NRS 429 Topic 4 Health Promotion in Minority Populations
NRS 429 Topic 4 Health Promotion in Minority Populations
The American healthcare system is faced with the great challenge of inequality which displays a disproportionate impact on marginalized communities, including people of color (Boyd et al., 2020). Such inequalities are the reason behind the gaps in the acquisition of health insurance coverage, leading to uneven access to care services and poor health outcomes among the minority populations. Additionally, studies show that African Americans are significantly impacted by these inequalities contributing to the high prevalence of chronic conditions such as hypertension and diabetes, in addition to the increased mortality rates among this minority population. This discussion provides an analysis of the health status of African Americans, as part of the minority population, in comparison to the national average.
Health Status of African Americans
African Americans make up approximately 13.4% of the United States population. The current health status of black Americans displays an increased prevalence of chronic conditions such as hypertension, obesity, cardiovascular diseases, sexually transmitted infections, and diabetes as compared to whites. Increased morbidity and mortality rates among African Americans have been associated with several economic and social factors.
For instance, studies show that African Americans have a more likelihood of not seeing a doctor when they are sick, as a result of high healthcare costs (Yearby, 2018). Despite the significant advances in the current healthcare system in the U.S., there is still evidence reporting that racial and ethnic minorities such as black Americans still receive a lower quality of care services leading to poor health outcomes as compared to the whites. As of 2019 August, it was reported that approximately 68 million people had been covered by the Medicaid program, with black Americans accounting for 20%. Given that most black Americans have lower social and economic status, they tend to be poorer than other demographic groups, hence making it harder for them to enroll in health insurance programs like Medicaid.
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The death rate among African Americans has declined by about 25% over the past 17 years precisely for populations above the age of 65 years, as reported by the Centre for Disease Control and Prevention (CDC). However, studies also show that young African Americans have a higher probability of dying at an early age as a result of increased risks for stroke, heart disease, cancer, pneumonia, diabetes, and HIV/AIDs among other conditions, as compared to their white counterparts. Social factors common among this minority group contributing to the above-mentioned health disparities include unemployment, smoking, alcoholism, obesity, sedentary lifestyle, and poverty among others (Bell et al., 2020).
Consequently, this group of individuals is also faced with nutritional challenges such as unfavorable nutritional environments, food deserts, food swamps, and food insecurities. For instance, black Americans are associated with poverty and a low level of education, which makes it hard for them to access quality and healthy foods as compared to the economically rich racial majorities. They end up consuming fast foods, among other unhealthy foods, which increases their risk of cardiovascular conditions and obesity.
Barriers to Health
Various barriers to the accessibility of quality health care services have been identified for the African American population. Predominating barriers include decreased understanding of care plans, inability to pay for care services, lack of transportation to care facility, and the inability of incorporating the recommended health care plans into their routine daily living pattern. These barriers are associated with several cultural, educational, socio-political, and socioeconomic factors.
For instance, cultural beliefs among African Americans promoting unhealthy eating habits and sedentary lifestyle, in addition to failure to follow up on routine screening, negatively affects their overall health and utilization of healthcare services irrespective of their social or financial status (Lewis & Dyke, 2018). Consequently, the low socio-economic status among African Americans in terms of low income, unemployment, low education level, and occupation status is also a significant inhibitory factor towards accessibility to quality healthcare services. Lastly, as part of the minorities, blacks in the U.S have limited political influence towards the development of appropriate policies such as the “Obama Care,” to promote their access to quality care services.
With regard to the numerous health disparities affecting African Americans, several health promotion activities have been proposed over the years to help promote the health and well-being of this minority group. The self-help initiative was introduced among African Americans to promote taking personal responsibility for their health and improving their quality of life. Self-help health promotion practices among black Americans include routine screening for predominating health conditions, physical exercise, healthy diet plans, adoption of recommended care plans, and disease prevention practices at home (Fletcher et al., 2018). Consequently, for the religious members of the community, faith-basedorganizationslike churches have promoted structural health promotion activities including education, health fairs, and smoking cessation among others.
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Approach for Health Promotion and Disease Prevention
One of the most effective approaches that can be utilized by African Americans in promoting their health as part of the care plan is the adoption of Pender’s health promotion model. According to the CDC, black Americans are at high risk of chronic diseases, with cardiovascular diseases being the leading cause of death among this group of individuals.
Health promotion practices focusing on lifestyle modification have displayed great significance in reducing the risks of cardiovascular diseases. Pender’s health promotion model, on the other hand, provides a foundation promoting the examination of the background influences of this minority population, in line with the health promotion practices that can lead to a healthy lifestyle (Fletcher et al., 2018). At the primary level, this model encourages regular exercise and a healthy diet to prevent chronic diseases and promote healthy living. At the secondary level, the model promotes routing screening for hypertension, diabetes, and cancer among other common diseases. Lastly, at the tertiary level, the model promotes education programs and rehabilitation among the affected individuals.
Cultural Beliefs and Practices
Other than social and economic factors, several cultural factors among black Americans must be considered when developing the most effective care plan. Some of such cultural beliefs include lack of trust in complementary medicine, misconceptions about immunization, and strong religious beliefs against organ donation among other medical procedures. With the theory of cultural humility, clinicians can now come up with flexible care plans, while still upholding the patients’ cultural values and beliefs (Boyd et al., 2020). This theory is based on the importance of preventing cultural discrimination and promoting the equal provision of care to the culturally diverse population.
Health promotion practices are crucial among the general population in disease prevention and improved quality of life. Minority populations such as African Americans, are faced with numerous health disparities as compared to the whites, hence the need for more health promotion activities. However, when coming up with a care plan for this minority population, it is necessary to identify and respect their cultural values and beliefs to promote positive outcomes.
