Building a Comprehensive Health History
The purpose of this post is to consider a comprehensive health assessment on a 40-year-old black recent immigrant from Africa without health insurance. This post will discuss questions that would be instrumental in building a health history, effective communication and interview techniques, and will identify potential risks based on the gender, ethnicity, and age of this patient. In addition, I will develop five questions that are targeted to assess health risks and build a health history.
Communication and Interview Techniques
Effective communication and interview techniques are integral to building professional rapport with patients and to creating an accurate health history to be used in assessment, diagnosis, and treatment. In this clinical scenario, these techniques are potentially more important than average due to the unique cultural and language needs of this recent immigrant from Africa. The practitioner needs to first determine if the patient requires a translator, and this interpreter should be a trained professional as opposed to a family member, ideally (Ball et al., 2019, p. 26). After determining language needs, the provider should attempt to determine some of the cultural beliefs and social determinents that affect health and treatment, such as beliefs around spiritual healing, modesty, gender roles, dietary practices, and culturally-influenced attitudes regarding pain, illness, and health (Ball et al., 2019).
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Questions for Building a Health History
A detailed health history is essential for effective diagnosis and treatment. In this scenario these questions should be targeted towards not only the patient’s current health and environmental influences but should also include the patient’s history in Africa and any changes since his recent arrival in the United States. The provider should include questions referencing the medical history of family members, going back at least three generations if possible (Ball et al., 2019). According to Lushniak (2015), “Family health history gives information not only about genes, but also about environmental and behavioral risk factors shared among family members. It therefore can provide a more accurate prediction of disease risk than many genetic tests can alone” (Lushniak, 2015, p. 4). Questions should include immunizations, prior infections, and previous treatment for any infectious diseases. In addition, the provider should inquire about previous psychological history and trauma history, as these tend to be common in immigrants/refugees. “Immigrants are generally prone to psychological health problems due to both pre-migration risk factors such as previous traumatic experiences and post-migration factors such as culture shock and low socioeconomic status”, (Adu-Boahene et al., 2017, p. 48).
Health-Related Risks Specific to Clinical Scenario
In this clinical scenario there are several patient demographics to consider when assessing risk. The patient is male, 40 years of age, and a recent immigrant from Africa. Each of these descriptors presents a different set of risk factors ranging from medical to behavioral and environmental. In addition, this patient does not have insurance, which represents an entirely different set of risk factors. Research indicates “the problem of high healthcare cost was compounded for participants without health insurance”, and frequency of provider visits and trust in the provider were bot significantly reduced in African immigrants lacking insurance (Omenka et al., 2020).
Health Risk Assessment Instruments and Five Targeted Questions
Advanced practice providers have a number of risk assessment tools at their disposal, and according to Wu and Orlando, “Health risk assessments (HRAs) are an important element of the healthy stage” (2015, p. 508). Ideally this risk information is obtained when a patient is healthy and coherent and has established a semblance of trust with their provider. One of the pertinent Health Risk Assessment tools to consider in this clinical scenario is an assessment of cultural needs. I was unable to procure a certified Cultural Assessment, but research provides a proliferative set of questions to aid in a cultural assessment (Ball et al., 2019).
Five targeted questions that should be presented in this health risk assessment (following language assessment and necessity of interpreters) include:
“What does being healthy look like to you? What does being ill look like to you?”
“How long have you lived in the US and where did you live prior to your move? Why did
you come to the United States?”
“What symptoms have you had in the past that concerned you… discomfort, pain, rashes,
feeling like you can’t breathe, or feeling very sad or anxious?”
“What sorts of illnesses are you familiar with, and what illnesses do you know that your
father, mother, sisters, brothers, or aunts and uncles have experienced?”
“Why are you seeking medical help right now, and what can I do to help you?”
Conclusion
It is imperative that advanced practice providers consider all aspects of a person’s health: their cultural expectations and beliefs, their environmental surroundings, their current complaints, their family history, their understanding of health, both ill and well, and their expectations of what health care looks like and how it should serve them best. Advanced practice providers need to carefully consider the unique descriptors of each patient to allow them to develop the most effective assessments to an accurate health history.
References
Adu-Boahene, A. B., Laws, M. B., & Dapaah-Afriyie, K. (2017). Health-Needs Assessment for West African Immigrants in Greater Providence, RI. Rhode Island Medical Journal, 100(1), 47–50. Retrieved November 29, 2020, from https://doi.org/PMID: 28060966
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). Elsevier Mosby.
Lushniak, B. D. (2015). Family health history: Using the past to improve future health. Public Health Reports, 130(1), 3–5. Retrieved November 29, 2020, from https://doi.org/10.1177/003335491513000102
Omenka, O. I., Watson, D. P., & Hendrie, H. C. (2020). Understanding the healthcare experiences and needs of african immigrants in the united states: A scoping review. BMC Public Health, 20(1). Retrieved November 29, 2020, from https://doi.org/10.1186/s12889-019-8127-9
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). F. A. Davis Company.
Wu, R., & Orlando, L. A. (2015). Implementation of health risk assessments with family health history: Barriers and benefits. Postgraduate Medical Journal, 91(1079), 508–513. Retrieved November 29, 2020, from https://doi.org/10.1136/postgradmedj-2014-133195
PEER RESPONSE
RE: Yoder- Main Post Week 1
Marsha,
Your post was a well thought out discussion. I would like to add more details regarding the patients lack medical coverage and how it can affect building a health history (primarily ethnicity). According to Adegboyega and Hatcher (2016), the inequities in healthcare cover not only inadequacies in access to care but also differences in the quality of care, as well as the burden of payment. The magnitude of these inequities increases the disease burden, widen social inequities in health status, and generate adverse social effects (Adegboyega & Hatcher, 2016). According Drewniak, Krones, and Wild (2017), not only does the ethnic minority population differ regarding to access to healthcare, face barriers to lower rates of health insurance, lower rates of having a regular doctor, and lower use of care. With that being said, this could cause anxiety, stress and insecurities for the 40-year-old African American immigrant man.
The cultural and ethnical stressors caused by not having insurance include the availability of access to healthcare providers. African immigrants differ by country of origin, reason for migration, languages, health practices and beliefs, education status and cultural background. Retrieving an adequate health history could not be accessibly if the patient is stressed over having no insurance to cover the bill.
References
Adegboyega, A. O., & Hatcher, J. (2016). Unequal Access: African Immigrants and American Health Care. Kentucky Nurse, 64(1), 10–12.
Drewniak, D., Krones, T., & Wild, V. (2017). Do attitudes and behavior of health care professionals exacerbate health care disparities among immigrant and ethnic minority groups? An integrative literature review. International Journal of Nursing Studies, 70, 89–98. https://doi-org.ezp.waldenulibrary.org/10.1016/j.ijnurstu.2017.02.015