HAP 445 Final (1)
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George Mason University *
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Course
445
Subject
Health Science
Date
Dec 6, 2023
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docx
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9
Uploaded by harshini12
1.
How does the CDC define “social determinants of health?” Explain the force fields in
Blum’s model.
The CDC defines the social determinants of health as “complex, integrated, and overlapping
social structures and economic system that are responsible for most health inequities. These
social structures and economic systems include the social environment, the physical
environment, health services, and structural and societal factors. They are shaped by the
distribution of money, power, and resources.”
According to Henry Blum, there are four
factors which are responsible for the overall health of an individual:
environment, lifestyle,
heredity, and medical care. These are called force fields.
Environment has little or no control
over an individual. Environmental factors which affect health include physical and social
dimensions. Physical factors which affect health are air, noise, and water pollution,
radiations, and toxic chemicals. Factors of social dimensions include income, education,
occupational status, behavior modifications, psychological stress, perceptional problems, and
interpersonal relationships. This is the most prominent forcefield and strength of Blum’s
model. Lifestyles are behavioral risk factors like individual habits, feelings, emotions, and
overall satisfaction which are grouped into leisure activity risks, consumption risks and
occupational risks. The impact of heredity on health status includes genetic disorders,
congenital malformation, mental retardation, and life expectancy. Access to medical care is
the least important forcefield and weakness of Blum’s model. The factors of medical care
which affect health are prevention, cure, care, and rehabilitation. This is another
consideration because it involves the identification of a disease, treatment, prevention, and
rehabilitation.
2.
What percentage of premature deaths can be attributed to inadequate access to medical care?
In a 1979 study, the Center for Disease Control identified environment, lifestyle, heredity,
and medical care contribute to health as identified by Blum. It also identified access to
healthcare is the least important factor that affect heath as identified in Blum’s model. The
CDC found that 50 % of premature deaths in US were caused by induvial lifestyle and
behaviors, 20% premature deaths were resulted from individual inherited profiles, 20%
premature deaths were caused by social and environmental factors and only 10% premature
death were resulted from inadequate access to healthcare. Inspite of more efforts and
expenditures towards the delivery of medical care, health status experienced little
improvement
by the services provided by healthcare . Access to healthcare depends upon the
availability of health insurance and around 16.7 % of the population lack coverage. The
ability to pay for services not covered by insurance also affect access to healthcare. The lack
for universal access to healthcare in the US increases mortality and reduces life expectancy.
3. What can be done to address this issue?
Access to healthcare is an important issue and there are many factors affecting access to medical
care: geographical location, socioeconomic status, government action, laws, and regulation.
France and Spain have universal health system and people have higher life expectancy. US
health system is a fragmented system (mixed system). In spite of spending more on healthcare
and after addressing other risk factors, it was found that individuals live longer with lower
mortality rate under a universal health system. To increase access and efficiency the United
States can adopt some methods from other countries so that life expectancy can be increased in
the long run. United States can use national health policies used by France by using state
governments. By giving more emphasis to population health universal healthcare can be
perceived as more feasible. Universal health care system is not accepted by the healthy and
wealthy people of US because they are not willing to pay for other’s care through higher taxes.
Americans die in larger quantities due to lack of access to care for preventable reasons. So,
United States must acknowledge the need for universal healthcare. Healthcare policies and
reforms must ensure our healthcare system to cover the cost for everyone at least for healthcare
screening or checkups. The American medical facilities must introduce self-management and
self-care improvements among patients since access to healthcare is currently limited in the
United States. Educate patients on healthier lifestyle practices.
How does access to healthcare affect life expectancy
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4. Describe the “Force Field and Well-Being Paradigms of Health” according to Blum. How do
we measure “poor health”? What are the indicators of “poor health”? Find information on the
CDC and the World Health Organization websites.
“Forcefield and Well- Being Paradigms of Health” is a medical approach by Henry Blum.
Environment, lifestyle, heredity, and medical care are the four factors which must be considered
while addressing health status of a population.
The health or wellbeing of individuals are
determined by the physical, mental, and social components. For example, a person’s physical
health is affected
by some ailments like stomachache, mental health by the stress and social
health by the loss of a job. The four forcefields environment, lifestyle, heredity and medical care
are shared with CDC as the four factors contributing to health and medical care as the least
important factor affecting health. Blum’s model gives more importance to overall wellbeing and
the environmental factors whereas the CDC gives importance to lifestyle behaviors and causes
leading to premature deaths.
The most commonly used indicators can be used to measure poor
health because measurements of health status are based on health problems such as diseases,
disability and death. Using mortality -based measures, life expectancy, morbidity-based
measures, poor health can be measured. We can use ADL to measure functional limitations of
elderly and chronically ill and IADL which measures functional capacity.