Bell, C. N., Sacks, T. K., Tobin, C. S. T., & Thorpe Jr, R. J. (2020). Racial non-equivalence of socioeconomic status and self-rated health among African Americans and Whites. SSM-population health, 10, 100561.https://doi.org/10.1016/j.ssmph.2020.100561
Boyd, R. W., Lindo, E. G., Weeks, L. D., & McLemore, M. R. (2020). On racism: a new standard for publishing on racial health inequities. Health Affairs Blog, 10(10.1377). https://doi.org/10.1377/hblog20200630.939347
Fletcher, G. F., Landolfo, C., Niebauer, J., Ozemek, C., Arena, R., & Lavie, C. J. (2018). Promoting physical activity and exercise: JACC health promotion series. Journal of the American College of Cardiology, 72(14), 1622-1639. https://doi.org/10.1016/j.jacc.2018.08.2141
Lewis, T. T., & Van Dyke, M. E. (2018). Discrimination and the health of African Americans: The potential importance of intersectionalities. Current Directions in Psychological Science, 27(3), 176-182. https://doi.org/10.1177/0963721418770442
Yearby, R. (2018). Racial disparities in health status and access to healthcare: the continuation of inequality in the United States due to structural racism. American Journal of Economics and Sociology, 77(3-4), 1113-1152. https://doi.org/10.1111/ajes.12230
Topic 4 DQ 1
What are the methods a nurse can use to gather cultural information from patients? How does cultural competence relate to better patient care? Discuss the ways in which a nurse demonstrates cultural competency in nursing practice.
There are several ways in which nurses can obtain necessary cultural information from a patient. The nurse can start by establishing a rapport through therapeutic communication, engaging the patient with open-ended questions about their preferences and beliefs, and participating in active listening. An understanding of the demographic of people in the community in which they work will also help the nurse in gathering cultural information.
Familiarizing themselves with the ethnic, racial, and socioeconomic status of the community can help the nurse to anticipate certain cultural tendencies and considerations. Cultural respect is critical to reducing health disparities. It helps improve access to high-quality health care that is respectful of and responsive to the needs of diverse patients. When developed and implemented as a framework, cultural respect enables systems, agencies, and groups of professionals to function effectively to understand the needs of groups accessing health information and health care (Cultural Respect, 2021). This proactive approach enhances the nurse’s ability to establish rapport and a meaningful connection that elicits information from the patient.
Having a broader awareness of the cultural groups they might encounter prepares the nurse for a more culturally competent approach to the assessment and care planning process. Cultural competency does not mean becoming an expert on every culture encountered, but it does mean that nurses should recognize what they do and do not know in order to provide appropriate care (Falkner, 2022). By prioritizing patient-centered care that respects and embraces diverse perspectives, nurses can motivate patients and their families to actively engage in healthy habits while also taking crucial steps to mitigate common risk factors prevalent within their community. For example, if the community has a sizable population of older adults, the nurse can learn about cultural beliefs and traditions related to aging, end-of-life care, and intergenerational dynamics.
Cultural Respect. (2021, July 7). National Institutes of Health (NIH). https://www.nih.gov/institutes-nih/nih-office-director/office-communications-public-liaison/clear-communication/cultural-respect
Falkner, A. (2022) Cultural Awareness. In Grand Canyon University (Eds.), Health promotion: Health and wellness across the continuum. In Grand Canyon University (Eds.), Retrieved from https://bibliu.com/app/#/view/books/1000000000585/epub/Chapter3
What are the methods a nurse can use to gather cultural information from patients?
As nurses we must practice with compassion and respect to everyone we care for without bias or discrimination despite the many differences we may encounter. Treating everyone with respect and empathy, while also acknowledging variances in a non-judgmental way, allows the nurse to collect cultural information to provide competent cultural care. Health care professionals can employ several different methods when gathering important cultural information from clients such as utilizing cultural assessment tools, health history questionnaires, engaging in open dialogue and active listening or keenly observing the clients body language depending on the depth and structure of the assessment being performed (Faulkner et al, 2022).
How does cultural competence relate to better patient care?
Cultural competence allows for a deeper connection with patients and is directly linked to better patient care outcomes. A culturally competent nurse is able to provide care that aligns with the values and preferences of the client, enabling for increase patient-provider trust, leading to better communication thus greater patient adherence and satisfaction (Faulkner et al, 2022). Nurses who practice with cultural awareness, diversity and inclusivity directly combat health disparities pertaining to economic, environmental, and social disadvantages in groups of people experiencing greater obstacles to health (Deering, 2022). By understanding and truly embracing cultural differences we can fully interact, assess, and provide high quality care and create individualized patient centered plans of action.
Discuss the ways in which a nurse demonstrates cultural competency in nursing practice.
The nurse can demonstrate cultural competency in several ways such as becoming self-aware of their own personal cultural preconceptions, as to not impose any bias when caring for others; by continuously engaging in education in diverse cultures, beliefs and disparities to implement in practice; and lastly by utilizing language interpreters or adapting communication styles to meet the needs of the patient they are working with (Faulkner et al, 2022)
Falkner, A., Green, S. Z., & Whitney, S. (2022). Health Promotion: Health & Wellness Across the Continuum. (Second Edition). Grand Canyon University.
Deering J.D., M. (2022) Cultural competence in nursing, NurseJournal. https://nursejournal.org/resources/cultural-competence-in-nursing/.
NRS 429V Week 1 Discussion 2
In the assigned reading, “How to Write Learning Objectives That Meet Demanding Behavioral Criteria,” Kizlik explained that “objectives that are used in education, whether they are called learning objectives, behavioral objectives, instructional objectives, or performance objectives are terms that refer to descriptions of observable behavior or performance that are used to make judgments about learning.” How do health providers design educational programs to clearly articulate objectives to engage both patients as well as families?
According to the family systems theory, a member of a family has to change its behaviors and influence everyone in the family to follow along and change to promote health and wellness. An example is a family member with a history of obesity decides to lose weight and creates a diet plan and exercise regimen and encourages the rest of the family to join him in the journey of losing weight. Behavioral changes when an individual decides to change for the better and act on it.
