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Contextual factors have varying impacts on each individual such as personal, social and cultural wellbeing. Nevertheless, contextual factors are paramount to how an idividual repond to presenting concerns allowing different response to the same situations. An intoxicated 49-year-old woman, Julie Williams, was admitted at midday due to a fractured right ankle following a fall. She is unemployed, has no fixed address, no family in Christchurch, has type two diabetes (T2DM) and has a low level of literacy. This essay will identify contextual factors that affected her health status prior to admission. It will link these factors to her acute presentation, analyse these factors and their potential future implications on discharge.
Contextual factors combination creates the emotional and cognitive state of an individual that are more important in understanding response than psychological relationship itself. Its ecology and environment characteristics relates to collaboration effectiveness. Julie has T2DM which have been affected by her health behaviours such as smoking, alcohol consumption, physical activity, diet and sedentary lifestyle. Julie has low level of literacy, unemployed with no fixed address and no family support in Christchurch. The collection of circumstances and life experiences such as culture, values and spirituality may have also contributed and affected her health prior to admission. There are also other factors such as gender, age, socioeconomic status, education, family dynamics and support systems. People that are diabetic tend to suffer from other comorbidities such as anxiety and depression. This supports a research suggesting positive association between anxiety, depression and high risk alcohol consumption.
Health behaviours play important role prior to admission and on discharge for Julie. Bakker et al. along with Hobbs et al. states diet, alcohol consumption along with sedentary lifestyle increase the prevalence of developing health risks such as obesity that can lead to T2DM and heart problems. Additionally, people living in stressful condition chronically are enclined to develop coping mechanisms such as binge-eating and smoking along with substance and alcohol use. Cavanaugh along with Bailey et al. also suggest in people suffering from diabetes, it is common to have low health literacy and poor numeracy skills. It is correspondingly linked with lack of self-efficacy, diabetes knowledge, self-care behaviors and poor glycemic control. Julie was intoxicated which resulted to a fall. She is also diabetic. This suggests that healing abilities are impaired. In relation to alcohol consumption, this can affect and prolong her stay in the hospital. It can also increase her succeptability to infection due to low level of understanding. Moreover, lack of literacy skills may have affected her access to health care and social skills. Her inability to establish rapport relates to no fix abode and lack of family support. Diabetes management adherence requires family and social support. Including families in diabetes self-management interventions has strong theoretical and cultural basis for many.
Socioeconomic status (SES) and gender also play a significant role. According to Schultz et al. SES is usually measured by “determining education, income, occupation, or a composite of these dimensions”. It is one of the strongest predictors of morbidity and mortality. Nevertheless between education and income, indications suggest that education is not a primary determinant of income. Julie has low level of education, unemployed and suffering from T2DM. Bakker et al. suggest low education level increase unemployment chances resulting to low income. This can also be linked to Julie being able to access healthcare, ability to afford a stable housing and food. Schultz et al. add men tend to have more years of education compared to women and from higher income households. Overall, lowest educational attainment exhibited highest risk factors prevalence and being predisposed to developing health conditions.
Additionally, Kautzky-Willer, Harreiter, and Pacini state gender also plays a part in T2DM development. It is frequently diagnosed at a younger age in men. However, obesity being most prominent risk factor is more common in women. Hobbs et al. concurs physical activity environment, SES, and obesity have correlation in the development of T2DM. Furthermore, Gordon Singh and Aiken state health literacy level are significantly associated with educational level and age. However, findings suggest no association between health literacy level and diabetic health outcomes. Education level may likely affect preventative knowledge and understanding than having high income or being in an occupation of high status. This could explain why education shows closer connotation with diabetes. Another possibility is education has greater effect on behavioural habit formation. This results in later life, shape behaviours and subsequently influence health. The relationship between SES and health behaviours demonstrated behavioural predictive impact on impaired glucose metabolism. Statistical associations supported observed evidence that SES do influence examined health behaviours and predict diabetes development. Furthermore, research shown “education was a more sensitive marker of socioeconomic status for the development of diabetes, compared with income and occupational grade”. Increasing knowledge and understanding of diabetes for Julie may help address her management of it after discharge.
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