The SF-36 survey is a
generic questionnaire survey which is useful for patients of chronic diseases to assist the quality
of life and ability to work.
Some indicators of poor health are number of times a person has
visited the doctor per year, percentage of patients during the last one year who have not seen the
doctor , duration between doctor visits,
rate of short stay admissions and discharge.
5. Self- administered questionnaire survey
In this survey the respondents are expected to fill the questionnaires by themselves. It can be
conducted by mail, in person or through the internet.
Most preferred type is mail survey. It can
also be administered to a group of respondents gathered in one place. Internet based surveys are
increasingly popular. Another way of administering this survey is Computer Assisted Personal
Interviewing in which researchers bring computers to respondent’s office, school or home and
respondents record their responses on the computer.
Interview survey
In this survey, questions are asked by the researchers or interviewers and answers are submitted
orally by respondents. Researchers or interviewers record respondent answers or choices. It may
be conducted face- to- face (in person or web camera) or by phone. Computer Assisted
Telephone Interviewing (CATI) is helpful for large scale surveys. Computer assisted self-
interviewing is administered by using the personal computers of the respondents.
Critical
components of this survey are selecting and training interviewers and conducting interview are
the essential part of this survey.
Strengths and weaknesses
Certain research topics are more amenable to interviews than questionnaires. Questionnaire is
more appropriate for better educated people and interview is suitable for less educated
respondents. Mail or internet questionnaire are better for geographically distributed respondents
than face—to-face interviews. Self-administered questionnaire is for larger samples, and the
interview is for smaller samples.
6. What is a validity threat to experimental research? Conduct research and find an example.
Summarize the example.
Validity threats are issues which threaten the ability to arrive at
correct conclusions
on the
experimental treatment/ conditions. Researchers experience two types of validity threats: internal
and external validity threats.
The internal validity threats affect the casual explanations or the
internal validity.
It includes history, maturation, attrition, statistical regression, instrumentation,
selection, and contamination.
External validity threats are explanations of how the
generalization might go wrong. It includes history, selection bias, experimental effect, hawthorn
effect, testing effect, aptitude treatment and situation effect.
Example for external validity threat: Experimented and found that practicing mindfulness for
fifteen minutes daily for two months decreased anxiety among people with clinical diagnoses of
mental disorder. Experiment was done on people aged 20-29 having depression for the last one
year. It was concluded that all clinical population benefit from mindfulness. External threats
involved in this experiment include: tested only on
people with depression for a certain age
group and did not consider people like personality disorder etc., some unrelated event like
disaster
might influence the pre-test anxiety score, unintentional influence of the trainer made
the participants to work hard to reduce anxiety, participants consciousness
of being studied
influenced the tendency of patients to change their behavior and participants become less
anxious because of familiarity with the process.
https://www.scribbr.com/methodology/external-
validity/
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Our immune system gets affected by HIV- human immunodeficiency virus because it destroys
cells which fights against infections and diseases. It cannot be cured completely but can be
controlled by proper medication. In the United States, many factors are responsible for certain
groups to have more risk for HIV than others.
HIV can be progressed to AIDS if not treated.
Effective HIV treatment help people with HIV live longer, healthier and protect their partners. It
can be prevented by following some strategies like abstinence, not sharing needles with others,
using condoms and medications like pre-exposure prophylaxis (PrEP) and post-exposure
prophylaxis ( PEP). It can be transmitted through bodily fluids but not by contacts with other
persons. HIV status can be found only by testing.
Around 40 years ago, HIV was the leading cause of death in US, but scientific
developments made fewer people becoming infected with HIV, live longer and
healthier. According to Census Bureau 2009, 15% of U.S population was made up of Hispanic
descent population and it will reach approximately 50% by 2100. One of the serious threats to
this population was HIV-AIDS and its rate of Hispanics was 3.5 times higher than that of whites
(CDC, 2008b). The main factors of the disproportionate impact of HIV among Hispanic/ Latinos
communities in the US are racism, discrimination, xenophobia, HIV- related stigma,
homophobia, economic disparities, fundamental health care system and other long-standing
barriers. In 2019, more than 25 % of all people with new HIV infection in the US were
Hispanic/Latino communities. Also, 25 % of all people with HIV in the US were Hispanic and
Latino communities. New HIV infections among Hispanic and Latino people remained stable
although it declined by 8 % overall from 2015-2019. This new HIV infection affected Hispanic
and Latino Gay and Bisexual men and Hispanic and Latino Heterosexual women
disproportionately. Among Hispanic and Latino women, new HIV infection by Heterosexual
contact was 91%, and the rate of HIV infection was 4.9 % which was little higher than the 4.5 %
rate among overall women. A recent CDC study claimed that 35% of transgender women were
affected by HIV infections.