The family systems theory helps in teaching behavioral changes because once a family member is involved in the plan of care and already decides to take part in the process of helping to live a better lifestyle, it is much easier to influence the rest of the family.
According to the ebookHealth Promotion: Health & Wellness Across the Continuum, variables that affect the ability to learn are race, ethnicity, immigration status, disabilities, sex/gender/sexual orientation, environmental threats, poverty, access to health care, and lack of education can be barriers that affect a patient’s ability to learn and move forward with the behavioral changes.
A patient’s readiness to learn to change their lifestyle for a better life improves the learning outcomes because once a patient understands the reasoning behind the need for the change, it is easier to change its bad habits to new habits and live a healthy lifestyle.
Grand Canyon University (Ed). (2018). Health promotion: Health & wellness across the continuum. Retrieved from https://lc.gcumedia.com/nrs429vn/health-promotion-health-and-wellness-across-the-continuum/v1.1/
This is an outstanding response Ronald. I agree with it. Health conditions tend to emanate from intricate factors such as those advanced by social, economic, and political determinants. Health is determined by the manner in which societies are structured and how health policy agendas are influenced by the political nature in the society (Laverack, 2017). Health promotion interventions that address behavioral risks are capable of supporting policies to enhance health or uphold inequalities in a society. This is attributed to the fact that behavioral change models have insignificant impact on wider conditions that result in poor health. Therefore, any health promotion model intended to initiate behavioral changes should be adopted as a component of a winder, inclusive policy framework. Ensuring a comprehensive and multi-component health promotion model is appropriate in changing bad behaviors that can cause negative health effects (Laverack, 2017). Advancing health promotion model through a strong policy framework is crucial in giving people greater control over their lives instead of instructing them on what to do.
Laverack, G. (2017). The challenge of behaviour change and health promotion. Challenges, 8(2), 25.
Developing health promotion programs that helps to set up healthy lifestyle behavior requires comprehensive planning. Theories and Models both include concepts and constructs. Health theories and behavior models helps to explain why individuals and communities behave the way they do.
Theories and models both include concepts and constructs. Concepts are the primary components of a model or theory. Constructs are components that have been created for use in specific model or theory. These terms are important to understand when discussing models and theories (Glanz, Rimer, &Lewis,2002).
Theories and models helps to understand the nature and understanding of the patients. In Tran theoretical model describes the process of how the behavior of individual changes, there are various factors that influence the behavior of patient.
These model includes five stages (Glanz, Rimer, &Lewis,2002;NCI, 2005)
Pre contemplation– In this stage the individual has no intention to change behavior within the next six months.
Contemplation- In this stage, an individual is considering a behavior change within the next six months.
Preparation– In this stage the individual takes some steps towards making a change doing so within the next 30 days.
Action– An individual reaches this stage once he/she has made a apparent behavior change and doing within next 30 days.
Maintenance– If behavior change last more than 6 months then moves in the final stage of maintenance.
Barriers that affect the patient’s ability to learn can be language, culture, beliefs, educational level of the patients, before set up the the plan for educating the patients nurse should assess the patient’s ability to learn and obstacles in the patient learning that can be face by the nurse.
Readiness to learn refers how patients in participating in the behavior change, patient should be ready physically, psychologically and cognitively engage in learning. Health status of the patient really affect the readiness to learn, in this patient is in pain or feeling weakness or fatigue may affect the readiness to learn. Nurse should always assess the learning style of the patient, patient’s environment such as loud noises, educational level, Nurse should always use the words as a Layman can understand, should avoid medical terms as much as possible.
Glanz, K., B. Rimer, ,& F. Lewis. (2002). Health behavior and health education. San Francisco, CA: John Wiley & Sons, Inc. National Cancer Institute (2005). Theory at a glance guide for health promotion practice.
The U.S. is a land of diverse cultural backgrounds and heritage with many different types of people based on their racial composition, beliefs, social statuses and views. The minority races are projected to become the majority in the next twenty years based on figures from federal agencies. As such, the increased diversity implies that healthcare providers and organizations must develop strategies focused on health promotion to reduce the overall healthcare cost in the country (Velasco-Mondragon et al., 2017). The diverse minorities have different cultural perspectives that affect accessibility, affordability, and quality of care provided. Therefore, health promotion can help minority populations lower cost of care and increase accessibility. As such, the paper compares and contrasts the health status of the Hispanic American population to the national average by looking at different components that define health and related services.
Nutrition plays a central role in health promotion due to its significant impact on overall well-being and disease prevention. A balanced and adequate diet provides essential nutrients necessary for optimal growth, development, and functioning of the body. The World Health Organization (WHO, 2020), showed that poor nutrition is a leading risk factor for various chronic diseases, including cardiovascular disease, obesity, and diabetes. In contrast, a healthy diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats has been associated with a reduced risk of these conditions. Also, nutrition affects mental health, as certain nutrients play a crucial role in brain function and mood regulation.
Emerging populations encounter numerous nutritional challenges that can impede their health and well-being. According to Jones and Shrinivas (2019), as globalization and urbanization continue to progress, there is frequently a shift away from customary, locally acquired food choices towards processed and fast-food alternatives. This shift leads to an increased intake of foods that are high in added sugars and unhealthy fats, while lacking in essential nutrients. Furthermore, socioeconomic factors and limited access to nutritious foods exacerbate these challenges, underscoring the need for targeted interventions, educational initiatives on healthy eating habits, and policies promoting the availability and affordability of nourishing food choices.
Nutritional deficiencies and excesses play significant roles in the development of diseases. As per Lichtman (2019), deficiencies in essential nutrients, such as vitamins, minerals, and proteins, result in a range of health issues, including compromised immune function, stunted growth, anemia, and impaired cognitive development. For instance, inadequate iron intake can result in iron-deficiency anemia, characterized by symptoms such as fatigue, reduced work capacity, and impaired cognitive function. Similarly, insufficient intake of vitamin D can cause skeletal disorders such as rickets. On the other hand, excessive consumption of certain nutrients can contribute to the onset of chronic diseases. High sodium intake has been associated with hypertension and cardiovascular disease, while overconsumption of added sugars and unhealthy fats is linked to obesity, type 2 diabetes, and cardiovascular problems. To mitigate both problems, maintaining a balanced and diverse diet would be essential. Consequently, that would help reduce the risk of various diseases.
