NUR 703 Discussion 6.1: Health Disparities and Culture

NUR 703 Discussion 6.1: Health Disparities and Culture

NUR 703 Discussion 6.1: Health Disparities and Culture

The title of the article I read is Living well with a disability, a self-management program.

This article focuses on the needs of approximately 56.7 million people in the United States (U.S.) who have one or more disabilities, such as “communicative, mental, or physical disabilities.” 61 (Ravesloot et al., 2016). These people are often excluded from health promotion programs, possibly due to a lack of knowledge about how to manage people in this group. Those with disabilities suffer from secondary conditions because the environment in which they live makes little or no provision for what they require to function in their current capacity.

The 2010 IOM report had four key messages or recommendations for nurses to position themselves strategically in healthcare provision. Firstly, the report stresses the need for nurses to practice to the fullest level of their education and training without any hindrances imposed by state boards of nursing. The message influences nursing practice as it means that nurses should be barred from practicing what they have trained on in different specialties (Price & Reichert, 2018). Secondly, the report asserted that nurses should engage in lifelong learning to acquire higher levels of education and training based on a better education system. The message means that the nursing practice requires professional nurses to engage in continual professional development to attain the latest skills and knowledge in healthcare provision, especially the deployment of technology.

Secondary conditions are defined as “… health conditions that are more common among people with disabilities than among people without disabilities.” … this could limit activities and participation even more, stress health-promotion routines, and lead to acute health care episodes requiring emergency care visits and hospitalization.” 61 (Ravesloot et al., 2016)

Many more people with disabilities report poor health status as a result of health disparities in the health-care environment. This article distinguished between disability and a negative health outcome. People with disabilities can improve their health outcomes by using the right tools and resources. According to the International Classification of Functioning, Disability, and Health, medical tools and technology, as well as social frameworks such as peer support, employment, and the environment, can be modified to benefit the special needs of those who are differently able. Individuals with specific health conditions such as spinal injury, amputation, stroke, multiple sclerosis, arthritis, intellectual and developmental issues have benefited from various health promotions, and so should anyone with any type of limitation (Ravesloot et al., 2016, p. 62).

According to the article, “improved health and wellness, as well as improved ability to advocate for structural changes… can improve their access to quality health care in the United States.” 61 (Ravesloot et al., 2016) As the authors correctly point out, prevention and intervention will include “… multiple levels of intervention… required to address environmental, health system, and individual behavior determinants of health.” 62 (Ravesloot et al., 2016). Primary intervention in the form of education, secondary intervention in the form of screening the group for proper needs, and tertiary intervention in the form of addressing any health conditions the individuals may have that will impact their care are all necessary.

Previously, there were no known strategies for promoting health among people with disabilities. The living well with a disability program (LWDP) was developed in collaboration with the national network of centers for independent living (CILs) to evaluate and provide a means for those with mobility disabilities to care for themselves.

CILs are federally funded organizations that assist people with disabilities. There are 600 offices that share common philosophies about disability models, consistent methods of supporting people with disabilities to function independently, in control, and accountable for their lives, referrals for peer support, access to community resources, and skills for self advocacy and independent living (Ravesloot et al., 2016).

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LWDP was created to teach people with disabilities life skills so that they can achieve their life goals just like everyone else. The

NUR 703 Discussion 6.1 Health Disparities and Culture
NUR 703 Discussion 6.1 Health Disparities and Culture

program was also designed to motivate them to pursue their needs with confidence. Many facilitators were trained to understand various aspects of the curriculum in order for it to be applied effectively and sustainably. Topics include recruitment and retention of participants, as there are many barriers to participation, such as fear and anxiety about basic living needs, such as access to the bathroom, and how to cope in such a situation. Participants learn how to assess their own support needs and the resources available to them. For self-management and identifying health needs, effective communication skills are taught. Sedentary-prevention activities are incorporated into the educational process. Diet and nutrition information is also provided for health maintenance.

The LWDP was evaluated using a convenient sample of 246 CILs from nine sites in the United States. A community-based participatory research (CBPR) process was used to determine participant needs in order to guide curriculum program development. Pre-intervention, immediately before and after intervention, 2, 4, and 12 months after intervention were all evaluated. The program assessed secondary conditions such as symptom days, life satisfaction, different types of health care use, cost, and a healthy lifestyle. Secondary conditions such as pain, obesity, and depression were identified as possible contributors to the mobility impairment.

