Introduction
Community-based interventions are useful in preventing and managing health concerns such as
communicable diseases, chronic diseases, and other forms that pose threat to people’s wellbeing.
Community interventions can be multifaceted encompassing both behavioural and educative
initiatives including lifestyle modification, psychosocial approaches, physical activity and
exercise, nutrition education, and counselling (Gyawali et al., 2019). The interventions are
delivered by a range of community health workers including community nurses, community
nutritionists, and social workers. This purpose of this report is to discuss the use of community
based interaction, strategies, community capacity building domains, and health promotion
approaches as roadmaps in implementing a program to address Type 2 diabetes.
Part 1: Identify a preventable health concern in which you are interested, such as dengue
fever or type 2 diabetes. Using Laverack’s ladder of community-based interaction as a
guide, describe three key strategies that you might use to engage with a community to
implement a program to address this health concern (Module 1).
Health Concern-Type 2 Diabetes
Type 2 Diabetes is a preventable health concern which burdens many middle-income and low-
income countries. It manifests in the form of hyperglycaemia triggered by insufficient insulin
production. Type 2-diabetes is almost at epidemic levels across the globe as it affects more than
400 million people, a number projected to surpass 600 million people by 2040 (Al-Lawati,
2017). According to Greenberg & Deckelbaum (2916), increasing trends in sedentary lifestyle
and inadequate health care coverage are key contributory risk factors. Scholars are alarmed that
prediabetes is also on the rise increasing the risk that people with a normal blood glucose level
will develop diabetes within the next decade (Gyawali et al., 2019). Adequate blood glucose
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control is a crucial step in diabetes management. Community based approaches that incentivize
people to reduce blood glucose levels lead to substantial reductions in development of diabetic
cases. The involvement of trained community workers greatly reduces contraction risks through
behavioural change to combat diabetes risk factors.
Laverack defines communities not just as people who are connected geographically, but people
who share both geographic and social characteristics. A community is typically characterised by:
the identification of shared needs and concerns; social interactions that are dynamic and bind
people into relationships; non-spatial dimensions such as identities, and spatial dimensions such
as places or locales (Laverack, 2007). It is possible for an individual to belong to different
communities at the same time. Diversity in communities can occasionally create friction. It is
important for community health practitioners to identify the legitimate community
representatives to avoid dictation of community issues by a minority.
The key role of the practitioner is to empower the community through providing resources and
technical assistance in a bottom-up approach. Laverack’s ladder of community-based interaction
sets out several community-based concepts that can be used to counteract Type 2 Diabetes. They
include community empowerment, community action, community capacity, community
development, community organization, community engagement, community participation, and
community readiness (Laverack, 2007). This study narrows down on three main strategies
namely community engagement, community capacity, and community empowerment.
Community engagement refers to the collaborative process between the community and an
outside agency where the people in the community formulate solutions to the issues that they
face in their lives. It entails formulation of partnerships that change relationships, influence
systems, and mobilize resources (Laverack, 2007). When implementing this strategy, it is
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imperative to ensure that solutions come from the community rather than ‘for’ or ‘to’ the
community (Harris et al., 2015). The community has to be fully involved in studying and
designing the relevant interventions informed by their values, interests, and perspectives. The
community engagement should be holistic as it must involve healthcare institutions and local
government administrative structures. Holistic involvement is particularly essential because
diabetes affects more than eight per cent of the adult population in the world and is the eighth
leading course of death (Gyawali et al., 2019). It tends to affect vulnerable communities who
face disproportionate socio-economic disadvantages.
Community capacity refers to systematically building the attributes and assets of communities
within a program context by unpacking areas of domains or influence. Community capacity can
be a strategic asset in increasing awareness of the risks for Type 2 Diabetes and addressing them
in a manner that is culturally appropriate. Capacity building a community helps members to
identify the underlying causes of Type 2 diabetes such as hypertension (Gyawali et al., 2019).
Community members are also able to identify how they can seek long term solutions to other
associated problems. For instance, poor diet due to poverty is a contributory factor to Type 2
Diabetes. Capacity building a community while involving all actors can include integrating
health determinants with other welfare and social programs (Harris et al., 2015). Social
protection could be the only way that vulnerable members in the community can afford to make
healthcare and dietary changes.
