Normative and Felt Needs Assessment Thesis

Normative and Felt Needs Assessment

Normative and Felt Need Assessment

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Over the last several years, the issue of Type 2 Diabetes Mellitus (T2DM) has been continually brought to the forefront. This is because an increasing number of minorities have been affected by this condition, in comparison with other population groups. In Australia, this has been having a dramatic effect upon Aborigines, who are 10 to 30% more likely to suffer from this condition than the rest of the population. (Summary 2010) As a result, growing concern is taking place among health officials, who are worried that the number of people suffering from the condition could increase. Especially when you consider the fact that six out of every 10 Aborigines are considered to be obese. To determine the overall scope of the problem: a needs assessment and felt assessment must be conducted. Where, both will concentrate on the Aborigine men and women, between the ages of 25 to 64 years old, living in Onkaparina. Once these two different examinations are complete, it will provide more insights into the overall scope of the problem.

Normative Needs Assessment

Relevant Health Data

Type 2 Diabetes is when the body is unable to break down blood sugar. Most people that develop the disease need to take insulin to control these levels (at some point). As the pancreas will turn food that is digested, into sugar instead of energy (which increases these levels). This is different from a normal person, where the pancreas will turn the food that is digested into energy. The major causes of the diseases would include: obesity, a lack of physical exercise, genetics, diet, poor standards of living and reduced access to medical care. As most people who suffer from the condition are not eating the proper amounts of: fruits and vegetables as part of their dietary needs. Where, this will help contribute to onset of the different symptoms, as the body is continuing to receive excessive amounts of sugar and fat. Over the course of time, this will cause the pancreas to become more inefficient at turning these foods into energy, which will cause blood sugar levels and the weight of the individual to increase. The various symptoms of diabetics would include: fatigue, frequent urination, blurry vision, increased hunger / thirst and erectile dysfunction. If the condition is not treated through insulin shots or medication, a number of complications could develop to include: glaucoma, heart disease, kidney disease, paralysis and possibly death. (Diabetes 2010) (Summary 2010) This is significant, because it provide a basic foundation as to what are the symptoms of the disease. In general, the overall diabetes rates for Australian are 3.5% of the population. (Diabetes 2010) Yet, when you look beyond the general statistics, it is clear that the number of case will rise dramatically when you look at Aborigines. This is because this sub-group of the population is suffering from one of the many different risk factors that were mentioned above. Evidence of this can be seen with a report conducted by the Institute of Health and Welfare, which found that 57% of Aborigines age 15 and over are considered to be obese. (Diabetes 2008) This is important, because with such a large portion of this sub-group suffering from this condition, it means that vast disparities could be occurring in the underlying health of Australians. In the areas of health care expenditures, the contrast between Australian society and Aborigines is obvious, with most of society spending less than 2% of their expenditures on health care services. While, Aborigines spend 17% or more of their income on health care services. At the same time, most of Australian society is more inclined to seek preventive health care services such as: physicals. Where, 85% of the population has visited their doctors at least once a year. This has caused the most common forms of death for males to be heart disease, while females have the highest mortality rates for breast cancer. When you compare this with Aborigines, they have the highest rates of heart disease and diabetes in the world. (Australia’s Health 2008) This is important, because it shows how some kind of disparity is occurring in Australian society, with the health of most Australians improving. Yet, the health of Aborigines is becoming worse.

According to the Australian Bureau of Statistics, Aborigines account for between: 418, 800 to 476,900 people living in the commonwealth. (Aboriginal Health 2010) This makes up .5% of the total population. Out of this number, the total amount of diabetics is: estimated to be between 41,880 to 143,070 people. The reason why this is occurring is because the lower income levels of this segment of the population, is causing their dietary choices to limited. Where, most people will choose the most affordable alternative. In this case, it more than likely would be some kind of unhealthy snack, as opposed to fruit and vegetables. Evidence of this can be seen by looking no further than the likelihood that indigenous people would eat fruit and vegetables. According to the AIHW, they found that Aborigines were 7 times less likely to eat vegetables and likely to eat fruits (in comparison with the rest of the population). At the same time, most indigenous people live in rural areas and are further away from various health care facilities. (Diabetes 2008)

