Community development as a possible approach for the management of diabetes mellitus focusing on physical activity lifestyle changes: A model proposed for Maltese people with diabetes

Abstract

Treating diabetes mellitus is very expensive and with 10% prevalence, the Maltese healthcare can face serious problems. Despite the evidence that regular exercise lowers blood glucose, few persons with diabetes participated in physical activity due to fear of hypoglycaemia and other barriers. Conventional management of diabetes imposes lifestyle changes and favours pharmaceutical administration. Implementation of grassroots initiatives through health needs assessment leading to community development is an alternative strategy. The main purposes of this article are, to present clear information on community development as an alternative to conventional diabetes interventions, and to serve as a model to stimulate interest amongst the authorities to use this approach for diabetes management. In a fictitious diabetes community scenario, based on available, limited literature, lack of physical activity was identified as the main need to improve health. Through a ‘bottom-up’ approach based on empowerment and participation, the sedentary community gradually progressed to active subgroups that eventually became less dependent on anti-diabetic medications and car-use. There was the possibility of a sports and recreational strategy. Health promoters were leading players, followed by local councils and other stakeholders.  After publishing physical activity guidelines, holding regular recreational activities and celebrations, the community development was sustainable, cost-effective and environmental friendly. Project evaluation was crucial. Funding was governmental and partly sponsored by health-compatible enterprises. Albeit time-consuming, community development is regarded as the most ethical and effective form of health promotion. It offers a challenge to the medical model.