The results showed improvement in all outcome measures within the intervention group, based on the participation of 279 community agencies and 8,900 participants with disabilities. Within the intervention group, secondary conditions were lower. A total of $28.8 million in health-care costs were saved.

Because the LWDP has proven to be cost-effective, it will benefit people’s lives across the United States if the government encourages more participation. Remote learning could also be used to train more facilitators, allowing more communities to benefit from the program. It is critical to raise awareness about this program so that those designing different wellness promotion programs are aware that there are people who can help in various ways.


Ravesloot, C., Seekins, T., Traci, M., Boehm, T., White, G., Witten, M., Mayer, M., & Monson, J. (2016). Living well with a disability, a self-management program.. MMWR. Retrieved November 15, 2021, from

The article I chose to write about was Health Promotion and Diabetes Prevention in American Indian and Alaska Native Communities — Traditional Foods Project, 2008–2014. The Author Dawn Satterfield mentions how the American Indians/ Alaskan Natives (AI/AN) communities most likely experienced type 2 diabetes at a very low rate before the 1940s. The mid-1900s was when industrial developments began to disrupt the tribal lands and way of life. During 2010-2012 AI/AN adults over 20 years old were 2.1 times more likely to be diagnosed with type 2 diabetes than non-Hispanic whites. From 1997-2007 the rate of type 2 diabetes rose 100% in AI/AN adults aged 18-34. The health disparity is related to biological, environmental, sociological, and historical factors. The Traditional Foods Project was chosen by the CDC’s Office of Minority Health and Health Equity to provide an example of a program that spreads awareness on health disparities and solutions to address them.

The health disparity and vulnerable population is type 2 diabetes among the American Indian and Alaska Native populations. In 2018 the prevalence of type 2 diabetes was highest in the AI/AN population at 14.7%. (Centers for Disease Control and Prevention, 2020).

Social determinants of health include conditions such as economic status, education, access to foods, health care, social engagement, security, and well-being. The AI/NA people had a disruption in their relationships with land, culture, and beliefs. Because of this disruption, there was phycological trauma that continued for generations. Stress has been shown to cause changes in the brain which can lead to chronic conditions, such as type 2 diabetes (Satterfield et al., 2016). The way the AI/NA people accessed food drastically changed as well. Due to the changes in the land in the mid-1900s, growing and gathering healthy food became increasingly difficult. In 2010 23% of the Native American families were living in poverty and 28% of Native American families had food insecurity (Satterfield et al., 2016). Food insecurity happens when there is a lack of money or resources to access enough healthy food. Food insecurity is found on many reservations due to the rural location and the low income of the Native American residents (Satterfield et al., 2016).

The Traditional Foods Project was a primary form of prevention due to the focus on bringing awareness and education to the AI/NA communities. The project proposed to support sustainable approaches to traditional foods and activities, encourage local practices to gain better access to food, retrieve and create stories of the healthy native traditional ways, and engage the community in the health promotion activities (Satterfield et al., 2016). The project was able to bring an emphasis on the education of traditional community values.

An additional intervention could be implementing biweekly meetings at a local community center. These meetings would be open to anyone in the community and teach about what diabetes is, the risks of diabetes, what healthy food is, how to cook it, and finally how the food, land, and connected within the native American culture. Teaching about the spirituality of the food and land is important to mention because in Native American culture food is not just one aspect of living but rather a connection to the way of traditional life and beliefs (Satterfield et al., 2016).

Centers for Disease Control and Prevention (2020, June 25). Prevalence of Diagnosed Diabetes. U.S. Department of Health and Human Services. (Links to an external site.)

Satterfield, D., DeBruyn, L., Santos, M., Alonso, L., Frank, M. (2016). Health Promotion and Diabetes Prevention in American Indian and Alaska Native Communities-Traditional Foods Project, 2008-2014. (Morbidity and Mortality Weekly Report Volume 65, Number 1). Centers for Disease Control and Prevention.

