January 5, 2010

DIABETES TYPE 2 EDUCATION IN NATIVE AMERICANS

INTRODUCTION

 

This study investigates the education of Native American regarding Type 2 Diabetes Mellitus. It explores how much knowledgeable Native Americans are about the disease as being such is one of the most important factors in the management of the disease.

The aim of the study is to build a plan that would educate Native Americans about Diabetes Mellitus. In order to do so, the study also explores the barriers to healthcare and uncovers the best education approach to the group.

The reason this topic is explored is because of the perception that minorities are uneducated and are often misinformed about the dangers of chronic diseases and how they can be managed. Furthermore, Native Americans have their own traditional practices in healthcare, which stands somewhat as a barrier for them to accept proper healthcare practices. Through this study, those issues will be explored. It will greatly help the Native Americans in understanding basic facts about diabetes and how it should be managed. The plan will be helpful in being able to penetrate deep into their culture and embed basic modern treatments and management of diabetes.

BACKGROUND OF THE STUDY

Diabetes is one of the most pervasive and worsening health problems facing the world today. The disease afflicts a broad swath of people, young and old. In the United States, there is at least 15.7 million people, have diabetes; of these, 5.4 million are unaware that they have the disease. Diabetes is among the leading cause of death. If inadequately treated, diabetes can cause blindness, kidney disease, nerve disease, amputations, heart disease, and stroke. Even conscientious and well-treated diabetics frequently suffer from these complications and have above-average medical costs.

The United States provide basic healthcare education to its citizens about the dangers of diabetes. However, special programs are made to educate minority groups such as the Native Americans. If observed, the Native Americans have many barriers to health education, which basically involves their culture, lifestyle, accessibility and socio-economic status. For instance, Native Americans are currently experiencing a crisis of hunger and poverty. The Native Americans suffer from a much higher rate of food insecurity and poverty than the general population (Henchy et al, 2000). Furthermore, because of poverty and living in rural areas, Native Americans mostly consume less expensive and often high fat foods, and less fruits and vegetables (Henchy et al, 2000). It has been reported that 40% of Native American diets are derived from fats (Henchy et al, 2000). Because of lack of financial capabilities, Native Americans usually do not have access to a decent hospital or doctor to consult their conditions. Also, because of lack of transportation and being far away in the rural area, there is a great difficulty in visiting doctors at urban locations (Henchy et al, 2000).

Approaches to Native Americans in terms of healthcare education are usually intervened by the government through the programs they develop. One example of these programs is the National Diabetes Education Program (NDEP), a program that delivers culturally and linguistically appropriate prevention and control messages through trusted and valued community-based delivery channels and intervention approaches (Vinicor, 1999). These approaches are usually common and are planned to be culturally sensitive enough to relate with the Native Americans so as they can absorb what the program tries to teach.

Traditional Healthcare Practices of Native Americans

Culture is an important issue in educating Native Americans about Type 2 diabetes. Native Americans have their own traditional healthcare beliefs that are deeply embedded within them. Their faith in these beliefs is one of the strongest barriers in educating them to embrace the modern methods of combating and preventing Type 2 diabetes.

Native Americans beliefs are as diverse as the numbers of their tribes. However, majority of tribes have the following beliefs in common: they believe in the supreme creator; man is made up of body, mind and spirit; plants and animals are part of the spirit world; the spirit world exists side by side and intermingles with the physical world; illness affects the mind and the spirit as well as the body; wellness is harmony of body, mind and spirit; unwellness is disharmony in body, mind and spirit; natural wellness is a cause of witchcraft, and; each of us is responsible for our own wellness (Schrader and Schrader, 1997).

Native Americans believe that they can acquire disease from the vengeful spirits of animals as well as disrespect towards nature. They believe they can also acquire diseases from a powerful spell casts by a witch. Diseases are not handled by modern nurses or doctors, but by traditional medicine men trained to perform 'healing ceremonies' (Schrader and Schrader, 1997). Ceremonies include ritual chants and some herbal remedies (Schrader and Schrader, 1997), which is overall based by faith and can be branded as 'faith healing'.

Methods to Approach the Group

 

According to Schrader and Schrader (1997), and based on the discussion above, the most important concept of health education to Native Americans is the overlapping of religion and medical treatment since such link is embedded within their belief system. This should be the basis in determining what type of adult learning education should be used so as to implant to them the basic ideas of diabetes implications management. In this lieu, the humanistic approach of learning should be applied to them. This may include the three basic types of learning: affective; behavioral; and cognitive learning. Affective learning is necessary to form their attitudes, feelings and preferences (Leith, 2002). Behavioral learning, on the other hand, is necessary to develop their actual performance on the methods and procedures (Leith, 2002). Finally, cognitive learning is necessary to ensure that they will remember basic knowledge and concepts (Leith, 2002).