Jones, A. D., & Shrinivas, A. (2019). Food systems and diets: Facing the challenges of the 21st century. Global Food Security, 20, 1-6. doi:10.1016/j.gfs.2019.01.001
Lichtman, S. W. (2019). Macronutrient deficiencies and excesses. In A. C. Guyton & J. E. Hall (Eds.), Textbook of Medical Physiology (14th ed., pp. xxx-xxx). Saunders.
World Health Organization. (2020). Diet, nutrition and the prevention of chronic diseases. Retrieved from https://www.who.int/publications/i/item/9241545903
Description of the Ethnic Minority & Current Health Status
The Hispanic population comprises of individuals that have ancestry or origin in Cuba, Mexico, South and Central America, Puerto Rico and other Spanish cultures and background. The Census Bureau estimates that there are close to 60 million Hispanic or Latino people in the country. Imperatively, Hispanic is the largest racial minority group in the country as it constitutes about 19% of the general population. Again, it is projected that by 2060, Hispanics living in the U.S. will account for about 28.6% of the total population (Census Bureau, 2019). The Latino population is concentrated in ten states with most of them having over one million people of this minority group. These ten states include California, Arizona, New Mexico, Colorado, Georgia, Florida, Illinois, Texas, New Jersey and New York. Hispanics have a rich cultural background in food and value family life and are fluent Spanish speakers (HHS, 2020). Their cultural practices are heavily influenced by the Spanish culture.
The health status of this population can be evaluated through different aspects that include uptake of medical or health insurance, access to health services and prevalence of lifestyle conditions among other socioeconomic determinants of health. Hispanics have limited insurance coverage compared to the general population. Hispanics constitute the highest number of uninsured individuals in the country. Figures from the Census Bureau show that in 2017, only 49% of Latino Americans had private insurance compared to the white Americans where close to 75% had medical covers. The Bureau also shows that more Hispanics depend on public health coverage than their non-Hispanic white counterparts (Census Bureau, 2019). About 17.8% of Hispanics did not have health insurance compared to about 6% of the non-Hispanic whites. These figures show that a majority of Hispanics struggle to access health services, especially preventive care.
Studies show that Hispanics are likely to suffer from, and die of, lifestyle conditions like diabetes and heart diseases as well as cancer compared to the general population (Velasco-Mondragon, 2017; Suarez-Balcazar et al., 2018). The health of Latino Americans is impacted by different factors that include limited or lack of access to preventive care services, language barrier, and cultural issues. As indicated, a majority of this population do not have health insurance coverage. The Centers for Diseases Control and Prevention (CDC) asserts that Hispanics are susceptible to diabetes due to cultural factors (CDC, 2020). They are also susceptible to stroke, asthma, obesity, liver disease, and suicide as well as HIV/AIDS. These factors lead to increased health disparities between the Hispanic population and the general population.
Health Disparities and Nutritional Challenges of the Hispanic Ethnic Group
Health disparities are the variations and variables that contribute to inequalities or unequal distribution of healthcare resources among various demographics and population. Disparities also include preventable differences in disease burden, injury and violence or chances to attain optimal health which disadvantaged groups encounter. Specifically, disparities are associated with socioeconomic and environmental conditions of certain populations, especially among groups in racial and ethnic minorities. The Hispanic population faces income disparities leading to high rates of uninsured individuals compared to the general population (Suarez-Balcazar et al., 2018).
Hispanics have increased health risk because of limited access to health care services and are 35% more likely to have heart diseases, 50% more likely to have diabetes, and 49% likely to suffer from cancer than the non-Hispanic white counterparts. The Hispanics are 23% more likely to have obesity and 23% less likely to go for colorectal cancer screening (Velasco-Mondragon et al., 2016). These statistics imply that the Hispanic population faces nutritional challenges. The nutritional challenge that exposes the population to a host of lifestyle conditions include having a diet with less recommended amounts of vegetable, whole grains and fruits and high amounts of sodium, sugar and saturated fats way beyond the recommended amounts.
Barriers to Health for Hispanic Population
Hispanic population faces significant barriers to health stemming from culture, socioeconomics, education and sociopolitical aspects. Hispanics are more unlikely to afford the cost of care and access healthcare services due to cultural issues like language barrier. Nurses can only offer effective care if a patient understand the language used by these healthcare providers. For instance, a good number of Hispanics do not understand English and many do not complete their high school education. Hispanic cultural beliefs are diverse as each group among this racial diversity has different cultural cues that nurses and other healthcare providers must understand.
Socioeconomic barriers among the Hispanics entail poor living conditions, low income and high poverty levels than the national average. For instance, one in every four Hispanics does not have a high school certificate (Velasco-Mondragon et al, 2016). The unhealthy lifestyles of the Hispanics increase the risk for developing chronic conditions. Low educational attainment means that an individual cannot be employed in a better workplace environment. Besides not being insured, they face barriers that impact their ability to access better health care services as they cannot afford to pay hospital bills out of pocket.
The sociopolitical factors affecting Hispanics entail changing immigration laws. Recent suggestions by the Trump administration to deport millions of illegal Hispanic migrants may have made many to fear accessing health care services or taking medical insurance (Velasco-Mondragon et al., 2016). The hundreds of undocumented Hispanics in the country increases barriers to better healthcare access as they have to give false information which makes it difficult for health care providers to monitor them closely. The Hispanics fail to return for reviews, making it difficult to provide effective services to them.