The article I have chosen to review is called Community Asthma Initiative to Improve Health Outcomes and Reduce Disparities Among Children with Asthma (Woods et al, 2016).  This article reflects upon health disparities related to the cause of hospitalization in children of the Boston area related to asthma exacerbation and ultimately preventable admissions.  Woods et al, perform a data collection with the hopes to intervene on the outcomes of two main neighborhoods in Boston, Massachusetts by gathering data related to emergency room visits or hospitalizations where asthma exacerbation is listed as a primary or secondary diagnosis for the admission.  A few other subsequent Boston neighborhoods were added to the study if they had high levels of poverty as well as high rates of children being hospitalized with asthma-related concerns.

According to Savage, “health disparity exists when ‘…a health outcome is seen to a greater or lesser extent between populations” (2020).  Woods et al. have discovered many health disparities and social determinants that contribute to frequent hospitalizations of children with asthma “low household income; environmental inequities…exposure to pests, mold, air pollution (including second-hand smoke); and high levels of stress due to community violence” (2016) as well as learning major barriers to health care access “lack of adequate health insurance coverage, overwhelmed clinics, shortages of culturally and linguistically competent providers and low health literacy” (2016).  The demographics of the neighborhoods include “federally defined poverty areas…and neighborhoods that are predominantly black, Hispanic, or both” (Woods et al., 2016). These combined have negatively affected the well-being of the youth living in the area leading to hospitalizations that could possibly be preventable with appropriate prevention techniques and prevention.

The prevention interventions used are at the tertiary level since these are already children diagnosed with asthma and now appropriate education and resources are to be provided to limit preventable hospitalizations.  Woods et al. discovered the multiple community partnerships in the Boston area that are aimed at helping those who are at greater risk for being hospitalized or missed days of school-related to asthma exacerbations.  One preventative technique used was the implementation of having home health visits to improve education for parents and children.

Additional interventions added might include the additional use of healthcare professionals that are able to speak the language and allow for the improvement of healthcare literacy of the populations who are less fortunate.  Due to geographical region the population located in the neighborhoods of Boston as low income many do not see the benefit of preventative care due to there being a cost for everything; so, if families are already struggling to provide, they are not going to think about prevention as something worth spending money on.  Especially if it comes down to things such as rent or car payments, there is, unfortunately, no choice but to pay for those before paying for healthcare.

In addition to having health professionals that speak the language, there must also be more emphasis on the educational aspect to encourage the benefits of healthcare prevention to limit further complications and damage of asthma in children if left untreated.  According to the study, the resources are available but the issue that also arises is that many parents must work, therefore the resource becomes once again theoretically unavailable.  I think to help those who need it most there needs to be a better strategy to get those who need the education and resources better ways of maintaining new information.  If children must be hospitalized or started on oral steroids that is the perfect time to educate and provide outpatient resources and other amenities to aid and decrease hospitalizations.


Savage, C. L. (2020). Public/Community Health and Nursing Practice: Caring for populations

(2nd ed.). F.A. Davis Company.

Woods, E. R., Bhaumik, U., Sommer, S. J., Chan, E., Tsopelas, L., Fleegler, E. W., Lorenzi, M.,

Klements, E. M., Dickerson, D. U., Nethersole, S., & Dulin, R. (2016, February 12). Strategies for reducing health disparities — selected CDC … Community Asthma Initiative to Improve Health Outcomes and Reduce Disparities Among Children With Asthma. Retrieved November 18, 2021, from

The title of the article I chose is “Adaptation and National Dissemination of a Brief, Evidence-Based, HIV Prevention Intervention for High-Risk Men Who Have Sex with Men”. The article outlines how Men who have sex with other men (MSM) are at higher risk for HIV and how those who are non-white are at even greater risk. The article goes on to relate that all area of HIV have decreased except in MSM (Herbst, 2016).

The health disparity is the increased instance of HIV in MSM. The statistics show that HIV diagnosis have decreased from 2002-2011 by 33.2% overall but it has increased in MSM ages 13-24 and for those aged 45 and above and has remained stable for MSM overall. This disparity affects Men who have sex with other men and this is the vulnerable population.  The social determinants that increase this risk is poverty, unemployment and a history of being abused. MSM also has a much higher instance of drug and alcohol abuse which causes poor decision making(Herbst, 2016).

