Psychological Factors In Diabetes Mellitus Health And Social Care Essay

mental Factors In Diabetes Mellitus wellness And Social C atomic number 18 Essay wellness psychology is a topical development in the integration of biomedical and social sciences in wellness billing. It addresses the role of psychological factors in the ca fall upon use of, progression, and way out of wellness and ailment (Ogden, 2007). Psychological theories back tooth guide wellness knowledge and promotion, and offer the health c be practitioner a structured approach to catch and playacting the health take ins of health and social c are service users (Morrison and Bennett, 2009). The quantifyment of health psychology cases quarter assist practitioners in evaluating their contri hardlyion to service users intelligence of health, conducts relating to health and the coiffe of health care. Appraisal and evaluation enable health care solveers to apply psychological illustrations and theories when analysing aspects of health and behavior relevant to practice (Marks et al, 2005).Health psychology is concerned primarily with intrinsic factors, especially undivided perceptions of health- touch ond behaviour. Health behaviour, defined as behaviour related to health spot, is adequate increasely main(prenominal). Public health policy has swop magnitude the emphasis on item-by-item responsibility and choice and because of this there is a corresponding absorb to mitigate understanding of private motivations that shine those choices and health-related behaviours (Marks et al, 2005). The health behaviours studied by psychologists are varied, just the some commonly studied health behaviours crap immediate or long-term implications for somebody health, and are partially inside the checker of the item-by-item (Ogden, 2007). persona 2 diabetes, formerly lie withn as non-insulin dependent diabetes mellitus, is a serious and progressive disease. It is inveterate in constitution and has no kn birth cure. It is the quadrupletth intimately common cause of closing in about developed countries (UK Prospective Diabetes Study Group, 1998a). Although no submit figures are available, it has been suggested that by the year 2010 there would be 3.5 million hatful with diabetes in the joined Kingdom (UK). However, approximately 750,000 of the estimated number whitethorn be undiagnosed (Diabetes UK, 2008a). Diabetes UK campaigns to raise alive(predicate)ness of role 2 diabetes because if left undiagnosed, the source tidy sum result in long-term complications much(prenominal)(prenominal) as retinopathy, nephropathy, neuropathy, and an increase stake of myocardial infarction and stroke. The total number of passel with diabetes has increased by 75% everywhere the last six years and the incidence in the UK is escalating at a faster rate than in the United States (Gonzlez et al, 2009).There is a higher incidence of instance 2 diabetes in tribe with South Asian or Afri apprize descent (Department of Health, 2007). angi o gosin-converting enzyme of the reasons for this is thought to be that these ethnic groups cast off increased insulin granting immunity. Signs of typesetters case 2 diabetes are al set present in UK children of South Asian and Afri abide-Caribbean contrast at ten years of age, match to search funded jointly by the British Heart Foundation and the Wellcome Trust (Whincup et al, 2010).The prevalence of type 2 diabetes increases with age to as much as one in ten in those aged 65 years. The flavour clip risk of evolution the school in the UK is greater than 10% (Leese, 1991). Diabetes-related complications can brook a major(ip)(ip) effect on the separate and family members, and are costly to the patient. A postulate undertaken by Bottomley (2001) examined the costs of living of patients with diabetes complications, including pickings time off work and transport costs for hospital appointments. The study showed that the cost of treating someone with type 2 diabetes with mi crovascular and macrovascular complications was 5,132 compared to 920 for someone who does non have diabetes-related complications (Bottomley 2001). This alike has implications for the National Health Service (NHS) in terms of the financial burden of managing and treating the condition and the use of resources. It has been estimated that the cost of treating diabetes nationally adds up to approximately 9% of the NHS annual budget, although most of that is use to treat associated long-term complications, much(prenominal)(prenominal) as kidney failure, blindness, amputations and organ transplantation, alternatively than the provision of medication (Bottomley, 2001).With regard to type 2 diabetes, psychological theories and models have a long history of informing contracts to change behaviour and break emotional well-being. Over recent years, m any(prenominal) clinical guidelines in the UK by the National Institute for Health and Clinical Excellence (NICE) have acknowledge recom mendations for psychological interventions for long-term conditions. Evidence-based recommendations have been make non only for the handling of associated mental health problems such as slump and anxiety (NICE, 2009 NICE, 2004) but likewise for sensual health conditions such as obesity (NICE, 2007) and ever- changing behaviour related to