why and where the intervention was taken
I chose cooking class intervention in 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 the 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 (Diabetes UK 2012). Lastly, ADA (2012) points out that weight loss are linked with good effects to diabetic people. The intervention was conducted in a community centre.
The targeted audience for this intervention is diabetic people aged 40-65 years. The reasons for choosing the audience is that almost all diabetic women aged between 45-65 years have type 2 diabetes (CDC 2001).moreover, department of health (2001) observed that adults of over 40 years are always diagnosed with type 2 diabetes. Like Sally Pust in the case study, this age group is vulnerable to diabetes type 2.
Caplan and Holand (1990) – traditional and humanist perspectives
The model of Traditional and humanist perspective developed by Caplan and Holand (1990) has been chosen to be used in this health promotion. The model has two facets or axes. 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 Shumaker et al (2009), the model applies educational approach with the main aim of knowledge and education provision to make people make informed decisions on their health. Furthermore, its humanists approach is relevant to the educational approach which makes people to maximize their skills and knowledge and make healthy lifestyle choices (Amdam 2011).
Gellman & Turner (2013) observes that the model covers a comprehensive health promotion as it analyses significant issues that are related to health promotion. In addition, it has ideological and epistemological assumptions that explains societal beliefs and health practice
Approaches to health promotion
Naidoo and Wills (2009) explain the behaviour change approach and educational approach as intervention mechanisms to 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 development of healthy cooking skills.
1.1 Aims and assumptions of Behavior change approach
According to Hayes (2009), the main aims and assumptions of behavior change approach include the following:
- It encourages people to adopt behaviors which are healthy so as to improve health such as cooking skills
- It perceives health as individual properties
- By 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 are 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 the individuals. Furthermore, Diabetes UK (2012) suggests that we can make use of the mass media to reach patients.
According to National Institute for Health and Clinical Excellence (2009), changing of health related behaviors of the type 2 diabetic people involves:
- Assisting them understand the long, medium and short term health related behavior consequences
- Assisting them 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 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. As explained by Parahoo (2008), decisions related to health are very complex to make. 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, making the decision to prioritize her health or her jobs and family becomes complex to her. She begins to but get discouraged along the way because she lacks free time to exercise and eat the recommended healthy foods.
Another limitation of the behavior change approach is that it depends on the readiness of a person to take action (Polit and Beck 2008). Sally Pust even after being diagnosed with diabetes type 2 is not ready to take action to exercise and take healthy foods. However, in the long run she changed after getting education and persuasion form the diabetic support group.
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 is portrayed clearly in the case study. Sally lacks enough time to eat and therefore opt for chocolate during her short breaks. Additionally, she rarely has regular lunch because of 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 work place. Besides, her job is stressful, tiring and monotonous but cannot change because she dropped out of school early with no good qualifications.
Behavior some time can be as 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.
- Educational approach
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 educational approach include the following:
- To enable people make choices that are informed about their health behavior by providing information and knowledge and developing the skills that are necessary. This will enable the diabetic patient have skills on choosing the healthy foods based on knowledge learnt.
- 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 to the one the health promoter prefers.
2.2 Assumptions and limitations of educational approach
The educational approach assumes that 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. From the support group, she increased her knowledge and changed her attitude. 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 made a decision to alight from the bus some two bus stops before on her way back home so as 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, decisions which are health related 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 include provision of booklets and leaflets, one to one advice and visual display. This can add more information to the patient and help change in attitude (Polit 2008).
Affective aspect– providing clients with opportunities to explore and share their feelings and attitudes. These may take form of group discussions, one to one counseling. This has proven helpful to Sally who is diabetic when she joined diabetic support group (Parahoo 2008). Through group discussions and counseling, she was able to have knowledge in choosing of healthy foods and exercising.
Behavioral aspect-assisting the clients to develop skills in decision making necessary for healthy living. These include exploration of real life circumstances, situations and role play. For example how to react 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 identification of areas to be improved during execution of the program (Jackson & Furnham 2010). In 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, attitude and motives of people with different behaviors and to measure the behaviors of the past to be used in future actions predictions (Jackson & Furnham 2010). Furthermore, questionnaires are the most suitable because they are cost effective, less likely to alter the participant’s behavior, are adaptable to surrounding, is simple to complete by the respondents with complete anonymity and lastly reliable and valid (Jackson & Furnham 2010). However, Jackson & Furnham (2010) adds that a questionnaire designed for a specific intervention must examine certain factors of duration, complexity, respondent’s intellectual capacity, age groups, activity being surveyed and the participant’s financial constraints.
Jackson & Furnham (2010) observes that closed questionnaires keeps the respondents to the topic and makes analysis of the responses from the evaluation easier. However, it forces the respondents to give 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 requires (Jackson & Furnham 2010).
According to Jackson & Furnham (2010), the questionnaires have their own limitations. Some of the questions in the questionnaires have pre-coded nature that deter the respondents or make respondents’ misinterpret the question asked. Moreover, it can create bias in the evaluation of the results by imposing answer structures that portrays the reflection of the researchers reasoning and not the respondent. Jackson & Furnham (2010) points out that truth in the answers cannot also be tested evasiveness and reluctance of the respondents cannot be reflected.
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