Health Promotion Activities Practiced by Hispanics
Health promotion activities are essential in preventing disease conditions in populations. Improving access to affordable services is critical to this population that does not seem to practice effective health promotion activities. Health promotion among the Hispanic should focus on reducing the high disease risk that include hypertension, obesity, and diabetes. Among the activities the population practices to promote health is creation of awareness about the effects of lifestyle conditions like diabetes and obesity. The population also focuses on movement strategy that aims at promotion of physical activity among the people (Avilés-Santa et al., 2017). These health promotions demonstrate the need for the population to increase the drive for more individuals to get medical insurance coverage.
Approach in Health Promotion
An effective health promotion model would be a focus on family and educating members about the need to prevent diabetes and obesity. The nurse should include the patient’s entire family into the plan of care. Diabetes is prevalent in the Hispanic culture and the primary level would entail giving basic information to patients on diet and blood sugar control. The nurse should provide an explanation to the patient about a healthy diet, especially one with low sodium, low sugar and low levels of saturated fats. The provider can teach the family how to check for blood sugar levels to ensure that it is at the normal rate. A secondary level model would entail teaching Hispanics with diabetes how and where to be screened for the condition. The healthcare provider should discuss the symptoms and signs of the condition (Avilés-Santa et al., 2017). At the tertiary level, the patients should be taught that untreated hypo and hyperglycemia leads to increased complications and possible hospitalization. The provider should ensure that patients understand the working of their medications to maintain their blood sugars to the appropriate range.
Health promotion is essential, especially among minority populations that experience increased health disparities and barriers. As demonstrated, health care providers and organizations in the country should ensure that they have cultural competencies to develop effective strategic models to promote quality care outcomes among the minority populations.
Avilés-Santa, M. L., Heintzman, J., Lindberg, N. M., Guerrero-Preston, R., Ramos, K., Abraído-
Lanza, A. L., … & Papanicolaou, G. (2017, October). Personalized medicine and Hispanic health: improving health outcomes and reducing health disparities–a National Heart, Lung, and Blood Institute workshop report. Biomedical Central, 11(11): 1-12. doi: 10.1186/s12919-017-0079-4
Centers for Diseases Control and Prevention (CDC) (2020). Health of Hispanic or Latino
Population. Retrieved on December 4, 2020 from https://www.cdc.gov/nchs/fastats/hispanic-health.htm
Health and Human Services (HHS) (2020). Profile: Hispanic/Latino Americans. Retrieved on
December 4, 2020 from https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=64
Suarez-Balcazar, Y., Mirza, M. P., & Garcia-Ramirez, M. (2018). Health disparities:
Understanding and promoting healthy communities. Journal of Prevention & Intervention in the Community, 46(1): 1-6. https://doi.org/10.1080/10852352.2018.1386761
Velasco-Mondragon, E., Jimenez, A., Palladino-Davis, A. G. Davis, D. & Escamilla-Cejudo, J.
A. (2016). Hispanic health in the USA: a scoping review of the literature. Public Health Reviews, 37(31). https://doi.org/10.1186/s40985-016-0043-2
U.S. Census Bureau (2019 August 20). Hispanic Heritage Month 2019. Retrieved on December
Health Promotion in Minority Population
An ethnic/racial minority refers to a group of people who vary in race or color or cultural origin from the dominant group, usually the majority population of the country in which they live. The distinct identity of an ethnic minority is exhibited in various ways, ranging from distinct customs, language, accent, lifestyles, dressing, and food preferences to moral values, attitudes, and economic or political beliefs (Kaholokula et al., 2018). Racial/ethnic minorities often encounter challenges in accessing health care in the US. This paper seeks to describe the health status of Native Hawaiians, including health disparities, barriers to health, and health promotion activities, as well as discuss a health promotion approach practical for this group.
Native Hawaiians Current Health Status
Native Hawaiians are people with origins in any of the original peoples of Hawaii, Samoa, Guam, or other Pacific Islands. According to the Office of Minority Health (OMH) (2021), there are approximately 1.4 million Native Hawaiians/Pacific Islanders alone or in addition to one or more races residing within the US. Native Hawaiians account for about 0.4% of the US population, with roughly 355,000 Native Hawaiians residing in Hawaii. As of 2019, the ten states with the largest population of Native Hawaiian were Hawaii, California, Texas, Washington, Utah, Florida, Nevada, Oregon, New York, and Arizona (OMH, 2021). The Census Bureau projections showed that the 2020 life expectancy at birth for Native Hawaiians is 80.8 years, with 83.2 years for females and 78.5 years for males. Their life expectancy is almost similar to non-Hispanic whites, 80.6 years, with 82.7 years for females and 78.4 years for males.
Native Hawaiians have high rates of alcohol consumption, smoking, and obesity. Besides, they have less access to cancer prevention and control programs. Some major causes of death among Native Hawaiians include heart disease, cancer, unintentional injuries, stroke, and diabetes (OMH, 2021). Other prevalent diseases and risk factors among this group are HIV/AIDS, hepatitis B, and tuberculosis. Native Hawaiians are confronted with racial and ethnic discrimination, leading to poor physical and mental health outcomes.
Health Disparities for Native Hawaiians
Health disparities refer to the differences in the occurrence, prevalence, and mortality of a disease and the associated adverse health conditions among specific population groups. Native Hawaiians face health disparities in HIV/AIDs, TB, and STDs. In 2018, the rates of new HIV diagnoses per 100,000 was 25.3 in males and 2.1 in females exceeding their White counterparts at 9.6 for males and 1.7 for females (Truman et al., 2018). Besides, the rate of reported chlamydia cases was 3.3 times the rate in Whites and 5.3 times in Asians. In 2018, reported gonorrhea cases were 181.4 cases per 100,000, 2.6 times the rate in Whites (Truman et al., 2018). Also, the rate of reported primary and secondary syphilis cases was 2.7 times the rate among Whites, 16.3 versus 6.0 cases per 100,000 (Truman et al., 2018). Furthermore, the prevalence of TB in Native Hawaiians is 20 per 100,000, which is 40 times higher than the rate of TB disease in non-Hispanic whites at 0.5 per 100,000. They also have higher rates of stroke, coronary heart disease, and congestive heart failure than the general population. They are affected with these chronic diseases about a decade earlier in life.
