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HPRO6715 Foundations Of Health Promotion

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HPRO6715 Foundations Of Health Promotion Question: The final assignment requires you to build upon the topic area and study objectives from Assignment 1 and develop a hypothetical health promotion intervention in the format of a grant proposal. This will involve incorporating your literature review and objectives from Assignment 1 into performing a needs analysis (including background literature, an analysis of the health problem, and consideration of the context in which you are proposing the intervention); setting intervention goals/objectives; planning strategies for achieving these goals; and identifying the means of e- valuating objectives. You may choose any topic area and geographic context you wish, as long as you can justify the public health importance of the health outcome as part of your proposal. You may choose to continue working on the same (or similar) topic area that you addressed in Assignment 1, but this is not imperative. In order to keep the scope and scale of the proposal realistic, you need to ensure that your budget does not exceed $200K per year and can be completed within 3 years. 1. Aims and objectives 2. Background and rationale 3. Proposed action plan 4. Anticipated outcomes and significance 5. Strategies to evaluate outcomes 6. Proposed timeline 7. Proposed budget, and justification of budget Answer: Background, Brief Literature, And Rationale Background Non-communicable diseases (NCDs) such as type 2 diabetes have been classified as one of the major global health issues especially in countries such as South Asian. Globally about 135 million adults are suffering from diabetes according to 1995; however by 2025 the figure is estimated to increase up to about 300 million; that is 120% increase (Chowghury, Billah, Arifeen & Hoque, 2018). Studies show that about 8.5 million people in Bangladesh are diabetic with the majority having type 2 thus without effective health intervention, the number is expected to escalate to about 16 million by 2030 (Caffrey, 2016). Brief Literature Review Bangladesh is situated in the northeastern of South Asian subcontinent and is surrounded by India and Myanmar. Bangladesh has a population of about 164.7 million of people by 2017. The population is projected to increase by another 100 million even be for the country stabilizes its core services such as health care that is critical to the economy; development of the country. Diabetes type 2 is recognized as one of the chronic diseases in Bangladesh however it remains unknown to the public due to a little survey that has been conducted in the country. It is estimated that more than 80% of bangladesh population are in the rural setting, however, some few studies indicate that the prevalence of diabetes is higher in urban settings (Molla & Chi, 2017). Study by Huda, Tahsina, El Arifeen and Dibley (2016) found out that prevalence was about 2.1% by 1995 while another study of 1997 indicated that prevalence from both the rural and urban was 3.8% and 7.8% respectively. This is a proof that there is an increasing development of diabetes in Bangladesh population that needs proper research and interventions (Biswas & Kabir, 2017) This led to the development of Systems for Improved Access to Pharmaceuticals and services in (SIAPS) Bangladesh, with a goal to assure the availability of quality pharmaceutical services products and services to the population to achieve the desired health status. Currently, the retail drugs support majority of the Bangladesh population, about 1,103400 of the licensed retail drugs are involved in the selling of drugs over the counter to patients of all types of disease (Rahman et al., 2018). According to Armed, Naher, & Hossain  (2017) most of the sales person s on those retail drugs shops do not have the required training and education in dispensing drugs and offering treatment. However, generally, the significance of the informal sector of retailing drugs among the Bangladesh population, it is very imperative that improved regulations are imposed to provide the population with an opportunity to receive improved services. Health private sectors play a significant role in Bangladesh populations since more than 80% of the population seek medical care from the non-private sectors (Adhikary et al., 2018). This means that retail drug shops are always considered the first stop by the patient especially the diabetic who does not want to seek medication in the public sector. According to Schwarz (2012), Bangladesh has approximate of 1, 103,451 licensed drug shops and about of the same number of unlicensed shops that sell drugs to about 5.5 million diabetics. However, most of the salesperson in those private drug shops have inadequate training and