This is significant, because it is highlighting how a whole host of social / economic issues could be contributing to the problem of high T2DM. Where, the different issues such as: poverty and a lack of affordable access to quality health care services are helping to contribute to the problem. With, poverty limiting the overall choices that many people will have as far as nutritional foods are concerned. Meaning, that because so many are living at or near poverty line, they cannot be picky about what kinds of foods they want to eat. Instead, they must eat those foods that are most affordable or not eat at all. Then, when you combine this with the lack of health care services in many rural areas, means that a number of Aborigines are unaware of various dietary needs. This causes most people not to be educated about various aspect of nutrition. At which point, they do not know what are the proper levels of nutrition, which helps make the problem worse. At the same time, this lack of access to health care in many rural areas; means that preventive medicine is not being practiced. This is when you are routinely screening for a variety of health conditions. Given the fact that health care services are more difficult to find in these areas and many are coming from a lower economic background. The chances increase dramatically that large segments of Aborigines would more than likely be: overweight and engage in a lack of physical activity. In many ways one could argue, that the lack of access to preventive health care services is causing, the underlying levels of health to decline. As the limited visits with health care professionals, will mean that the chances to: diagnose and treat conditions early decrease. Once this condition begins to become worse, is when the underlying levels of health in the individual will begin to decline. This will cause the overall amount of spending on health care services to increase and it will place an added strain on the local economy. As a result, one could take the information that was discussed earlier on health care expenditures and theorize; that the lack of health care services in rural areas is causing an increase in diabetes cases. This will cause the costs in treating the conditions to be more expensive. These two elements are two of the main causes of: diabetes and can directly be tied to the obesity epidemic in Aborigines. Where, the lower social / economic class and the lack of access to affordable health care services; have caused the common symptoms of the disease to appear in a variety of individuals.

What all of this shows, is that on a national level, the overall cases of diabetes are becoming more severe in Aborigines. Part of the reason for this is because the social / economic conditions that they endure are contributing to the problem. Where, the lack of health care services in many areas and the underlying levels of poverty are making the situation worse. As these two issues, are causing the overall levels in obesity to increase from the lack of proper diet, exercise and the inability to receive preventive health care. When you put all of these different elements together; this highlight why the underlying obesity problem, is so severe in the Aboriginal sub-culture, as opposed to the rest of Australian society. This means that the government should aggressively target the most at risk individuals, within this population demographic. Where, they should focus on eating fruits / vegetables and receiving the proper amount of exercise. Otherwise, the vast disparities between the Aborigines and the rest of Australia society will become worse.

Target Group and their Local Government

To determine the actual effects of diabetes on the indigenous population, you must examine the areas where many of these individuals live. This will provide insights as to possible issues that could be contributing to the problem by: examining the policies of the local government, looking at relevant health statistics, determining fruit / vegetable consumption and looking at the different support services / infrastructure. These different elements are important, because they provide insights about how the local community could be contributing to the problem. If you can see how these factors are affecting a particular community, then the government can begin to design intervention strategies to reduce the overall effects. Once this takes place, is when you can see how this demographic of 25 to 64-year-olds can be effectively targeted for an intervention.

A description of the Local Government and relevant socio-demographic characteristics of the population.

When you look at the City of Onkaparinga, it is clear that the majority of the population would fall within the age demographic for both males and females. Evidence of this can be seen by looking no further than the number of residents that live between the ages of 24 to 54 years old, which makes up 48. 3% of the population (72, 264). Then, when you look at the total number of residents that are between 60 and 64 years old, it is obvious that the number of resident within this demographic are well over 50% of the population. As this sub-group would account for 7,514 of the community’s total inhabitants. This means that the total number of people in the community within the targeted age group would be 79,778 (72,246 + 7,514 =79,778). (Age Structure 2009) The total number of Aborigines that are in this population group would be 684 people or .85%. (Indigenous Profile 2009) The weekly income for most of the community will range between: $150.00 to $799.00. Below charts illustrate the difference between the total population of the community in the targeted age group and the indigenous demographic.

(Age Structure 2009)

(Individual Incomes 2009)

What this shows is that the majority of the community is within the national population demographics of Australia. As the total number of Aborigines account for a small portion of the community

Relevant health status information including the prevalence of T2DM and related risk factors amongst this group

Within the community the total number of diabetes cases has been steadily rising between 2005 and 2008. Where, the number would increase from: 4.9% of the population to 8.3%. When you look at the total amount of obesity within the community, this number has been consistently increasing. With the rate going from: 37.4% in 2005 to 42.4% in 2008. When you compare this with the national average of 10 to 30% of Aborigines being diabetics, it means that community is seeing between 68 and 205 people affected by the condition. (Chronic Conditions 2009) Depending upon which number you are looking at, the total diabetes rates among the indigenous demographic could be slightly above the average to almost triple the diabetes rates of the community. The reason why such a broad range is given is because of the fact that many of the Aborigines do not have access to variety of health care services. This means, that large segments of the population could be affected by the condition and may not know it. The below charts illustrate the underlying trends.