public health issues such as locoweed and lack of course session (NICE2007). The fair game of this essay is to explore the psychological implications for a person admiting from type 2 diabetes and others have-to doe with in the get a line of that illness.Type 2 diabetes, is caused as the result of dressd secretion of insulin and to encircling(prenominal) resistance to the action of insulin that is, the insulin in the body does not have its customary biological effect. It can much be markled by diet and exercise when first diagnosed, but many patients require oral hypoglycaemic agents or insulin in order to maintain satisfactory glyca emic statement and prevent the complications of diabetes (Diabetes UK, 2008a). To lose weight the risk of long-term complications, both macrovascular and microvascular, quite a little with type 2 diabetes need access to appropriate, individual(a)ised upbringing, which informs them about the risks associated with the condition. Information relating to livelinessstyle changes such as healthy eating, increasing activity levels, and smoking cessation are decisive (Diabetes UK, 2008a). well-nigh plenty accept their diagnosis of diabetes and all that this means, and manage to reconcile to their new lifestyle, but others find it difficult. Changes get out need to be made to the type of food they eat, the amount they eat of particular foods and perhaps to the time at which they eat their meals. As a consequence of the required changes to lifestyle, it is not surprising that many people need some headmaster psychological jut (Diabetes UK, 2008a).Diabetes whitethorn have an bear u pon on peoples careers, driving, and insurance policies (life, driving, and travel). Difficulties surround holidays, work or travel abroad whitethorn prove unclimbable without support. People with diabetes who are also caring for others, for example children or olden relatives, may find it very difficult to put themselves first (Diabetes UK, 2008a).Some people who have been diagnosed as having diabetes tint that they have been condemned to a life where everything has to be planned. There are, however, support networks available. For example Diabetes UK, a charity that supports people with diabetes, their families and the health headmasters who care for them, has local and regional branches where people can meet and discuss problems and learn from each other how they manage their day-to-day-life (Diabetes UK, 2008a).The majority of people with type 2 diabetes are insulin resistant. Obesity exacerbates insulin resistance. As many as 80% of people with type 2 diabetes are obese at the time of diagnosis (Marks, 1996). Weight loss not only improves insulin resistance, but also lowers gunstock glucose, lipid levels, and simple eye pressure. Cardiovascular disease is often present in people with type 2 diabetes. The presence of insulin resistance accelerates atherosclerosis, leading to macrovascular complications such as myocardial infarction, stroke, and peripheral vascular disease. The mechanisms responsible for(p) for this are thought to be hyperinsulinaemia, dyslipidaemia and hypertension (Garber, 1998). However, microvascular problems such as retinopathy, nephropathy, and neuropathy heretofore occur. The mechanism responsible is thought to be hyperglycaemia (Garber, 1998). Therefore, unattackable blood glucose control is of crucial importance.Although the prognosis for people with type 2 diabetes mellitus is slight than favourable, evidence has shown that making major lifestyle changes, such as having a healthy diet, smoking cessation, and increasing a ctivity levels, can reduce the risk of long-term complications (UK Prospective Diabetes Study Group, 1998a). However, using the scourge of long-term complications as a means of inducing lifestyle or behaviour changes has not proved to have any prolonged beneficial effect (Polonsky, 1999). continue support and appropriate education is required to empower individuals to take appoint of their condition and make appropriate and timely therapeutic decisions. The health care professional and the individual must decide on the most appropriate intervention regimen to provide optimum care and the best medical outcome (Marks et al, 2005). NICE published a document in 2008 entitled CG66 Type 2 diabetes which recommended that all people with diabetes should be offered structured education, provided by a trained specialist team of healthcare professionals (NICE, 2008). The utilisation of theoretical health psychology models can assist these specialist team practitioner in empowering individu als with type 2 diabetes to contemplate and instigate the changes in lifestyle behaviours such as smoking, lack of exercise and unhealthy eating habits that have adverse consequences on long-term health outcomes.With regard to health psychology, as previously mentioned, health psychology is concerned primarily with intrinsic factors, especially individual perceptions of health-related behaviour. Attributing health-related behaviours to inborn or impertinent factors has been discussed in relation to the opinion of a health locus of control. Individuals differ as to whether they regard events as governable by them (an internal locus of control) or uncontrollable by them (an external locus of control) (Ogden, 