dispensing drug information which falls on their daily tasks (Javanbakht et al 2015). According to the regulation, the drug salesperson should acquire training not minimum to four months and attain a grade not less than C in pharmacist before they can be awarded any license on pharmacy or run a drug shop. The training that is conducted by the Bangladesh Pharmaceutical Society in conjunction with Bangladesh Chemist and Druggist Samity ensure that the public receives the correct drug, quality and at an affordable price. Rationale Since most of the private drug sellers have inadequate exposure and training, they tend to misguide a large number of patients since their drug sales information and recommendations do not meet the requirement; thus resulting into new disease, long-term treatment and even financial constrict among the patients especially the diabetic who use drugs for quite a long tie of period (Flood et al., 2016). Studies indicate the irrational use of drugs such as over-prescribing, use of unnecessary drugs, multi-prescribing, drug dispensing without prescription, improper injections and overuse of antibiotics are common among these private drug retailers and always results into severe medical complications. Several studies that have analyzed the adherence of diabetic medication found out than non-adherence had a high frequency of hospitalization. Professional says that diabetes is chronic and a progressive in nature, meaning that early medical intervention is significant to its management (Ong et al., 2018). In Bangladesh, the newly diagnosed type 2 diabetes patients always fail to adhere with the prescribed standards either through dropping out of medications or seeking other types of medicines from these private sectors that increase the rate of hospitalization by about 24%. The association between poor drug dispensing practices and prevalence of diabetes among the Bangladesh population has not been fully studied, thus this project aims at fulfilling the gap in the studies. Aims Due to the high rising rate of HIV, and other prevalence in Bangladesh, the government built a health care system in 1970 to reduce the spread and growth of the communicable among the population and forgot of these non-communicable diseases such as diabetic that has attacked a large number of people. To fully address these communicable diseases, the stakeholders need to understand the underlying factors that facilitate the infections and how these diseases can be controlled. The aim of this study thus is to generate an understanding of how improving the Bangladesh pharmaceutical services would impact the prevalence of type 2 diabetic among the Bangladesh population. Research Questions/ Objectives The following principle research questions will assist the researcher in collecting relevant information about the topic under study: RQ1: Do the drug sellers in Bangladesh meet the minimum legal requirement such as posing valid business license? RQ2: What are the accredited opportunities for drug sellers to improve the quality of services in Bangladesh? RQ3: How affordable, available and level of quality of the drugs in the private drugstores in Bangladesh? RQ3: How does the services offer generally affect the treatment of diabetes in Bangladesh? Objective The objective of this project is to improve the diabetic prevention and treatment among the Bangladesh population by improving the pharmaceutical services and designing a better way of the drug dispensing process among the salespersons. Through the use of the findings of this project, both the community and drug salesperson will not only be enhanced on the knowledge about common illness but will be equipped with better ways, of eliminating the possibility of contracting the non-communicable disease. Study Methods This paper is a facility-based and cross-sectional study, aim at exploring the nature of the regulations and operations of the retail drugs shops and drug dispensing services practices in Bangladesh. The paper also finds how the service is impacting the general health of the population especially those that are suffering from type 2 diabetic. The respondents of this study will be salespersons from the selected drug dispenser shops,   a sample of the Bangladesh patients/community who were at the areas of the surveys, structured observing dispensing practices of the drug salesperson the dispensing practices of the drug salespersons. Sampling Methods This study entails all the drug shops from both the rural and the urban setting that are spread across all the seven divisions of Bangladesh. The rural samples will be retrieved from the drug shops that are in the neighborhood of the Upazilas health complex, business centers, and markets, and because of the time constraint, the number of samples limited.  