The prevention intervention is personalized cognitive counseling. This is where the person is screened for adequate need of PCC, The counselor after determination administers the PCC questionnaire. After the questionnaire the counselor gets their story and than identifies self-justifications of the behaviors after these are identified the counselor works with the person to implement future approaches to the situations(Herbst, 2016).

The PCC is a great approach but it would hinder some men from seeking treatment related to stigmas and being gay. This is especially profound in the Hispanic culture. It is looked down upon in the Hispanic culture to be homosexual and so getting treatment for risky behavior related to homosexuality would be something that they may avoid. I think that implementing these treatment options in confidence and offering a safe haven for people with the same preferences to be able to practice their sexual preferences safely is a way to start. Determining how the person should progress would be something the counselor could help with as well. Coming out to family will be difficult and it may be warranted at that time to move forward in pursuit of happiness (Srikanth,2020).

Herbst, J. H., Raiford, J. L., Carry, M. G., Wilkes, A. L., Ellington, R. D., & Whittier, D. K. (2016). Adaptation and National Dissemination of a Brief, Evidence-Based, HIV Prevention Intervention for High-Risk Men Who Have Sex with Men. MMWR Supplements, 65(01), 42-50. doi:10.15585/mmwr.su6501a7

Srikanth, A. (2020, September 15). Stigma is keeping LGBTQ Hispanic and Latino men from seeking HIV care: Report. Retrieved from

“Preventing Violence Among High-Risk Youth and Communities with Economic, Policy, and Structural Strategies” compares the rate of violent crime in adolescents especially homicide in at-risk minority groups usually in inner-city communities. “The homicide rate in 2013 for non-Hispanic black youth was 13 times higher than the rate for non-Hispanic whites, 16.2 times higher than the rate for Asian/Pacific Islander youth, 4.3 times higher than Hispanic youth, and five times higher than the rate for American Indian/Alaska Native youth (Massetti, David-Ferdon, 2016).” Community risk factors such as the level of community organization, availability of illicit drugs and prevalence of use, access to firearms, and physical environment that endorses violent behaviors were included. Lastly, this article discusses three programs/interventions; namely, “business improvement districts”, “Alcohol Policy”, and “Baltimore Safe Streets”,  implemented in three different metropolitan areas, their methods of implementation, as well as the results. of each. Primary and secondary prevention are present among the three interventions. “Business Improvement districts” implemented in communities of Los Angeles, California focused on building up, beautifying communities, and promoting public safety. Considering the idea of this intervention is  to clean up the community and improve morale before deterioration fuels violence, I consider this primary prevention. “Alcohol Policy” involves community leaders restricting licenses for the sale of single serve alcohol by convenience stores. “Baltimore Safe Streets” is an outreach organization used to interrupt the transmission of violence. This program intertwines itself in the community and informs the community of violence ad its effects as well as the acceptability of violence because it’s sometimes overlooked. “Alcohol Policy” and “Baltimore Safe Streets” exemplify secondary prevention as they both recognize that there is already violence occurring in the community and this is an attempt to interrupt the cycle and stop it or decrease the rate of occurrence. “Business improvement districts” and “Baltimore Safe Streets” proved a noticeable decrease in community violence, however, “alcohol policy” struggled to succeed because of disgruntled grocery store owners fighting the alcohol restrictions because of decreased revenue. The only drawback to these studies are lack of repetition in other communities and only reported violence cases were considered. Each failed to account for unreported violent acts.

Considering the highest rate of violence occurs among non-Hispanic black youth and secondly, Hispanic youth I’m interested to discover the percentage of violent crime related to feeling a racial disparity. To further address this cultural issue I would conduct research to determine the percentage of violent cases are directly related to racial oppression. After conducting this research, I would implement outreach programs similar to “Baltimore Safe Streets” that promote community unity among races as well as education to the community focused on the specific cultural backgrounds seen in the community to promote general understanding.

Massetti, G. M., & David-Ferdon, C. (2016). Preventing violence among high-risk youth and communities with economic, policy, and structural strategies. MMWR Supplements, 65(1), 57–60. (Links to an external site.)

Savage, C. L. (2020). Public/Community Health and Nursing Practice: Caring for populations. F.A. Davis Company.