2007). Accessing diabetes related health go for testing or interference could be viewed from either perspective. The healthcare professional is perceive to be a powerful individual who can diagnose and treat diabetes (external) however, by accessing services the individual is taking responsibility for determining their own health status (internal). It is recyclable for the healthcare practitioner to retrieve that in attending diabetic health services the individual has made an initial step in taking control of their own health needs (Marks et al, 2005).Individuals with an internal locus of control are more promising to act in musical harmony with advice from a health professional than those with an external locus of control (Ogden, 2007). sharp this can assist practitioners in their communication style with individuals who have type 2 diabetes. Identifying the specific needs of the individual, by understanding their locus of control, can help the healthcare practitioner to tailor the assessment (Marks et al, 2005). When an individual has a sense of responsibility for actions or behaviours that exposed them to a potential risk of diabetic complications, the practitioner can work on exploring the circumstances that touch those behaviours. The ind ividual may al score feel motivated to change these circumstances. In the case of a client who does not recognise that their own behaviour or actions were a contributory factor in posing a risk of behaviour related complications, the practitioner should focus on developing the individuals level of awareness to shift their locus of control from the external to the internal. For example, the individual who perceives that taking responsibility for healthy eating use is always that of their provide (Ogden, 2007).Self-management for chronic illnesses such as type 2 diabetes requires adherence to sermon regimens and behavioral change, as well as the learning of new make out strategies, because symptoms have a great effect on many areas of life (Glasgow, 1991 Kravitz et al, 1993). For many individuals, optimum self-management is often difficult to achieve, as indicated by myopic rates of adherence to give-and-take, reduced quality of life, and poor psychological wellbeing, set up t hat are frequently reported in several chronic illnesses (Rubin and Peyrot, 1999). Self-management interventions aim to enable individuals to take control of their condition and be actively involved in management and treatment choices. In the 1980s, psychological supposition was use to develop theoretical models and their constructs have had a particular effect on the development of self-management interventions.The Health Belief theoretical account (Becker 1974) defines two related appraisal processes undertaken by the healthcare practitioner in partnership with an individual the threat of illness and the behavioral response to that threat. Threat appraisal involves consideration of the individuals perceived susceptibility to an illness and its anticipated severity. behavioural response involves considering the costs and benefits of gentle in behaviours likely to reduce the threat of disease. It can be useful for the healthcare practitioner to establish the clients perception o f risk and implications of their adverse health behaviours when discussing the reasons for healthy eating, increasing exercise, and smoking cessation. It is also important to discuss the likely tinge of diabetes on the individuals lifestyle and behaviour (Marks et al, 2005).The Health Belief Model can be applied to evaluate the risk of lifestyle changes. The healthcare professional can initiate structured discussion with the individual to name their educational needs, particularly around developing a realistic understanding of risk factors associated with diabetes and unhealthy eating habits, lack of exercise and smoking. It is important for the healthcare practitioner to discuss the efficacy of changes in the preceding(prenominal) in bar of diabetic complications, while discussing other methods of behaviour modification in mount (Marks et al, 2005). It is also important to establish that the individual feels confident in the practicalities of and behavioural change. Therefore, the healthcare practitioner must support the diabetic in behaviour change by giving practical health education advice on the issues of healthy eating, the benefits of exercise and the importance of giving up smoking (Marks et al, 2005).The trade protection want Theory (Rogers 1975, 1983) expands the Health Belief Model to include four elements that predict behavioural intentions to improve health-related behaviour, or intention to modify behaviour. These include self-efficacy, responsive effectiveness, severity, and vulnerability. In social cognitive theory, behaviour is thought to be affected by expectations, with individuals confidence in their ability to perform a given behaviour (self-efficacy) particularly important (Bandura, 1992). Therefore, self-efficacy can be verbalize to be the belief in ones ability to control personal actions (Bandura, 1992), and is alike(p) with the concept of internal locus of control. It is based on past fuck off and evokes behaviour concordan t with an individuals capabilities. Self-efficacy is distinct from unrealistic optimism and