Exercise and Discussion Questions from Curley Text Book

Diabetes affects a growing number of Americans. An APRN working in a local hospital is part of a collaborative of community agencies strategically addressing diabetes from a community perspective.

1.What social determinants of health should the community look at in relation to risk or incidence of diabetes?

2.What resources could the APRN use to identify different outcomes related to diabetes?

3.What outcomes related to diabetes are of most interest to community members?

4.Using the AHRQ’s Healthcare Quality and Disparities Report Data Query (nhqrnet.ahrq.gov/inhqrdr/data/submit), what related national and state level data are available to the APRN?

Reading from Textbook- Examples of Health Disparities

Even a cursory review of reports and studies available through government agencies and various other organizations as well as peer-reviewed journals reveals many examples of healthcare disparities in the United States. The following are just a few examples.

Despite advances in diabetes prevention and treatment, American Indian/Alaska Natives (AI/AN) have a higher age-adjusted percentage of people with diabetes mellitus (as compared to Whites), followed by non-Hispanic Blacks and Hispanics (CDC, 2017; Subica, Agarwal, Sullivan, & Link, 2017). African Americans 65 years and younger continue to have a higher death rate than Whites (851.9 per 100,000 compared to 735.0 per 100,000) for all-cause mortality (CDC, 2017). Gu, Yue, Desai, and Argulian (2017) found poorer hypertension control in African Americans and Hispanics compared to Whites in analyzing data from 2003 to 2012. Even though the infant mortality rate in the United States has declined in recent years, and even when controlling for socioeconomic factors, the African American infant mortality rate is more than double that of rates for Whites or Hispanics (El-Sayed et al., 2015; Gregory, Drake, & Martin, 2018).

Examples of studies that explore gender inequities include a literature review of 11 studies on acute coronary syndromes in older adults that found that women had a higher in-hospital mortality rate than men (Gillis, Arslanian-Engoren, & Struble, 2014). Researchers in the area of health literacy have found disparities based on the literacy level of the client and the ability of the provider to facilitate patient understanding of treatment and management of a disease. Studies on the impact of health literacy on health outcomes have found that there is poor access to care, lower health-related 44quality of life, and lower health knowledge among people with low health litreracy (Cajita, Cajita, & Hae-Ra, 2016; Hälleberg, Nilsson, Dahlberg, & Jaensson, 2018; Levy & Janke, 2016).

Evidence-based nursing interventions can be successful in addressing such disparities (AHRQ, 2017; Schneiderman et al., 2014). One research team successfully integrated a diabetes education program within a faith-based framework for use in African American churches to support health behavior changes (Whitney et al., 2017). To address the higher prevalence of diabetes in Hispanic/Latino populations, researchers in the Diabetes Among Latinos Best Practices Trial (DIALBEST) randomly assigned a group of Latinos with type 2 diabetes to community-health workers (CHWs). They received culturally and linguistically appropriate services (CLAS) through education sessions on nutrition, blood glucose monitoring, medication adherence and other topics. The researchers found that subjects in the CHWs group had improved HbA1C at 3, 6, 12, and 18 months post intervention, but there was no change in serum lipid levels, hypertension, or weight (Pérez-Escamilla et al., 2015). Similar findings were found across 53 studies in a scoping review on CHWs’ role in diabetes management (Egbujie et al., 2018). Policies are being written and adopted at all levels of government to address healthcare disparities. Some of these policies can be reviewed on the National Conference of State Legislatures (NCSL) website at www.ncsl.org/research/health/population-groups/

health-disparities.aspx.

In summary, health disparities are deplorable, and effective strategies to reverse this trend are urgently needed. Although much research has been done to better understand healthcare disparities, researchers suggest that a multidimensional approach is needed; a history of institutionalized racism and individual racism that is embedded in every aspect of life of ethnic minorities must be recognized and properly addressed (Hardeman, Murphy, Karbeah, & Kozhimannil, 2018). For the purpose of eliminating health disparities, the National Stakeholder Strategy for Achieving Health Equity, a product of the National Partnership for Action, established guidelines for the development and continuous assessment of the impact of policies and programs to improve the health of vulnerable populations and achieve health equity. Healthcare workers need cultural competency training, communication needs to improve between providers and patients, strategies to improve community relations are needed, and adherence to nondiscriminatory health policies is also necessary to bridge the gaps in providing equity and quality care to eliminate health disparities. (See report at www.minorityhealth.hhs.gov/npa/files/Plans

Respond with a minimum of two (2) paragraphs of 4-5 sentences each.

1. You should address each bullet point in the exercise you select.
2. Your work should have in-text citations integrating at a minimum one scholarly article from this week’s readings and course textbook.
3. APA format should be utilized to include a reference list.
4. Correct grammar, spelling, and APA should be adhered to when writing, work should be scholarly without personalization or first person use.

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