Community empowerment refers to the process of ensuring that communities take control over
the resources and decisions that govern their lives including the social determinants of health.
The community gets to get a perception of liberation after a struggle of to take back control
(Laverack, 2007). Most communities that are disposable to Type 2 diabetes exist in
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marginalized peripheries. Community empowerment is important to ensure that diabetes
prevention and health promotion approaches are culturally adapted (Harris et al., 2015).
Empowerment can be attained through better collaboration between local community
associations and formal institutions to reach the most at risk population. Diabetes prevention
brochures, for instance, can be translated into local languages in neighbourhoods with migrant
communities.
Part 2: Discuss how you could use the core domains of capacity-building identified by
Liberato et al (2011) to support the journey to community empowerment and ownership of a
prevention program for your chosen health concern (Module 1).
Liberato et al (2011) identifies nine core domains of capacity building communities. They
include development pathway, communication, sense of community, assets-based approach,
participatory decision-making, leadership, partnership/networking/linkages, resource
mobilization, skills development, and learning opportunities. I would use the core domains to
support the central involvement of communities in the Type 2 Diabetes prevention program by
ensuring individual and collective participation in the planning stages and implementation
delivery of the program. The program would mainstream equity to ensure that the community
has a voice in the rollout of the program.
Cantering the community according to the domains of capacity building ensures that there is
increased community ability to respond to any Type 2 Diabetes threat; increased competence and
passion for health action and reform at the local level, better use of resources, and better reach of
the affected community (Liberato et al., 2011). In applying the development pathway domain, I
would ensure that there are sustainable methods for the prevention program to survive beyond
the immediate future. Sustainability can be ensured by training community member to be trainers
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of trainers and ensuring that there is inter-generational exchange of the information provided
(Harriset al., 2015). Communication is a critical core domain which can be mainstreamed by
ensuring that there are published communication protocols. The prevention program I would
design would ensure that all communication is channelled through the community and their
feedback is incorporated before rolling out any interventions.
A sense of community is a critical component of capacity building without which the
implementation of the program would falter. A sense of community can be created by ensuring
that members are there for one another during health tests or any other difficult times (Liberato et
al., 2011). Members can also be encouraged to shop together at a local organic store to minimize
the risks of indulging in unhealthy diets. An assets-based approach is critical to program
execution since it involves emphasizing the positive attributes of the people and their
communities. The starting point of the program should be the strengths that the community
already possess (Harris et al., 2015). The program would encourage community members to be
innovative and propose solutions for preventing Diabetes in their communities. Studies have
established that incorporation of community innovations in prevention and management of
chronic diseases often has positive ramifications (Gyawali et al., 2019). For instance,
communities can propose a combination of cultural diets and exercise routines which are fruitful
in preventing diabetes.
Participatory decision-making is the king maker core domain in community capacity building. It
incorporates aspects of community engagement that were discussed in the first section. All
program outputs and objectives must come from the community (Liberato et al., 2011). If a
community is not comfortable with an initiative, it should be withdrawn. Participatory decision
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making is a cross-cutting domain which extends to other matrices including resource
mobilization and resource allocation.
Leadership is a dynamic domain on which the success of the community prevention program
vests. It is important for the team leader to involve the community as much as possible by
making the program a safe space (Harris et al., 2015). Focus groups should be conducted on a
frequent basis for community members to provide views on the leadership direction (Liberato et
al., 2011). Good leadership is essential in overcoming program obstacles, negotiating conflicting,
and motivating community members to fulfil the objectives of the program
Partnership/linkages/networking is essential in creating equal relationships across and within
communities. Communities must be able to work with other communities, the private sector, and
the public sector to mitigate the relevant risk factors for Type 2 diabetes. Resource mobilization
is a very important domain both in terms of access to funds but also in terms of building robust
systems and structures (Liberato et al., 2011). Resources should first be dedicated to the most
vulnerable members for the community, particularly those who already have type 2 diabetes and
are trying to manage it. It would be critical to ensure that the conditions of such patients do not
deteriorate. Skills development and learning opportunities are crucial domains as they equip
community members with the technical knowledge to strengthen and build their capabilities
(Liberato et al., 2011). Learning opportunities prepare the community to continue with best
practices even after the end of the program.