does not elicit excessive risk-taking (Ogden, 2007). Within the context of smoking and diabetes, an example of self-efficacy might be, I am confident that I can take responsibility for protecting myself from increasing the risk of further complications by giving up smoking. This concept has been used in self-management interventions through the teaching of skills, such as problem solve and goal setting, to increase self-efficacy. Again, in type 2 diabetes, this could mean the acquisition of knowledge relating to healthy eating principles and putting that knowledge into practice by bending foods that would make the blood glucose rise quickly. The goal would be to incorporate this behaviour into daily life on a long-term basis (Marks et al, 2005).Behavioural intention can also be predicted by severity, for example Diabetes go forth have serious implications for my health and lifestyle, but conversely, Good blood glucose control leave decrease the risk of diabetic complications. The fourth predictor of behavioural intention is vulnerability, which in the context of diabetes may be the likelihood of cardiovascular disease or diabetic retinopathy occurring. Rogers (1983) later suggested a fifth component of fear in response to education or information as a predictor of behavioural intention.The concepts of severity, vulnerability, and fear outlined in tribute Motivation Theory relate to the concept of threat appraisal, as discussed in the context of the Health Belief Model. Self-efficacy and response effectiveness, on the other hand, relate to the individuals lintel response, which is the behaviour intention. If a person has self-efficacy and perceives benefits in taking control of their actions (response effectiveness), they are likely to have the intention to modify their behaviour to reduce health risks (Ogden, 2007). Information or education that influences an ind ividuals emotional response can be environmental (external influence, such as advice from a health professional), or interpersonal (relating directly to past run across). Information and education contribute to an individuals self-efficacy. This in turn helps develop a robust internal locus of control and will inform and/or contribute to the individuals get by response (Marks et al, 2005). The make do response is considered to be adaptational (positive behavioural intention) or dysfunctional (avoidance or denial). Assessment of the individuals capacity to understand and apply information and to have an adaptive response is a live skill of the health professional. A maladaptive coping response, such as the denial of identified risk factors, has potentially serious consequences for the health of the individual (Marks et al, 2005). Successful implementation of the Protection Motivation Model can enable informed choice and empower the individual to take personal responsibility and control of behaviours influencing their health (Morrison and Bennett, 2009). Skilled speculative and the use of checking skills by the healthcare professional following information-giving are important to evaluate the benefit, if any, to the individual with diabetes (Ogden, 2007).Readiness to change is a concept derived from Prochaska and DiClementes (1983) transtheoretical model. It refers to how alert or ready individuals are to make changes to their behaviour. Interventions guided by this theory focus on individuals motivation to change and the approach is adapted according to differences in participants motivation to change behaviour. Success is achieved only when the individual is ready to take on the actions needed to change behaviour. An individual may know that smoking and type 2 diabetes are not a good combination. However, unless the person is ready to quit smoking, no amount of discussion with a healthcare professional will change the persons decision to continue smoki ng. Establishing an internal motivator is a good first step to assessing an individuals readiness to change, however, an individual also needs to feel that the time is right and that they are hustling to change. Readiness to change can be assessed by asking individuals, as soon as the potential problem is identified, whether they have ever try to change the behaviour before. Six stages of change were identified in Prochaska and DiClementes (1983) Transtheoretical model of behaviour change Pre-contemplation Contemplation Preparation Action Maintenance and Relapse. just about people (around 60%) will be at the pre-contemplation stage when they are identified by the healthcare practitioner and will generally oppose in a closed way to the idea of change (Prochaska and Goldstein, 1991). They may be rebellious to the idea, they may rationalise their current behaviour or be resigned to it, or they may be reluctant to consider the opening of change (Prochaska and Goldstein, 1991). In this situation, it is tempting to push people into making an sample at behaviour change using their health as a motivator or by making them feel guilty. However, this is likely to cheer the individual to either lie about their behaviour or avoid the nurse completely. During the contemplation phase, it is suggested that individuals who are starting to consider change count on for information about their current and proposed behaviours, and analyse