Native Hawaiians have the highest rates of overweight and obesity than all other ethnicities, mainly attributed to poor dietary habits. Overweight and obesity have led to a high prevalence of lifestyle diseases such as heart disease, hypertension, diabetes, and cancer, which cause high morbidity and mortality rates (Uchima et al., 2019). The occurrence of heart disease is 68% higher than the US total population, diabetes is 130% higher, and cancer is 34% higher (Uchima et al., 2019). Overweight and obesity rates are attributed to genetics and the western lifestyle, characterized by poor diet and exercise habits. The Native Hawaiian diet consists of high amounts of complex carbohydrates, moderate amounts of vegetables, and small amounts of lean animal food (Uchima et al., 2019). The diet is 78% carbohydrate, 12% protein, and 10% fat, contributing to obesity and lifestyle diseases.
Barriers to Health
Despite Native Hawaiians having high healthcare needs, they continuously face barriers in accessing and utilizing quality healthcare services due to cultural, socioeconomics, education, and sociopolitical factors. Deficiencies in local language skills, communication, and cultural competency and contradicting perceptions, beliefs, attitudes, and values toward health and healthcare are significant cultural barriers to accessing health care (Kaholokula et al., 2018). Native Hawaiians are highly likely to be unemployed, have less than high school education, and live below the Federal Poverty Line (Morisako et al., 2017). The low socioeconomic status limits their health insurance coverage and ability to pay for health services. Lack of health insurance is a major barrier to access quality health services for minorities in the US.
Native Hawaiians have lower education levels than the general US population, characterized by high rates of school failure and dropouts. Low literacy levels contribute to a low socioeconomic status, poor health-seeking behaviors, and poor health outcomes (Morisako et al., 2017). The history of colonization is a major sociopolitical barrier that limits their access to health care since it is a major determinant of health in the population (Morisako et al., 2017). Colonization of Native Hawaiians curbed the spread of culture, language, and traditional practices, significantly damaging their education, health, and social wellbeing.
Health Promotion Activities Practiced By Native Hawaiians
Native Hawaiians use respected traditional healers and kumu (teachers) in health-related activities. They seek services from traditional healers who utilize herbal plants and practices such as massage and conflict resolution (Kaholokula et al., 2018). Herbal plants are used to manage various conditions, including headaches, burns, chest pain, hypertension, stomachache, ringworms, toothache, asthma, diabetes, and cancer (Kaholokula et al., 2018). Massage is used during childbirth and in managing inflammation, rheumatism, asthma, and bronchitis since it increases blood circulation to a specific body part. The healers use conflict resolution, which involves counseling and meditation to solve conflicts and balance relationships, thus fostering general wellness.
Health Promotion/ Prevention Approach
Chronic diseases are a major concern for Native Hawaiians due to high rates of obesity, cigarette smoking, alcohol consumption, and physical inactivity. The most effective health promotion approach to use in a care plan for this group is primary prevention. The primary prevention can center on health education on lifestyle modification in diet and physical exercises. Lifestyle modification reduces factors that prevent good health and increase those that promote health. Primary prevention will entail educating individuals on taking healthy meals, increasing physical exercises, land limiting alcohol intake to lower the incidence of obesity and chronic diseases. It will also entail educating individuals on the importance of smoking cessation to reduce the prevalence of hypertension, COPD, and complications of diabetes.
Cultural Beliefs and Practices to Be Considered When Creating a Care Plan
Several cultural aspects should be considered when creating a care plan for a minority group to promote culturally sensitive care. The aspects include health customs, beliefs, religious beliefs, interpersonal customs, ethnic customs, and dietary customs (Kaholokula et al., 2018). The Purnell Model for Cultural Competence would be ideal for fostering culturally competent health promotion among Native Hawaiians. The model has twelve domains: overview or heritage, family roles and organization, communication, workforce issues, high-risk behaviors, healthcare practices, nutrition, bio-cultural ecology, pregnancy, spirituality, death rituals, and healthcare professionals (Purnell, 2019). It can be used to assess Native Hawaiians’ traits and characteristics. It can also identify the cultural factors contributing to chronic lifestyle diseases among Hawaiians and ways to modify these factors to improve health outcomes.
Native Hawaiians are a minority ethnic group in the US, accounting for about 0.4% of the total population. They have high rates of alcohol consumption, smoking, and obesity and less access to cancer programs. Besides, they face health disparities attributed to environmental destruction, racism, colonization, and colonial oppression of this group. Health disparities are evident in the high rates of HIV, TB, STDs, diabetes, heart diseases, and chronic respiratory diseases. They face cultural, language, socioeconomic, and sociopolitical barriers which curb them from accessing quality and specialized healthcare services. Primary prevention is suitable for this population to educate them on lifestyle modification to lower the incidence of chronic illnesses.
Kaholokula, J. K., Ing, C. T., Look, M. A., Delafield, R., & Sinclair, K. (2018). Culturally responsive approaches to health promotion for Native Hawaiians and Pacific Islanders. Annals of human biology, 45(3), 249–263. https://doi.org/10.1080/03014460.2018.1465593
Office of Minority Health. (2021, April 5). Native Hawaiian/Other Pacific Islander – The Office of Minority Health. Not Found. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=65
Morisako, A. K., Tauali‘i, M., Ambrose, A. J. H., & Withy, K. (2017). Beyond the ability to pay: the health status of native Hawaiians and other Pacific Islanders in relationship to health insurance. Hawai’i Journal of Medicine & Public Health, 76(3 Suppl 1), 36.