From the Upazilas center, there will be 30, and the choice will be based on geographical distance; it is situated on the remote area of the district; those that are at the periphery of the district and those that are situated at the center of the district.  All the drug shops will have to fulfill the following criteria: Drug shops must have the highest customer traffic. Drug shops must be in the neighborhood of the UHC and drug shops selected must be strategically placed( one must be near to UHC, another further from UHC and the last must be centrally placed). The urban samples also will be regulated by the time and resources available, thus out of the 11 city corporations, 7 cities will be selected and from each of this, 3 drugs shops will be identified to bring a total of 21 drug shops in the urban setting (Urach et al.,2016). The drugs shops selected from the urban setting thus will have to meet the following criteria: Drugs shop selected should be near to subdistrict The second drug shop should be 1 kilometer from the first selection. The third shop should be at the periphery of the subdistrict. Sample Size And Power An approximate of 500 individuals both male and female above 20 years will be identified through census before the commencement of the survey from all the division s and the drug shops. The sample size will be calculated through N=Z 2PQ/d2 Intervention There is a high risk of death for patients with type 2 diabetes and is increasing due to poor medication among the patients. The glycaemic control among the patients helps in reducing the risk of death. When insulin is provided in approximately, then the patient might develop a severe condition that might also lead to death (Biswas & Kabir 2017). Therefore, it is imperative for the pharmacist to be familiar with particular educational pints to ensure maximum therapeutic results among the diabetic patients in Bangladesh. Thus it is apparent to the medical providers to help the patients achieve an optimum blood glucose level, adherence to drugs and acquirement of self-management. The global statistics indicate variance of between 36% and 93% adherence to drugs (Animaw & Seyoum, 2017). The most commonly used drug is insulin and the injection should always be adjusted systematically to help the patients adapt to it and maintain a particular glucose level. The educational points include insulin storage and handling conditions, compatibility of insulin with other mixtures and insulin administration. Insulin is protein in nature, thus loses potency in presence of high temperatures. Unopened bottles should be kept in cool places until the need of the use arises and should be discarded on the passage of the expiration date (Animaw & Seyoum, 2017). Without adherence to these conditions, such affected insulin always causes discomfort among the patients. Insulin is not compatible with glargine and short-acting insulin are compatible in the same syringe with NPH, while regular insulin is compatible with Lente and Ultrallente. Lispro is compatible with Ultralente, thus any combination results into side effects, however, Lente and Ultralenet can be combined without side effects.  On the administration, patients should always be aware that the primary injection sites entail abdomen, thigh, buttock and upper arms. The injections are always made at the pinched area of the subcutaneous lately at 90-degree to ensure that insulin directly gets into the bloodstream. Injection into different places other than the prescribed ones will slow the rate of absorption, hence might not help the patient (O’Reilly et al., 2018). These are information that these pharmaceuticals should know at the tip of their fingers, unfortunately, due to inadequate information, they commit clinical errors on the patients that seek assistance from them. The wrong dosage of insulin always results in hypoglycemia; a situation where blood glucose level is higher than 70mg/dL. Pharmacist thus is required to know symptoms of hypoglycemia: tremor, perspiration, confusion and tachycardia and pharmacists should know how to treat in case of hypoglycemia, without over treating it through the provision of right glucose tablets and always repeated systematically until the blood glucose returns to the normal level. Data Collection Method The data collection method of this study will extensively entail the use of survey questionnaire and the FGD guidelines that will be made from the tools adapted to form the Management Science for Health (MSH) of same studies in other countries such as Pakistan. A list of the essential drugs on common illnesses, especially on the diabetic, will be retrieved from the Government update list of Essential Drugs to help in counterchecking the essential drugs dispensed in this selected drug retails. The retrieved reference list will be useful in confirming whether the essential drugs for the illness such as diabetic are readily available in these drug