Levels of children and young people diagnosed with type 1, type 2 and other variants of diabetes are increasing and this has become a priority issue for commissioners in the area where Amelia works as diabetic nurse. As one part of a local strategic response to this issue, Amelia has been asked to come up with some interventions that could help improve health and well-being outcomes for young people with a diagnosis of diabetes. Amelia is aware that improved diabetes control in young people can reduce the incidence of microvascular complications and delay their progression. She also understands that a diagnosis can affect a young person's mental health, emotional well-being and even attendance at school and engagement in extra-curricular and social activities.
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1. What different perspectives of health exist, within which Amelia might consider this issue? How would adopting different perspectives influence her thinking?
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If Amelia considered this from a preventative-medical perspective, she might consider primarily interventions with a clinical focus such as annual retinal screening or screening for coeliac disease or thyroid disease. If she approached it with a behavioural perspective, she might think about working to help young people change their lifestyles, especially around diet and exercise. If she was thinking about it from a socio-environmental perspective, she might be thinking about whether there are any structural barriers that make it harder for a young person to manage their condition. An example of such a barrier might be the high cost of transport to the hospital where they receive care.
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2. In designing interventions to promote the health and well being of young people diagnosed with diabetes; what health promotion models might Amelia use to guide her thinking?
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Amelia might use Tannahill's model of health promotion (Downie, 1996) which sees health promotion as being made up of three overlapping areas of health education, health protection and prevention. Alternatively she might use Beattie's model (1991), which identifies four domains of health promotion activity: health persuasion, legislative action, personal counselling and community development.
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3. Having reflected on these models, what interventions might Amelia come up with that might promote the health and well-being of young people diagnosed with diabetes?
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Correct answer:
Using Beattie's model of health promotion, Amelia came up with a number of different types of interventions. These included:
(a) A health persuasion intervention involving setting up and referring patients to a healthy lifestyles programme. This programme would be designed to provide education and information on issues such as diet and exercise for young people living with diabetes.
(b) A legislative action-based intervention. This would involve Amelia working with managers to try and change the diabetes unit policy on clinic times and home visits. The current policy means clinic times are during the school day and home visits are limited to exceptional cases. Amelia is concerned about the impact this has on patients' school attendance and wider well-being. She wants to work towards a system where out of school hours appointments or home visits can be made for children and young people, especially those in exam years.
(c) A community development intervention. This initiative would involve working in partnership with a diabetes charity to establish an empowerment-based user group attached to the diabetes clinic. This would aim to bring together young people to explore what makes it difficult to live with diabetes and identify areas that they could work together to change. Amelia would work to ensure that the group could feed any issues that related to the hospital and delivery of services into the management team.
(d) A personal counselling intervention. This would involve Amelia targeting those patients who appeared to have particular difficulties in managing their condition. Amelia would arrange a home visit with the patient and their family to look at problem-solving strategies. This might involve the use of motivational interviewing.