Purnell, L. (2019). Update: The Purnell theory and model for culturally competent health care. Journal of Transcultural Nursing, 30(2), 98-105. https://doi.org/10.1177/1043659618817587
Truman, B. I., Mermin, J. H., & Dean, H. D. (2018). Measuring progress in reducing disparities in HIV, tuberculosis, viral hepatitis, and sexually transmitted diseases in the United States: a summary of this theme issue. https://doi.org/10.2105/AJPH.2018.304761
Uchima, O., Wu, Y. Y., Browne, C., & Braun, K. L. (2019). Peer-Reviewed: Disparities in Diabetes Prevalence among Native Hawaiians/Other Pacific Islanders and Asians in Hawai ‘i. Preventing chronic disease, 16. https://doi.org/10.5888/pcd16.180187
Health Promotion in Minority Populations
An ethnic minority group refers to individuals who constitute less than half of the population in an entire State or country and whose members share common characteristics of language, culture, religion, or a combination of these. Socio-economic, cultural, and political factors often limit ethnic minority groups in the US from accessing quality health care. The purpose of this paper is to compare and contrast the health status of Native Hawaiians to the national average and discuss health promotion that can be applied to this minority group.
Identification and Description of Selected Minority Group
Native Hawaiians include people with origins in the original peoples of Hawaii, Samoa, Guam, or other Pacific Islands. The estimated population of Native Hawaiians as of July 2022 was 1,440,196 based on statistics from the .S. Census Bureau. Of this population, 5.7% are children below 5 years, 21.1% are persons below 18, and 19.6 % are adults above 65. Besides, females constituted 49.7% of the total population. The states with the highest population of Native Hawaiians are Hawaii, California, Washington, Texas, Utah, Florida, Nevada, Oregon, New York, and Arizona. Native Hawaiians suffer from poor health outcomes, like high rates of overweight/obesity, hypertension, asthma, and cancer mortality (Long et al., 2022). The major mortality causes among this group are heart disease, unintentional injuries, cancer, stroke, and diabetes.
Health Disparities and Nutritional Challenges for Minority Group
Health disparities refer to the differences in access to healthcare and outcomes between groups. Health disparities among Hawaiians include a 37 times higher rate of TB and an 80% higher overweight/obesity rate. In addition, they are four times more likely to develop a stroke and 30% more likely to die from a stroke (Long et al., 2022). The group also has almost double the infant mortality rate of the general population. Furthermore, diabetes is a major cause of mortality in Native Hawaiians. Data shows that Hawaiians are 2.5 times more likely to be diagnosed with diabetes or die from the disease than whites (McElfish et al., 2019). Statistics also reveal that 39% of the population has uncontrolled diabetes, which surpasses the Healthy People 2020 goal of 16.1%.
The high rates of overweight/obesity, hypertension, and diabetes can be attributed to poor dietary habits. Long et al. (2022) explain that Native Hawaiians have a high incidence of food insecurity, contributing to chronic illnesses. The population has poor dietary habits high in complex carbohydrates, and has moderate amounts of vegetables and minimal lean animal food. Hawaiians’ diet comprises 78% carbohydrate, 12% protein, and 10% fat, which contribute to overweight and obesity.
Barriers to Health for Minority Group
Poor health outcomes among Native Hawaiians can be attributed to cultural, socioeconomic, educational, and sociopolitical factors. Language and cultural barriers hinder many Hawaiians from accessing quality healthcare. Most healthcare providers are not conversant with the group’s cultural beliefs and practices, which hinders them from understanding their health needs and the best measures to address their health problems (McElfish et al., 2019). The median household income for Native Hawaiians in 2019 was $66,695, lower than whites at $71,664. Besides, more Hawaiians (15%) lived at or below the poverty level than whites 9%, and Hawaiians had higher unemployment rates (McElfish et al., 2019). These have affected access to health due to lack of insurance and limited access to healthy foods. Furthermore, 23% of Hawaiians face challenges paying medical bills compared to whites at 16%. The limitations in accessing health care contribute to poor health outcomes, lower quality of life, and inefficient use of health services.
Hawaiians have a lower level of educational attainment than Whites. Approximately 24% of Native Hawaiians have a bachelor’s degree or higher compared to 37% of whites. Besides, fewer Native Hawaiians have a graduate or professional degree than whites. Higher education levels are linked with better health outcomes and a longer lifespan. Native Hawaiians have a political history of long-term injustice and discrimination (Lee et al., 2022). They lost their agricultural and aquacultural way of life because of urbanization and had limited access to their Native foods limiting their ability to attain optimal health.
Health Promotion Activities Practiced by Minority Group
Native Hawaiians engage in various activities to improve and promote their health. They seek traditional healers’ services that provide massage and treatment with herbs. Hawaiians use massage to alleviate pain during childbirth and manage inflammation, rheumatism, asthma, and bronchitis to improve circulation to specific body parts (Kaholokula et al., 2018). Herbs are used to manage burns, headaches, high BP, GI distress, toothache, worm infections, respiratory symptoms, and hyperglycemia.
Three Levels of Health Promotion Prevention
Primary prevention would be the most effective level of health promotion for Native Hawaiians. The population has a high prevalence of chronic diseases associated with poor lifestyle practices like poor dietary habits (excess fat and energy intake), smoking, and inadequate physical activity. Primary prevention will focus on educating Hawaiians on measures to prevent these chronic illnesses, particularly lifestyle modification. Lee et al. (2022) recommend culturally-appropriate measures to increase physical activity among Hawaiians, which can alleviate high rates of overweight, obesity, and diabetes. Hawaiians can be educated on reducing caloric consumption while considering their cultural practices. For instance, the health provider can help create a healthy meal plan using their native foods. Primary prevention is key to reducing the incidence of new diagnoses of chronic illnesses since it promotes behavior change.