dispense shops with the required prices, quality, packaging, storage and are within the shelf-life. A research Assistant with enough knowledge on the health and sciences will be employed to assist in this study and will be subjected to a one-week day training to enhance the reach requirements. The training will entail all the lecture notes on the research methodology, and simulation of the perceived study areas as the daily training activities will be overseen by the lead trainers from renowned institutions (Lai, Chen & Wu, 2017). The trainees will be provided with guidelines by the PIs and Co-PIs and the whole research data collection process will be supervised and managed by the researcher and is expected to be completed within four days. Data will be collected through the use of different methods that are document review to ascertain the regulatory and policy environment. Quantitative survey to help in grouping the drug shops and determine the training end experiences level of the salespersons. Qualitative exploration among the community and other stakeholders to elicit their perceptions of the products and services of the drug shops Structured observation of the sampled drug shops to document the nature of the dispensing practices. Therefore, a total of 111 drug shops (21 from the urban and 90 from the rural setting) all from the seven divisions in Bangladesh will be included in the study. Ethical Statement The researcher will obtain consent from all the participants before the commencement of the study, by making them understand the importance of the study to the general public and the business. All the participants will also not influenced or coerced to provide information that might alter the results as intended by the researcher and will be allowed to exit wherever they feel like. The secondary source of information will also be used only after the consent of the authors by writing and privacy will be acknowledged. The study process will be reviewed by the cause supervisor before the commencing and relevant adjustments will be made as communicated by the lecturer. Data Analyses The secondary collected data, such as those that will be retrieved from the Health Sector and government database will be coded and entered into survey data for easy analysis. The primary collected from the questionnaire will be fed into the MS Access database and the data management will be accomplished by an identified professional data entry operator, assisted by the data management team to ensure minimum error in the data analysis who will enter five per cent of the total data into control quality (Aldhdouh, 2018). During the data entry session, both the PIs and Co-Pis and the researcher will have the total control over the data entry team to ensure that the correct data are entered into the system. The data entry method will be facilitated by the codebook that will have been constituted by the researcher and will be strictly followed to ensure validity. After the completion of the data entry, the data will be analyzed through the use of SPSS, whereby the biostatistician will ensure that the data we cleaned at least two times to remove any ambiguity (Pulverer &  Rmbruster (2017). The data will then be analyzed on the basis of demographics; rural versus urban and by the division. The results will be presented in the forms of means, frequency, and standard deviations to bring the relationships between the drug shop services and the prevalence of diabetic among the population. Anticipated Outcomes And Significance Anticipated Outcomes After the completion of this research, the researcher is anticipating to find a relation between the services offered by private drug sellers and the level of diabetes among the population. Based on the underlying literature, most of the private drug sellers have inadequate medical information and training especially on diabetes; this will have little effect in reducing or helping the patients in controlling and managing the condition. The situation is more worse since most of the Bangladesh patents visits these private drug points wherever they feel uncomfortable, this means that a large number of the patient of type 2 diabetes are more likely to suffer hyperglycemia as a result of poor insulin storage, handling, and ministration by the pharmacists. Significance The information received from this study will be helpful to the general public, government agencies, and the private sectors. The general public will have adequate information on the type of private clinics they should go to acquire assistance, especially on the chronic medical conditions since most of the private sectors do not have the required legal and professional standards. Attending such clinical points will only elevate the medical condition that might result into loss of life. The government agencies will also benefit in that they