the risks involved in changing or maintaining their current behaviour. The most appropriate action is to ask the individual to formalise the analytical process by undertaking a decisional sense of balance exercise (Health Education Authority (HEA), 1996). In this exercise the person is asked to consider the positive and negative implications of maintaining or changing their behaviour. The individual then decides whether maintaining or changing the behaviour will give them increased positive outcomes, and if they are willing to attempt the c hange. To be at the preparation stage, individuals need to conceptualise that their behaviour is causing a problem, that their health or wellbeing will improve if they change the behaviour, and that they have a good chance of conquest (Prochaska and Goldstein, 1991). Once the healthcare practitioner establishes that the individual has an internal motivator and is ready to make an attempt at behaviour change, a supportive treatment plan is needed. Individuals who are in the process of behaviour change, or who have achieved and are maintaining the new behaviour, need help to avoid relapse (Prochaska and Goldstein, 1991). The most effective way to do this is to ask the individual to reflect on their experiences so far.Apart from taking into account the management behavioural change for those with type 2 diabetes, it is also of vital importance that there is a consideration the emotional push of a diabetes diagnosis and living with the condition. How patients feel when presented with the diagnosis of a chronic illness such as diabetes can have an enormous impact on their lives, and on their ability to make emotional adjustments to the disease itself (Marks et al, 2005). enquiry has ground that that the diagnosis of a chronic illness can have a strong emotional impact on individuals, with reactions of grief, denial and depression. The emotional aspects of developing and coping with diabetes can affect overall control of the disease profoundly. Similarly, these feeling may form a barrier to effective listening and learning during the consultation process and any future self-management strategies. Therefore, it is proposed that this should be taken into consideration when developing educational programmes and protocols for people with diabetes (Thoolen et al, 2008).Coping and adapting to a long-term chronic illness is a major theme in health psychology (Ogden, 2007). Leventhal Nerenz (1985) propose that individuals have their own common sense beliefs about their illness. These include identity diagnosis (diabetes) and symptoms (elevated blood sugar levels, excessive hunger and excessive thirst). Perceived cause of illness test, a virus, unhealthy lifestyle. Time line acute or chronic. Consequences physical (pain, mobility problems) and emotional (lack of social contact, anxiety). Cure and control for example by taking medication or getting plenty of rest. With regard to adapting to an illness such as diabetes, the stress coping model of Lazarus and Folkman (1984) Transactional model of stress is the concept that is most widely utilised.The model suggests that there are key factors in adaptation to chronic illness, disease-specific coping efforts, changes in illness representation over time, interaction between psychological reality of disease and affective response, procedures for coping with the disease and interaction with context. The stress coping model (Lazarus and Folkman, 1984) emphasises the value of coping strategies to deal with a particular condition. Self-management strategies based on this model attempt to improve the individuals coping strategies. In type 2 diabetes, people are faced with the prospect of long-term complications caused by the condition. If people are aware of these possibilities and also that productive treatment is, available it makes a diagnosis of such problems less daunting. However, there are limitations to this model. It is debated that it is a frame of reference, not a theory that ignores specific features of the illness. The situation dimension poorly represented and it is not specific. The model also neglects interactions with context (e.g. social support, other life events) and offers no account of life goals on illness representation and coping (Ogden, 2007). It is of vital importance that stress is controlled and managed in an individual with type 2 diabetes. Research has shown a link between stress as a causal factor and that stress has been found to be a factor in regulat ion of blood glucose regulation. Sepa et al (2005) found that family stress has a profound impact on the and development of diabetes among infants. With regard to stress and metabolic control, research has found that stressful life events predict poor glucose control. In a study by Surwit et al, (2002) the management of stress was found to improve glucose control.Therefore, it is posited that the impact of stress can affect diabetes adversely and any interventions to manage stress may be a worthwhile component of diabetes education programs.An supernumerary influence on coping and adapting to living with diabetes and the development of self-management strategies has come from clinical psychology, particularly Cognitive Behavioural Therapies (CBT). Central to these therapies is the