(Chronic Conditions 2009)

(Chronic Conditions 2009)

(Chronic Conditions 2009)

Information on their vegetable and fruit consumption.

When you look at the food and vegetable intake with the community, it is clear that two opposite trends have been occurring. Where, the total amount of insufficient vegetable intake would increase. As this number, would rise from 86.8% of the community in 2005 to 90.7% in 2008. While the number of people not receiving the proper amount of daily fruit intake, would decrease from: 60.3% in 2005 to 56.7%. (Chronic Conditions 2009) The below charts illustrate these changes that are taking place, as far as nutritional standards are concerned.

(Chronic Conditions 2009)

(Chronic Conditions 2009)

What all of this information shows, is that the community is having a divergence in their nutritional needs. Where, the majority have been eating more fruit and fewer vegetables. While this is good start (as far as fruit is concerned) the fact that the majority of community is not consuming these different foods one a regular basis, is evidence why the obesity and diabetes rates are increasing. As result, one could infer that these two factors are having an equally devastating impact upon the indigenous community.

A profile of relevant health & community services and community infrastructure in the local government area (with a view of highlighting accessibility or gaps in services and opportunities for potential collaboration and partnerships.

On the national level a number of different programs are funded through: Acting on Australia’s Weight, Draft National Physical Activity Guidelines, Active Australia and the Obesity & Prevention Lifestyle Programs. These are used to fund various anti-obesity efforts on a local level that are targeted toward children. (OPAL 2009) (National Focus for Government Action 2009) In the City of Onkaparinga there are a number of different services that are offered to residents including: counseling services, diabetes support groups, diet / nutrition services and exercise groups. In general, most of these services are free, with the exception of the exercise group (where there is a fee that must be paid). On the surface it appears as if these different programs are providing a solid foundation for addressing the diabetes epidemic and the symptoms associated with it. Yet, when you look beneath the surface it is clear that these programs are often limited in size and the hours they are available for operation. A good example of this can be seen with the diabetes, exercise and diet / nutrition programs. Where, the diabetes program is limited as far as bookings and the total number support groups available. The exercise program only focuses on Thi Chi (a form of martial arts). While, the diet / nutrition program has limited number of courses and times that they are offered. These different areas are important, because they highlight why the obesity problem in the community is becoming worse. As the overall number and availability of various support / preventive programs are limited as far as size and the hours of operation. Then, when you look at the choices that are offered by some classes (such as the exercise class only offering Thi Chi), it is obvious that a lack of funding is taking place. This is problematic, because it is not addressing the problem with the general community, as only a limited number of resources are dedicated to the issue. Given the overall number of obesity and diabetes cases, these programs are too small in scope to make any kind of a difference. As a result, one could infer that the increase in the number of people eating fruit was the direct result of these efforts. Yet, because a large enough of resources was not dedicated to the problem, the rates of: diabetes and obesity would increase. Therefore, one could infer that until the proper amount of resources is dedicated to the problem, it will only become worse, until serious steps are taken to address the situation. (Southern Primary Health 2001)

Felt Needs Assessment

Describe the selected method for surveying the felt needs of your target group.

To determine the felt needs of the community some kind of examination be conducted of the target group. The best way to collect the data would be to use the internet and pen / paper, as a way for each of the different individuals to respond to series of different questions about how and why they do / do not consume fruit / vegetables. At the same time, there will be an emphasis on identifying why no one is engaging as much physical activity as they should. The survey can be implemented by working with: local schools, health clinics and community outreach groups. Where, you will send out invitations to these various organizations. The different groups will meet informally, where the session would begin by offering respondents something to drink such: as coffee or soda. The sample population would be divided into two different subgroups. Once this is accomplished, you would focus the survey on: the attitudes and viewpoints of the indigenous population. The best way to understand the overall attitudes about diet / exercise would be: to survey children in school and then survey different respondents at health clinics. Since the information is being collected over the internet, means that researchers will be able to categorize the different response. Once this takes place, you would communicate the results of the findings to stakeholders through an email communication (that will have a written report). At which point, the different results would allow health officials to design a customized program that will reach out to the indigenous population. Where, they can be able to target their message based upon specific factors that could be affecting perceptions, as to why someone is not eating properly or remaining active. The plan will involve what is known as sampling, this is where you will survey a small portion of the population and will make inferences about the overall issues that are occurring. The possible limitations and barriers could include: the lack of access to the internet and the ability to conduct effective follow up. To counter these issues, a written survey could be provided to the targeted group and then the different response could be entered into electronic form later. If this kind of an approach was taken for conducting the survey, it would help to accurately sample and assess the various views / attitudes, about health from the indigenous population.

