A Person with a Long-Term Condition May Face Many Challenges in Sticking to a Treatment Programme. Using Diabetes as an Example, Discuss These Challenges and the Kinds of Health Care Support That May Help a Person to Overcome Them.

I can identify three kinds of reason why people may experience challenges. I will be discussing them each in turn.

Diabetes is a condition where the amount of glucose in the blood is high because the body cannot use it properly, this is because the pancreas does not produce any insulin or not enough insulin to help glucose enter the body's cells or the insulin that is produced does not work properly, known as insulin resistance. (www.diabetes.org.uk).

One of the most common barriers is the cultural barrier, it is important to respect a patient's cultural value and beliefs. Anwar migrated from Pakistan, as a young man and he is a Muslim, even though he migrated to the U.K. as a young man that is not to say that he might have forgotten or left his cultural roots and beliefs. It is very difficult to change a person's diet at once or ask Anwar to change the ways of preparing his meals. He will be scared of being seen by his family members or fellow community members eating different food as this may seem as an offence or even lead to isolation. Another issue could be that he is not responsible for the food purchase or the cooking; this is his wife's responsibility. In most cultures food patterns are learned in the family context and have highly symbolic and affective association, food is considered as a tribal identity. He could also be confused about the sudden dietary changes.

While everyone can benefit from exercise, those who have diabetes derive even more benefit than most other people. Many people are aware of the benefits of exercise, but have difficulties incorporating physical activities into their lifestyles. Exercise could be difficult for Anwar as it isits not part of his culture, he could be finding exercise quite boring. He could also be worried at what his fellow community members will think of his sudden interest in exercise. Attitudes toward exercise, physical limitations and discomfort could have prevented him from taking regular exercise.

Anwar had some symptoms of diabetes; if only he had the knowledge or knew anything about diabetes he might have taken his condition seriously and would have gone to see the doctors. As Anwar is, Him being from a different culture he could have some different illness beliefs and practices. Many people do not seek health care unless their condition interferes with their social or personal activities of their daily living, there is often fear or reluctance to seek professional care unless necessary just as in the case of Anwar. His lack of knowledge could have impeded his ability to manage diabetes. Language barriers contribute to miscommunication and inappropriate treatment plans, often resulting in decreased patient and provider satisfaction, poorer patient understand of disease, less recall of information, and premature termination of care.

Patients with diabetes face a major self-management burden. ‘Beyond culture, is the whole issue about how people psychologically cope with disease. And that goes from people who are in complete denial about the fact that they've got anything wrong with them at all, right the way through to people who instead of managing their diabetes in order to live their lives, live their lives in order to manage diabetes.'(K101, audio 2, 5, section 1). Major depression and depressive symptoms are the most studied psychological challenges that affect self-care in people with diabetes. Major depression, as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (text revision), affects 20% of people with diabetes-it's at least twice as prevalent among people with diabetes as among the general population.

Many patients with diabetes are often reluctant to begin treatment, living with diabetes is a demanding task, and Anwar could find it difficult to face changing his life style while adjusting to living with diabetes. Once diagnosed he could have felt guilt, ashamed and even angry, this could lead to depression as the stress of facing a lifelong condition, this could make him feel depressed, stressed and low emotionally.

Anwar may feel reluctant to share his illness with others for fear of discrimination which could hinder ability to optimally self-manage diabetes. He could feel embarrassed of eating different kind of food from his social friends. He may also decide to isolate himself socially, as just the thought of being invited by a friend and not being able to eat what is cooked for him could seem being ignorant so he could decide to just stay away from friends. ‘Low income,