will be able to identify the substandard private medical point that risk the life of the public by breaking the rules, hence shut them down in a move to reduce the infection of chronic diseases, controlling of the non-communicable diseases and eliminate exploitation of the public. Consequently, the private sectors will also benefit from the study by getting to know the minimum requirement and the consequence of not adhering to the rules and regulations. Proposed Timeline                                          Budget And Justification Of Budget Budget, Project Activities And Gantt Chart The budget for the study has been allocated as result of the following reasons: The literature Review will require the use of the journals, textbooks, websites that are charged to have accessibility and that will cost about $3000 The data collection materials such as printing of interview questionnaire will cost about $ 4,500 Data analysis will cost about $3,000 Summary Of The Budget Purpose Estimated Amount($) Literature Review 3,000 Data Collection 4,500 Data Analysis 3,000 Total Estimated Budget 10,500 References: Adhikary, G., Shawon, M. S. R., Ali, M. W., Shamsuzzaman, M., Ahmed, S., Shackelford, K. A., … Uddin, M. J. (2018). Factors influencing patients’ satisfaction at different levels of health facilities in Bangladesh: Results from patient exit interviews. PLoS ONE, 13(5), 1–13. Aldahdouh, A. A. (2018). Visual Inspection of Sequential Data: A Research Instrument for Qualitative Data Analysis. Qualitative Report, 23(7), 1631–1649. Retrieved from Animaw, W., & Seyoum, Y. (2017). Increasing prevalence of diabetes mellitus in a developing country and its related factors. PLoS ONE, 12(11), 1–11. Biswas, R. K., & Kabir, E. (2017). Influence of distance between residence and health facilities on non-communicable diseases: An assessment over hypertension and diabetes in Bangladesh. PLoS ONE, 12(5), 1–11. Caffrey, M. (2016). Lancet. Global Diabetes Population Reaches 422M; Most New Cases in Low- and Middle-Income Countries. American Journal of Managed Care, 7–8. Retrieved from Chowdhury, S. K., Billah, S. M., Arifeen, S. E., & Hoque, D. M. E. (2018). Care-seeking practices for sick neonates: Findings from cross-sectional survey in 14 rural sub-districts of Bangladesh. PLoS ONE, 13(9), 1–12. Flood, D., Mux, S., Martinez, B., García, P., Douglas, K., Goldberg, V. Rohloff, P. (2016). Implementation and Outcomes of a Comprehensive Type 2 Diabetes Program in Rural Guatemala. PLoS ONE, 11(9), 1–14. Huda, T. M., Tahsina, T., El Arifeen, S., & Dibley, M. J. (2016). The importance of intersectoral factors in promoting equity-oriented universal health coverage: a multilevel analysis of social determinants affecting neonatal infant and under-five mortality in Bangladesh. Global Health Action, 9, 1–14. Javanbakht, M., Mashayekhi, A., Baradaran, H. R., Haghdoost, A., & Afshin, A. (2015). Projection of Diabetes Population Size and Associated Economic Burden through 2030 in Iran: Evidence from Micro-Simulation Markov Model and Bayesian Meta-Analysis. PLoS ONE, 10(7), 1–17. Lai, E.-Y., Chen, Y.-H., & Wu, K.-P. (2017). A knowledge-based T2-statistic to perform pathway analysis for quantitative proteomic data. PLoS Computational Biology, 13(6), 1–29. Molla, A., & Chi, C. (2017). Who pays for healthcare in Bangladesh? An analysis of progressivity in health systems financing. International Journal for Equity in Health, 16(1), 1–10. O’Reilly, de B. M., de Brún, T., O’Donnell, C. A., Papadakaki, M., Saridaki, A., Lionis, C., … MacFarlane, A. (2018). Material practices for meaningful engagement: An analysis of participatory learning and action research techniques for data generation and analysis in a health research partnership. Health Expectations, 21(1), 159–170. Ong, S. E., Koh, J. J. K., Toh, S.-A. E. S., Chia, K. S., Balabanova, D., McKee, M., … Legido-Quigley, H. (2018). Assessing the influence of health systems on Type 2 Diabetes Mellitus awareness, treatment, adherence, and control: A systematic review. PLoS ONE, 13(3), 1–42. Pulverer, B., & Armbruster, C. (2017). Where does the buck stop? Research ethics and publishing. Information Services & Use, 37(1), 13–16. Rahman, M. M., Haider, M. R., Moinuddin, M., Rahman, A. E., Ahmed, S., & Khan, M. M. (2018). Determinants of caesarean section in Bangladesh: Cross-sectional analysis of Bangladesh Demographic and Health Survey 2014 Data. PLoS ONE, 13(9), 1–14. Schwarz, P. E. H. (2012). Diabetes prevention – the global hope on the horizon. Indian Journal of Medical Research, 136(5), 719–721. Retrieved from Urach, C., Zauner, G., Wahlbeck, K., Haaramo, P., & Popper, N. (2016). Statistical methods and modelling techniques for analysing hospital readmission of discharged psychiatric patients: a systematic literature review. BMC Psychiatry, 16, 1–9.

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