HEALTH EDUCATION

THE IMPORTANCE OF HEALTH EDUCATION AS AN INTEGRAL PART OF PRIMARY HEALTH CARE

by Kenneth Kee 1993

A Dissertation Presented in Partial Fulfilment of the Requirements for the Degree of Doctorate of Philosophy with a Major in Health Care Administration and approved in 1993

ABSTRACT OF DISSERTATION:

This paper examines how health education and promotion forms an integral part of the Primary Health Care System.

It also shows how the concept of health has changed from its original definition by the World Health Organization as a state of complete physical, mental and social well being and not merely the absence of of disease and infirmity to something more realistic, dynamic and measurable.

The original definition has been described as an ideal state which is rarely attainable in real life.

The definition of of health care has also changed from a hospital based curative medicine to one of Primary Health Care and Preventive Medicine.

Primary Health Care is emphasized as the cornerstone of all good health care systems.

The escalating cost of health care associated with high technology and hospital based medicine in the treatment and rehabilitation of chronic diseases has led to the realization among many health care providers that many of the risk factors in the chronic diseases can be prevented at the Primary health care level.

A more rational approach to the current health may require more of a preventable rather than a curative approach in medical treatment.

To this end health education and promotion has proved its importance in the fight against disease and form an integral part of the health care system.

This paper also examines some well known models of health education and promotion such as the Tanahill's model of identifying key groups and their roles in health education and the Green's Proceed-Precede planning framework which identifies various behavioral and environmental factors affecting health.

It recommends various strategies for the [promotion of health such as formulation of definite goals, intersectional collaboration in health education and community participation in health education and community participation.

This dissertation about health education has brought me more knowledge about health issues than 20 years of practice in the field of primary health care.

It has focused my mind on the very important field of preventive medicine and health education.

It has made me more determined than ever to continue my work as a health educator as well as a medical practitioner

It has made me even more aware of the need of continuous medical education to keep abreast of the latest advances in medicine.

Unless I continuously update my medical knowledge I will not be able to explain the latest medical advance to my patient.

Lastly I must always remember that it is the patient who will benefit from my knowledge and that knowledge is not to be kept but to be imparted.

In the words of Professor Rosalind Miller:

"it is a society with myopic vision that foster episodic medical care than health care that includes Primary prevention particularly for those at greatest risk and where social welfare and health problems are indispensable"

A Simple Guide to Diabetes Part 2

A Simple Guide to Diabetes Part 2
----------------------------------------

What is the treatment of Diabetes?
-----------------------------------------

Control of Diabetes
-----------------------

Diabetes is a chronic disease which cannot be cured.
It can be controlled to prevent the development of the above serious complications by :
Living a healthy lifestyle
--------------------------
1.diet -

Reduce your intake of sugar and sweet food
Increase intake of more high fibre and wholegrain food like brown rice, wholemeal bread and oats
Take food with less fat content like lean meat, fish, skinless poultry and low fat milk
Have at least 2 servings of vegetables and 2 servings of fruits a day
Use healthier methods of cooking such as grilling and steaming rather than deep frying and use less salt and sauces
Take multiple (4-6) small meals a day that contains enough complex carbohydrates (e.g. rice), some lean meat or fish and vegetables.
Have regular meals and avoid skipping meals
Do not overeat

2.regular exercise-

This helps your body to use glucose more efficiently
Frequency: 3-5 days per week(daily if low intensity)
Intensity: 60-85% of maximum heart rate till the patient feels warm or sweats and breathes deeply but easily
Time: 20-60 mins each time
Type: aerobic exercises like walking, jogging, swimming, cycling

For those who have not been active for some time should start with walking first, then increase to more active exercises

3.weight control -

lose extra body weight by proper dieting and exercise
Aim for half kg loss per week
Aim for a BMI of 18.5-22.9kg/m2

Insulin works better in a lean healthy body.

