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Evaluate the evidence for a self-management programme for a group of clients with a long-term condition, showing how you have considered the impact of social factors such as socio-economic status or gender or ethnicity on clients’ needs.

Evaluate the evidence for a self-management programme for a group of clients with a long-term condition, showing how you have considered the impact of social factors such as socio-economic status or gender or ethnicity on clients’ needs.

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An essay for the 2011 Undergraduate Awards Competition by Jonathan Scott. Originally submitted for Psychosociocultural influences on occupation and health at University of Ulster, with lecturer Karen Jeffers in the category of Social Studies
An essay for the 2011 Undergraduate Awards Competition by Jonathan Scott. Originally submitted for Psychosociocultural influences on occupation and health at University of Ulster, with lecturer Karen Jeffers in the category of Social Studies

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Published by: Undergraduate Awards on Aug 29, 2012
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12/04/2013

 
OTH311J1
Psychosociocultural Influences on Occupation and Health
 Assignment QuestionEvaluate the evidence for a self-management programme for a group of clients with a long-term condition showing how you have considered theimpact of social factors such as socio-economic status or gender or 
ethnicity on clients’ needs.
 Reference should be made to the relevant literature and the Harvardsystem of referencing must be used throughout the text and referencesection.
 
 Living with a long-term condition (LTC) requires multiple managementstrategies adjusted over time for changing symptoms, circumstances andfluctuations in the disease process. Consequently current thinking states that thepatient should play an integral role in the supervision of their condition (Warsi et al.,2004), and be understood as the agent who is predominantly responsible for implementing treatment through self-management (DeCoster, 2008). To supportclients in this endeavour, numerous (National Institute for Health and ClinicalExcellence (NICE), 2008) group based self-management programmes have beendesigned and are being delivered by health care providers. This essay aims to defineself-management, investigate the evidence surrounding these interventions and indoing so suggest good practice for such a group, based on client need, with regardto the particular LTC of Type 2 diabetes mellitus.Diabetes is a complex and time consuming condition (NICE, 2008). Over 90%of people with diabetes have Type 2 (The National Collaborating Centre for ChronicConditions (NCC-CC), 2009) and in Northern Ireland it is more common in older unskilled adults (McWhirter, 2004). It involves frequent visits to primary careproviders, requires comprehensive behaviour management (Longo and Schubert,2006) and is seen as an
isolating ‘invisible’ disease (Zerbiec, 2003
). It can bringfinancial difficulties, have a significant psychological impact and has been associatedwith depression (Carrier, 2009). Complications include heart disease, stroke,blindness, amputation and kidney failure. Northern Ireland remains the only part of the UK not to have a dedicated Service Framework for diabetes (Diabetes UK,2008), but does recommend effective, equitable and patient centred education andsupport for those diagnosed (Department of Health Social Services and PublicSafety Northern Ireland (DHSSPSNI), 2009).Becoming ill involves social, psychological and biological change (Taylor,2007). Self-management therefore can be understood simply
as the client’s ability to
deal with all that a LTC entails including symptoms, treatment, lifestyle changes,physical and social consequences (Carrier, 2009). This concept emerged from thework of Kate Lorig, Albert Bandura and others (Lorig et al.,1999) with the solidifyingof the Chronic Disease Self-Management Programme (CDSMP) in the early nineties
 
in America which was a move away from traditional one to one and didactic methodsof management. These ideas translated to the UK in the form of the Expert PatientsProgramme (EPP), retaining the key concepts of client centrality and empowerment(Stanford School of Medicine, 2010). Professionals are now seen as providing the
safety net above which client’s work to find their own best solution
to their particular LTC (Aldridge, 2005). Structured programmes have been designed to improve
people’s knowledge and skills and
help motivate them in taking control of their condition and by effective self-management (National Collaborating Centre for Chronic Conditions, 2009). However, guidelines require provision of an alternative of equal standard for those unable or unwilling (Clark and Hampson, 2001) toparticipate in group education (NICE, 2010), underscoring the commitment to clientautonomy (Department of Health, 2001).Recent Cochrane reviews have identified that group-based self-management strategies for people with type 2 diabetes are effective in improving anumber of outcomes (Deakin et al., 2005) and that there is no significant differencebetween individual education and usual care (Duke et al., 2009). Strong evidencetherefore supports this approach although none was found to be based in NorthernIreland.Disease epidemiology suggests that the potential local client populationcould be a sedentary mixed older adult group, unskilled, unemployed, poor and livingin deprived areas (Institute of Public Health in Ireland, 2010).Having limited personalsocio-economic resources to reduce threats to well-being has been identified as afactor in degrading the will and an ability to cope (Cockerham, 2002). Human healthbehaviour has to be understood in terms of the social contexts in which it takes place(Taylor, 2007).
Understanding the client’s normal environments is vital (Creek,
2008a).Currently, only two UK based programmes meet NICE criteria but both showgood evidence of positive outcomes for clients in the short and long term (Khunti etal., 2009 and Deakin et al., 2006) and therefore, along with further sound evidence,forms the basis of planning and design (Appendix A).The Diabetes Education andSelf-management for Ongoing and Newly Diagnosed Programme (DESMOND)provides six hours of structured group education for six to ten patients. Attendeesmay be accompanied by a person of their choice and delivery is by two healthcare

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