Cultural Competent Health Promotion for Ethnic Minority Population
A health promotion care plan for a minority group should incorporate the population’s health beliefs, health and ethnic customs, religious practices, diet customs, and interpersonal customs. Leininger’s Culture Care Theory can be applied to support culturally competent health promotion for Native Hawaiians. It asserts that different cultures have different caring behaviors as well as values on health and illness, beliefs, and behavioral patterns (McFarland & Wehbe-Alamah, 2019). The theory’s primary aim is for nursing care to have beneficial meaning and health outcomes for people from similar or different cultural backgrounds.
Health disparities are apparent among Native Hawaiians and have contributed to a poor health status compared to the general US population. They have high rates of overweight/obesity, hypertension, asthma, and cancer, contributing to poor health outcomes, low quality of life, and reduced life span. Poor diet habits among Hawaiians have contributed to the high obesity and diabetes rates. Primary prevention should aim to increase Hawaiian’s knowledge of lifestyle practices contributing to poor health outcomes to encourage them to modify their behavior.
Kaholokula, J. K., Ing, C. T., Look, M. A., Delafield, R., & Sinclair, K. (2018). Culturally responsive approaches to health promotion for Native Hawaiians and Pacific Islanders. Annals of human biology, 45(3), 249–263. https://doi.org/10.1080/03014460.2018.1465593
Lee, Y. J., Braun, K. L., Wu, Y. Y., Burrage, R., Muneoka, S., Browne, C., … & Hossain, M. D. (2022). Physical activity and health among Native Hawaiian and Other Pacific Islander older adults. Journal of Aging and Health, 34(1), 120–129. https://doi.org/10.1177/08982643211032468
Lee, Y. J., Braun, K. L., Wu, Y. Y., Hong, S., Gonzales, E., Wang, Y., … & Browne, C. V. (2022). Neighborhood social cohesion and the health of native Hawaiian and other Pacific Islander older adults. Journal of Gerontological Social Work, 65(1), 3–23. https://doi.org/10.1080/01634372.2021.1917033
Long, C. R., Narcisse, M. R., Bailey, M. M., Rowland, B., English, E., & McElfish, P. A. (2022). Food insecurity and chronic diseases among Native Hawaiians and Pacific Islanders in the US: results of a population-based survey. Journal of Hunger & Environmental Nutrition, 17(1), 53–68. https://doi.org/10.1080/19320248.2021.1873883
McElfish, P. A., Purvis, R. S., Esquivel, M. K., Sinclair, K. I. A., Townsend, C., Hawley, N. L., … & Kaholokula, J. K. A. (2019). Diabetes disparities and promising interventions to address diabetes in Native Hawaiian and Pacific Islander populations. Current diabetes reports, 19, 1–9. https://doi.org/10.1007/s11892-019-1138-1
McElfish, P. A., Yeary, K., Sinclair, I. A., Steelman, S., Esquivel, M. K., Aitaoto, N., Kaholokula, K., Purvis, R. S., & Ayers, B. L. (2019). Best Practices for Community-Engaged Research with Pacific Islander Communities in the US and USAPI: A Scoping Review. Journal of health care for the poor and underserved, 30(4), 1302–1330. https://doi.org/10.1353/hpu.2019.0101
McFarland, M. R., & Wehbe-Alamah, H. B. (2019). Leininger’s Theory of Culture Care Diversity and Universality: An Overview With a Historical Retrospective and a View Toward the Future. Journal of transcultural nursing: official journal of the Transcultural Nursing Society, 30(6), 540–557. https://doi.org/10.1177/1043659619867134
There is no information on the patient’s culture, ethnic background, or religion. These questions are part of a thorough nursing assessment. The patient could be asked about his cultural and religious preferences.
Additional information that could have benefited his holistic care would be information about his marital status, family structure, whether he is a father of children, what is his occupation, and is he currently employed?
As a Nurse Case Manager, I always try to determine the patient’s world view by asking about their employment or previous employment. This gives great insight into educational and learning styles. For example, Engineers tend to like data and graphs, Teachers like to receive printed materials to read, and Artists like pictures. This is a concept found in the VARK analysis. (VARK-Learn.com, 2022.)
The nurse should ask the patient what a typical day looks like for him, and who is his support system at home, or does he live alone? What health-protecting behaviors, such as diet and exercise, does he already have in place? Does he need assistance with developing any new lifestyle plans? Does he take any medications or supplements? What are his beliefs about health maintenance? How does he rate his current stress levels and how does he manage his stress?
Asking the correct questions can reveal everything that is needed in order to develop a more effective plan of care. This plan of care will be highly individualized and will provide holistic care, leading to improved outcomes for this patient.
Current Health Status
Asian Americans have an estimated life expectancy of 80.7 years with 78.4 years for men and 82.7 years for women. Asian Americans experience issues such as cultural and language barriers in healthcare, which lower their healthcare service utilization. Asian Americans are increasingly at a risk of health problems such as stroke, unintentional injuries, stoke, heart disease, cancer, and diabetes. They also have a high prevalence of hepatitis B, smoking, HIV/AIDs, liver disease, tuberculosis, and pulmonary disease. An example is the fact that tuberculosis was 33 times more common among Asian Americans in 2019 as compared to non-Hispanic whites. Health insurance coverage varies in this population. For example, the rate of non-insurance among them in 2019 was 6.6% compared to 6.3% in non-Hispanic white Americans (minorityhealth.hhs.gov, n.d.).
Effect of Race and Ethnicity
Race and ethnicity affect the health of Asian Americans. Race acts as an influential factor determining the life circumstances of Asian Americans through pathways such as determining their economic opportunities, residence, and experiences with healthcare. Opinion polls support Asian Americans’ experiences with discrimination due to their race and ethnicity. For example, Americans express mixed feelings towards individuals of Asian American backgrounds. They have positive feelings towards them as compared to African Americans. However, these feelings are not similar to those that Americans have towards the whites. Most (74%) of Asian Americans have reported unfair treatments from others due to their ethnic and racial backgrounds. They also experience discrimination in utilizing healthcare services due to culture-related issues (McMurtry et al., 2019). As a result, they have an increased risk of poor health outcomes as compared to American whites.
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