Survey Tools

Tool is appropriate for target group with regards to selected method, content, layout and language used.

The survey tool that would be utilized to address community perceptions about nutrition and health will be in the form of a survey that will be given. The different questions will be targeted to address specific aspects that are relevant to diabetes and the various symptoms. For example, a general section will ask for respondents to answer lifestyle questions about how frequently they exercise and eat healthy foods. Then, a second section of the survey will ask respondents specifically their perceptions of fruit / vegetables and why they do not eat them. This will allow researchers to see specific and general factors that could be contributing to the increase in people susceptible to diabetes. Once this take place, you would then have two different groups. One group would be: the general community. While the second group, will target the indigenous community. At which point, the results from the two surveys can be compared with one another, to determine the views that are contributing to the problem and the overall severity of the situation. There would then be continuous follow up in the months / years after the survey was complete, to see the overall effect that government programs are having on both groups.

Survey questions consider individual, environmental & social factors affecting fruit and vegetable consumption

Utilizing this kind of survey tool will address the specific factors that could be contributing to the problem, by asking a variety of questions and then examining the different responses. This would include looking at: individual factors, attitudes / behaviors, environmental factors and social factors. Where, the surveys would ask both general and specific questions to determine the thoughts as well as frequency of the different patterns are occurring. Then, comparing the results of Aborigines with that of the community would help to provide an accurate assessment, as to what specific factors are contributing to the problem.

Survey questions are relevant, useful and logical

The different questions from the survey will help various health officials to know how they can begin addressing the problem, within the at risk population group. Over the course of time, this kind of survey allows communities to focus the various resources to the areas where they are most needed. This is how the community can be able to slowly reverse the rising obesity and diabetes rates.

Clearly, the issue of obesity is becoming a major factor that is affecting the underlying levels of health in the indigenous community and is contributing to the increases in diabetes cases. In the City of Onkaparinga, these issues are more of a challenge as the underlying levels of: obesity, lack of vegetable consumption and diabetes cases have been rising dramatically in the general population. Give the fact that Aborigines have higher rates for diabetes than the general public, means that the overall number of cases in this sub-group could be skyrocketing. This is because the weekly income of community is fairly low (with most salaries ranging between: $150.00 to $700.00 per week). Then, there is a lack of infrastructure to help support a healthy lifestyle. To determine how to reach out to most at risk population groups requires conducting a survey that will ask: how often respondents eat fruit / vegetables and engage in physical activity. Then, the different responses will be divided between the indigenous community and the general population of Onkaparinga. Once this takes place, it will provide specific factors that are causing the problem and the general trends that are taking place. This information will help health officials in designing an intervention program, that will reach out to the at risk groups within this population demographic.


Aborigonal Health, 2010, MMHR, viewed 16 August 2010

Age Structure, 2009, City of Onkaparinga, viewed 17 August 2010

Australia’s Health, 2008, AIHW viewed 15 August 2010,

Chronic Conditions, 2009, City of Onkaparinga, viewed 17 August 2010

City of Onkaparinga, 2010, Onkaparinga City, viewed 17 August 2008

Community Profile, 2010, City of Onkaparinga, viewed 17 August 2010

Diabetes, 2008, AIHW, viewed 15 August 2010

Diabetes, 2010, AIHW viewed 15 August 2010

Indigenous Australians, 2009, AIGW, viewed 17 August 2010

Indigenous Profile, 2009, City of Onkaparinga, viewed 17 August 2010

Individual Incomes, 2009, City of Onkaparinga, viewed 17 August 2010

Labor Force Participation, 2009, City of Onkaparinga, viewed 17 August 2010

National Focus for Government Action, 2010, Department of Health and Aging, viewed 18 August 2010
OPAL, 2009, Government of South Australia, viewed 18 August 2010.

Southern Primary Health, 2001, Care Link, views 18 August 2010

Summary, 2010, Better Health, viewed 15 August 2010,

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