importance of attempting to change how people think about their illness and themselves, and how their thoughts affect their behaviour. Depression is one of the most common psychological problems among in dividuals with diabetes, and is associated with worse treatment adherence and clinical outcomes (Gonzalez et al, 2010). A randomised controlled trial (RCT) undertaken by Lustman et al, (2008) found that the percentage of patients achieving remission of depression was greater in the CBT group than in the control group. Although the research found that there was no difference in the mean glycosylated haemoglobin levels of the groups post-treatment, finish mean glycosylated haemoglobin levels were significantly better in the CBT group than in the control group. Therefore, it is debated that the combination of CBT and supportive diabetes education is an effective non-pharmacologic treatment for major depression in patients with type 2 diabetes. It may also be associated with improved glycaemic control. It is important to note however, that certain limitation apply to the above study that may have an effect on the findings.The generalizability of the findings is uncertain. The study was special to a relatively small number of patients. Similarly, the follow-up interval was trammel to the 6 months forthwith after treatment. Likewise, the researcher cannot exclude the possibility that CBT and diabetes education interacted in a way that potentiated antidepressant effectiveness analogous interactions may have occurred in many clinical trials. Further studies comparing CBT and diabetes education, singly and in combination, are needed to answer such questions and to see whether successful CBT alone is sufficient to produce glycaemic improvement. Correspondingly, it is worth noting that patients in the CBT group had education almost a full year longer than controls. The difference in education was not statistically significant, but the extra educational experience may have contributed to improved outcome in the CBT group. Finally, treatment was administered by a single psychologist experienced in the use of CBT. Whether treatment would be as effective when administer ed by other therapists is uncertain.For any person with type 2 diabetes to engage in any self-management strategy, good mental health is necessary. However, studies have shown reduced self-worth and/or anxiety in more than 40% of people with diabetes (Anderson et al, 2001). There are several possible reasons for this. Being diagnosed with diabetes immediately poses major concerns for the individual, including what the future holds in terms of health, finance, and family relationships. Although everyone deals with diagnosis differently, for some it can cause immediate stress, including feelings of shock or guilt. Some individuals may also be ashamed and want to keep the diagnosis a secret. Others may be relieved to know what is causing the symptoms they have been experiencing. An Audit guardianship (2000) report acknowledged that people with diabetes are more likely to suffer from clinical depression than those in the general population. The report then went on to specify that there fore, diabetes services should make explicit provision for psychological support and should monitor the psychological outcomes of care.In conclusion, to be successful in changing behaviour to negate the complications of type 2 diabetes, individuals need to decide for themselves which behaviours are undesirable, that is, which behaviours could have negative health, financial, social or psychological implications. People with diabetes also need to feel that the negative impact of risky health behaviours will be reduced or altered if they change their behaviour. It is important that individuals have confidence in their ability to make and maintain behavioural changes. It is not the health practitioners role to make this judgement or impose his or her beliefs. To support behavioural change, healthcare professionals need to feel comfortable in discussing lifestyle behaviours. They also need to assess an individuals preparedness to make a change and chance upon the factors that motivate them to change. The application of health psychology models, such as the Health Belief Model, the Protection Motivation Theory and the Transtheoretical model of behaviour change, to the management process can enable healthcare practitioners to assess contributory factors to health behaviours. Applying models can also help to identify motivators and barriers to health-improving and health-protecting behaviours, and identify strategies which assist the person in behavioural change. The role of the healthcare professional is to enable individuals to make an informed choice by working in partnership with them to decide when and if behaviour change is desirable. By understanding how an individual copes and adapts to living with a long-term condition such as diabetes can assist in empowering individuals to managed stress that appears to have a negative impact on blood glucose levels. Correspondingly, the use of CBT as a non-pharmacological treatment has been shown to improve depression th at is often apparent in individuals with diabetes. Healthcare practioners caring for those with diabetes should be trained in the use of CBT.