 

            One of the concepts of learning that should be addressed among Native Americans is the learning environment. The learning environment should be comfortable in a sense that there is mutual trust, respect, mutual helpfulness, freedom of expression, and acceptance of difference (Leith, 2002). Such learning environment approach should promote a humanistic type of learning, where Native Americans will be respected of their culture, and at the same time will accept the modern concepts that are being taught to them (Leith, 2002).

Another humanistic learning concept that should work with Native Americans is the acceptance of shared responsibility (Schrader and Schrader, 1997). The learner should develop a strong sense of responsibility to self and to others with the ability to develop towards one's fullest potential (Schrader and Schrader, 1997). In other words, the Native Americans to be educated about diabetes should have responsibility for planning and operating the learning experience (Leith, 2002).

PLAN FOR IMPLEMENTATION OF HEALTH PROGRAMS

One focus that will be emphasized in the plan is that management of nutrients in the body is important for a person with Type 2 Diabetes. In his journal article, Decoster (20002) presents challenges to diabetic patients posed by type 2 diabetes. A section reviewing literature on diet and exercise states that medical nutritional therapy (MNT) is often the first-line therapy of choice, and that its goal is to maintain near-normal glucose levels by matching dietary consumption with actual caloric needs, necessitating that the right foods in correct proportions be eaten at prescribed times. Another goal is weight loss. In meeting either goal, the person must become aware of his or her individual food consumption patterns and basic caloric needs for height, weight, age, and level of activity; be able to prepare and plan well-balanced meals using fresh foods as often as possible; be able to read and interpret nutritional information on food labels; and be able to incorporate regular meal times into work and home schedules. The problem however is that these management techniques may contradict with the basic beliefs of Native Americans. Thus, the following objectives below will be implemented.

The aims of the study are: to know if Native Americans are well-educated about the basic facts of Type 2 Diabetes; how it can be managed to avoid and prevent the different complications associated with it; and to present a plan on how to educate them effectively despite of the barriers to learning that were identified earlier.  The plan is to divide the learning experience into three sections:

1.      Development of attitude of Native Americans about the modern management of diabetes.

This will be done by doing a simple analogy of the modern management process effects using basic Native American beliefs. Since there are many beliefs among different tribes, the main task then is to retrieve the basic beliefs of each tribe that will be addressed. Afterwards, analogies will be developed so as to relate situations with their culture.

2.      Applying a humanistic approach on teaching.

This means ensuring that the teacher will reach out to the students individually. It will be ensured that a comfortable physical environment will be provided. Teachers should act as resource and co-learners. Mutual trust should be gained by respecting the basic beliefs of the Native Americans and commenting anything negative about them. Furthermore, responsibilities should also be developed. The students must be able to share their options in design and experience and selection of methods and procedures.

3.      Finally, the development of cognitive knowledge.

After attuning to their behavior and attitude, the cognitive side of learning will be targeted. This will be done by conducting daily tests that will monitor the progress of the students on learning. Tests will be graded typically through percentage analysis.

Overall, the following is the list of important points in the plan:

1.      The program should last a month and should address families with or without diabetes. It should focus on one tribal group at a time (other groups that will be addressed will also be for a month).

2.      The approach should be humanistic, but also incorporates cognitive development.

3.      The focus of the education is on how Type 2 diabetes can be prevented and personally managed.

4.      The Native American culture should be respected.

5.      Growth and progress should be monitored.

FOLLOW-UP

            To monitor the progress and effectiveness of the program, a simple quantitative research will be conducted a few months after it.     

For this task, a structured questionnaire will be constructed. The questionnaires will be sent to those who attended the programs.

            A 5-point Likert Scale will be used to measure the degree of agreement on each question or statements on the questionnaires.

            Data will be analyzed with the use of the latest SPSS. The percentage and weighted mean of each response on statements will be presented on tables. Conclusions will be given to confirm the change in attitudes among them and how they embraced the new knowledge that was taught to them.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REFERENCES:

 

 

Decoster, V. A. (2002), "Challenges of type 2 diabetes and role of health care social work; A neglected area of practice", Health and Social Work, 26(1), p. 26.

 

Henchy, G., Cheung, M. and Weill, J. (2000). WIC in Native American Communities: Building a Healthier America. Food Research and Action, Washington DC.

 

 

Leith, K.P. (2002). Adult Learning Styles and the College Classrooms. Paper Presented at the Annual Meeting of the American Psychological Association. Chicago IL.

 

 

Schrader, E.L. and Schrader, D.C. (1997). Community Health Resource Training for Native Americans. Paper Presented at the Annual Meeting of the National Communication Association. Chicago IL.

 

Vinicor, F. (1999). Diabetes. National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention , U.S. Department of Health and Human Services


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