Part 3: Describe the models and approaches of health promotion (such as the health belief
model or the education approach) that you would use to motivate and educate the
community about your chosen health concern, and discuss the advantages and
disadvantages of each model/approach (Module 2).
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Health promotion refers to the process of enabling individuals and communities to improve their
health and increase their control over it. Health includes physical capacities, personal resources,
and social resources. There are five main health promotion approaches which include the societal
change model, the client-centred model, the educational model, the behavioural change model,
and the health belief model (Shabibi et al., 2017) The educational model and the health belief
model are the ideal approaches when working on community engagement preventative programs
involving type 2 diabetes.
I would adopt a health belief model when rolling out the program. The health belief model has a
strategic advantage over the educational model since it promotes self-care approaches among
potential patients of Type 2 diabetes. The WHO has correctly labelled type 2 Diabetes as a non-
communicable silent epidemic (Gyawali et al., 2019). The health belief model is effective in
preventing chronic conditions because it puts patients in control. Individuals are best placed to
observe and monitor their diets, exercise regimens, and overall lifestyle behaviour.
The self-care practices promoted by the health belief model include foot care, regular exercises,
urine or blood glucose self-testing, timely use of medication, and maintenance of a health
nutrition. The health belief model reduces hospital costs and improves the quality of life of both
patients and community members (Shabibi et al., 2017). The health belief model will be vital in
guaranteeing results since it ensures that community members fully internalize the risks of the
complications of type 2 diabetes. It is the most efficient model since it focuses on behavioural
change to avoid illness so as to focus on disease prevention.
The education approach is also a good approach but it is not suitable for this type of community
health based intervention since it is more of a treatment and management model rather than a
preventative model. The education approach placesemphasis on specific skills relating to the
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control of blood sugar levels and the administration of the insulin injection (Shabibi et al., 2017).
It also lays emphasis on physical activity and basic principles of nutrition. It requires the
involvement of more experts and more resources making it a costlier option when compared to
the health belief model (Shabibi et al., 2017). It is also patient centred rather than community
centred and would work best for individuals. The Health Bases model would work best as it
aligns with the core domains of community participation, partnerships, and learning
opportunities since the prevention program is a young program.
Conclusion
This report has identified the use of community based approaches and strategies in the
prevention of type 2 diabetes. It expounds on how the concepts of community engagement,
community capacity, and community empowerment can be maximized to design a responsive
type 2 diabetes prevention program. It also elucidates on how Liberato and others core
community capacity building domains can be leveraged in the program design to ensure that it
centres community needs at all phases. Also, it identifies the health belief model as the best
health promotion model in community based initiatives to prevent type 2-diabetes. Finally, it has
used a health belief model because it is more proactive, less costly, more community centred,
and more sustainable.
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References
Al-Lawati, J. A. (2017). Diabetes Mellitus: A Local and Global Public Health Emergency!.
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Greenberg, H., & Deckelbaum, R. J. (2016). Diet and non-communicable diseases: An urgent
need for new paradigms, Available at https://www.karger.com/Article/Pdf/452379
Gyawali, B., Bloch, J., Vaidya, A., & Kallestrup, P. (2019). Community-based interventions for
prevention of Type 2 diabetes in low-and middle-income countries: a systematic review. Health
promotion international, 34(6), 1218-1230.
Harris, J., Graue, M., Dunning, T., Haltbakk, J., Austrheim, G., Skille, N., … & Kirkevold, M.
(2015). Involving people with diabetes and the wider community in diabetes research: a realist
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Laverack, G. (2007). Health promotion practice: building empowered communities. McGraw-
Hill Education (UK).
Liberato, S. C., Brimblecombe, J., Ritchie, J., Ferguson, M., & Coveney, J. (2011). Measuring
capacity building in communities: a review of the literature. BMC public health, 11(1), 850.
Shabibi, P., Zavareh, M. S. A., Sayehmiri, K., Qorbani, M., Safari, O., Rastegarimehr, B., &
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