4.Avoid smoking-

smoking increases all the risks associated with diabetes

5.Avoid stress -

by meditation, yoga, deep breathing exercises

Medication for Diabetes
-----------------------------

1.oral tablets:

a. Insulin secretagogues - drugs that increase insulin release from pancreas

eg. glibenclamide, repaglinide
Side effects: low blood sugar

b.Insulin sensitisers- drugs that make insulin work better especially in muscles and liver
eg.metformin
side effects: gastric discomfort, metallic taste in mouth
eg. rosiglitazone
side effect: water retention

c. Alpha-glucosidase blocker -slows digestion of carbohydrates in the intestine

eg. acarbose
side effect: stomach discomfort, bloating, diarrhea

If the oral medicines even in combination cannot bring down the blood sugar, the insulin injection may be required either alone or together with oral medication.

2.insulin injections

Insulin is destroyed in the stomach so it cannot be taken orally and has to be given as an injection.
Best place to inject the insulin is in the abdominal area where there is a lot of subcutaneous fat.
Avoid 2 fingers around the navel and below the rib cage where there is a rich nerve supply and therefore more painful.
Injection is usually done in the morning and evening.
Night injection controls the glucose when the patient sleep and avoid early morning high glucose.

a.Rapid and short acting insulin

eg. regular soluble insulin
onset 30-60min, peak 2-4 hrs, duration 6-8 hrs

b.intermediate and long acting insulin

eg. NPH insulin
onset 1-4 hrs, peak 8-12 hrs, duration 12-20hr

c.premixed or biphasic insulin

eg. NPH/regular 70/30
more convenient and less injections

Important hygience tips:

Use needles once only
Mix well by shaking bottle or injection pen 20 times
Store all unused insulin in fridge(will keep until expiry date).
Do not freeze insulin.
Insulin in use can be kept at room temprature away from sunlight and direct heat and must be discarded 4-6 weeks after use

Follow the instructions very carefully and keep detailed records of your treatment.

Home blood glucose monitoring
--------------------------------------

1. monitor your progress with the help of your daily home blood glucose records.
Monitor;
a. before and after meals
b. before and after exercise
c. when feeling giddy to confirm low blood glucose
d. when sick and not eating well

Type 1 diabetes should be monitored 3-4 times a day

Type 2 non-insulin diabetes 1-2 times a day followed by 1 every 2-3 days

Type 2 insulin diabetes 2-3 times a day followed by 2-3 days a week.

Pregnant diabetic patient should also monitor their blood glucose daily

Aim for a Fasting Blood glucose 4.0 -7.0mmol/l
Blood HbA1c 4.5 -7.0

This will check if your diabetes is under control.

If not, you need more medicines or further change in diet.

High blood pressure and high blood cholesterol level
---------------------------------------------------------------

Reducing high blood pressure and high cholesterol level help to keep diabetes under control and protect against its complications.

Aim for a blood pressure of 130/80 or less
LDL cholesterol of 2.6mmol/l

Regular checkups is important in the treatment of Diabetes
-----------------------------------------------------------------------

1. Regular monthly checkups for diabetes until fully controlled, bimonthly after that.

2. Check for hypertension and heart disease at the same time

3. Check for high blood cholesterol once a year.

4. Check eyes once a year.

5. Check for kidney problems at least once a year.

6. Check teeth once a year

7. Check you feet for signs of infection, gangrene and neuropathy.

Foot care:
-------------

1. wash feet daily with soap and water
2. After washing ,dry thoroughly especially betwwen the toes
3. keep yor toe nails short,trimming them straight across to avoid ingrowing toenails
4. moisturise feet daily to prevent dryness and cracking of skin
5. examine feet daily for scratches, cuts, blisters and corn
6. use a mirror to check the sole of your feet
7. wear shoes that fit well and wear clean cotton socks which has loose fitting elastic tops
8.Avoid going barefoot
9.Seek prompt treatment for cuts and sores
10.annual review for foot ulcers,risk of neuropathy(poor sensation), blood circiulation( palpable pulses)

Health education
---------------------

It is important to increase your knowledge of diabetes and its complications.

With knowledge, diabetes can be more easily controlled.

A well controlled diabetic patient can live a normal life.