Many people throughout California died from HIV since the beginning of HIV/AIDS and
many are currently living with HIV. This fatal disease shifted to a chronic disease by the
improvements in treatment. In 2020, there were approximately 134,381 people living with HIV
and 3924 were diagnosed newly for HIV in California. Among them 88.1 % were males and
11.9% were females.
The percentage of Hispanic/Latinos living with HIV virus was 39.6% and
newly diagnosed HIV virus was 50.1 % in 2020. California has the largest number of new
HIV
diagnoses in US and its aim is to get to zero new HIV infections. HIV from sexual contact is
reduced to 90% by PrEP: Pre-exposure Prophylaxis. In California, the PrEP use is increased by 4
times in women between 2013-2016. Since more Hispanics/Latinos are living with HIV in
California than other races/ethnicities it became an epidemic.
The purpose of this study is to find out the common problems faced by Hispanic women with
HIV in California. It is hypothesized that HIV stigma and health care discriminations are
commonly reported problems of Hispanic persons with HIV. The percentage of Hispanic persons
with HIV who received care, retained care, and virtually suppressed were lesser than non-
Hispanic white persons with HIV. HIV stigma and discrimination are human rights issues which
are national priorities to eliminate. Health care discriminations was faced by 23% of Hispanic
persons with HIV. Hispanic men (23%) experienced health care discrimination more than
Hispanic women (18%). HIV stigma was due to disclosure concerns. To reduce stigma and
discrimination, it is important to understand the experiences of stigma and discrimination and
design an appropriate intervention.
This study will be based on the sources available from
HIV
Stigma And Healthcare Discrimination Experienced by Hispanics or Latino Persons with
HIV, United States 2018-2020/ added October 13, 2022:
https://www.cdc.gov
A team of trained researchers will be used to conduct the survey. The population involved in this
study will be 5,000 Hispanic women living in California. Personal interview will be the best
suitable data collection method because of the sensitivity of the topic and to respect an
individual’s privacy. The researchers will be using computer assisted telephone interview
( CATI) system and will type the respondents answers directly into the computer. The factors
used to measure stigma: personalized stigma (consequences of other people knowing their
status), disclosure concerns, negative self-image, public attitude, and responses. Each item was
measured using scores: 0,2.5,5,7.5 and 10 and the total was 100. Zero represents no stigma and
100 high stigma. Healthcare discrimination was measured for the previous one year. The factors
used to measure healthcare discrimination: treated with less respect than others, treated with less
courtesy than others, received poorer service than others, have the doctor or nurse acted as if the
patient was not smart,
have the doctor or nurse acted as if the patient was afraid, have the doctor
or nurse listen to the patient or not and whether the patient experienced these never, sometimes,
rarely, most of the time or always. If the participant was experiencing at least one form of
discrimination he was considered as he experienced discrimination in healthcare.
The following
characteristics were used to assist HIV stigma and healthcare discrimination: country or region of
birth, Hispanic origin, and English proficiency.
Analyze the data collected to find out
Percentage of Hispanic Women with HIV according to their origin, country of birth and
English proficiency.
Determine the percentage of women who experienced no stigma or high stigma.
Percentage of Hispanic women in California who experienced health care discrimination
during the previous year.
These findings will give us a report which could be used to determine if there really problems of
HIV stigma and discrimination of healthcare among Hispanic women in California and if so,
necessary suggestions and education can be provided. This study may help healthcare researchers
for improving HIV treatment programs to eliminate HIV stigma and discrimination in healthcare
which will in turn improve the quality of life of people living with HIV and one day stamp out of
disease.
Results: HIV stigma and healthcare discrimination were commonly reported by Hispanic persons
with HIV. HIV stigma were highest among women and American Indian or Alaskan Native
persons. Men experienced more healthcare discrimination than women. African American
Hispanic persons experienced more healthcare discrimination than white Hispanic persons.
References:
https://www.cdph.ca.gov/Programs/CID/DOA/CDPH%20Document%20Library/2017_Epi_Report.pdf
[PDF] 2017 Epidemiology of HIV in California
www.ncbi.nim.nih.gov>PMC5302118
aidsvu.org>…>United States> West California- AIDSVu
https://www.californiaaidsresearch.org/files/PrEP_Brief_2.8.18.pdf
https: //www.cdc.gov>hiv>women
HIV: Latest Research- WebMD
HIV and Hispanic and Latino People in the U.S. | Fact Sheets | Newsroom | NCHHSTP | CDC
https://www.cdc.gov/hiv/basics/index.html
HIV and Hispanic and Latino people in the U.S. / factsheet
Centers for Disease Control and Prevention
HIV Stigma and Health Care Discrimination Experienced by Hispanic or Latino Persons with HIV —
United States, 2018–2020 | MMWR (cdc.gov)
HIV Stigma And Healthcare Discrimination Experienced by Hispanics or Latino Persons
with HIV / United States,
2018-2020
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