Question 1: Social factors influencing individual and population health.

Comprehensive and quality healthcare provision plays a fundamental role in promoting and
maintaining individuals and the population's health. Though health care is an essential aspect of
health, research shows health outcomes of individuals and the community are also influenced by
other factors, including health behaviors, underlying genes, and social factors (Artiga & Hinton,
2019). Social determinants have a significant impact on the outcomes of health in a community.
In the community context, race and ethnicity are the key socio-cultural constructs linked to
socio-economic factors. Racial and ethnic discrimination leads to disparities in education income
and health care access. Research shows that higher diabetes rates and shorter life expectancies,
high infant mortality is seen among Hispanic Americans, American Indians, and African
Americans than white Americans (Cooper et al., 2016). Low household income and poverty are
correlated with poor health because people can't afford quality healthcare and have reduced life
quality. There is an excellent health difference between the poor and the rich.
Health care services have recently been considered an important social determinant of individual
and population health. The inequalities in healthcare access include barriers encountered by
specific population groups at the point of care, lacking cultural competence in healthcare
provision, and barriers due to gender identity and sexual orientation. This barrier determines
differential healthcare access and utilization, resulting in inequitable health and well-being
promotion and disease prevention (Adler et al., 2016). How we perceive different cultural issues
determines how health care practitioners provide care to people. Some practitioners lack
competence in providing care to matters regarding sexual orientation and gender identities.
Equity is an underpinning principle of healthcare; thus, healthcare providers should promote
professional ethics by providing equal services to different races and social groups through
training and awareness.
Question 2: the current political climate concerning healthcare.
The federal government in the U.S. plays a vital role in the public healthcare system of the states.
It surveys the population's health needs and status, sets standards and policies, passes regulations
and laws to be used in the system, helps finance provision of health services and health-related
research, and provides protection from international health threats. This is possible through the
governments delegated power to tax and spend for the general welfare and regulate interstate
commerce.
Healthcare care laws and policies have a large impact on health of individuals and the
population. Law and healthcare policies are an effective way of improving health and dealing
with health problems in the state. they influence an environment of quality and equal care
provision to all the citizens of the states. Current political issues in healthcare policy are related
to health care coverage and the underlying cost of healthcare. Policies related to healthcare
coverage include how citizens receive health insurance, how the insurance is paid, and what the
insurance does and doesn’t cover. Current debates are on narrowing the eligibility of healthcare
insurance and reducing the generosity of Medicare and Medicaid, and debates on lowering
healthcare prices (Young, 2020).
The Doctor of nursing practice (DNP) is a clinical doctorate which prepares graduates for
advanced roles in nursing including leadership and clinical practice. DNP graduates have
significantly impacted nursing practice and the shape of the healthcare system in the U.S.
(Edward et al., 2018). DNP nurses engage in coalition building, policy development,
intervention and evaluation. They develop policy agendas, serve as content experts, and
advocate for better policies in the healthcare system. Furthermore, they play an indispensable
role in designing and innovating patient care models and strategies, and health policies.
Question 3: Program development model.
In health promotion and prevention programs, Communities use various guided strategies,
theories and models to develop and implement effective programs which will motivate and
empower the communities towards better health management. Program models serve as proven
frameworks for health promotion organization and disease prevention activities.
The PRECEDE-PROCEED model is comprehensively structured for assessing healthcare needs
for designing, implementation, and evaluating the promotional program to meet the assessed
needs. PRECEDE is an acronym for Predisposing, Reinforcing, and Enabling Constructs in
Educational Diagnosis and Evaluation. PRECEDE provides healthcare practitioners with a
structure to plan a focused and targeted community health program. It involves epidemiological
assessment, social assessment, ecological assessment, policy identification and factors
influencing the program intervention, and implementation of intervention. PROCEED, on the
other hand, stands for Policy Regulatory and Organizational Constructs in Educational and
Environmental development. PROCEED offers healthcare providers with a structure of
implementation and evaluation of the health program. It involves design intervention
implementation, process evaluation, impact evaluation and outcome evaluation (Fernandes et al.,
2019).
In creating a successful and sustainable program it’s important to develop a planned intervention
which draws its conceptual framework and support from multiple theories. Various theories add
important elements to the framework which make it effective in fulfilling its purpose. designing
health programs that impact personal, behavioral and environmental factors from Bandura’s
social cognitive theory makes the intervention to produce a more likely anticipated outcome.
Lastly to have maximum and far reaching outcomes it’s important to incorporate partnerships
from partners who are critical to improving and sustaining the community’s health.
Collaboration from various partners is essential in creating advocacy needed and budgetary
support, legislative change needed to create new programs and technical help necessary to propel
the program forward. An example of an effective multi-sectoral partnership is the immunization
coalitions at the state and national level, the coalition involved partners from community
organizations, government agencies, individual philanthropists, and volunteers (Frieden, 2014).
Question 4: Affordable Care Act.
the patient protection and affordable care act, commonly known as the Affordable Care Act was
implemented in 2014 and included components such as individual mandate, state Medicaid
expansion and subsidized market place coverage. The act intends to expand health insurance
coverage for people who fall through the cracks of the public and private insurance mechanism
in the U.S. The act's main target was individuals and families from low and middle income levels
because they are the majority of people who are uninsured in the U.S. this is done through two
primary approaches; expansion of access to Medicaid based on income and creation of legibility
for those with incomes from as low as 139% FPL to apply for money subsidies to purchase
qualified and quality health plans.
The act transformed the market of individual health insurance by changing how insurances are
subsidized and sold. The act brought reforms on individual health insurance in three key reforms;
it prohibited insurers from considering the health risk of subscribers, provided subsidies for a lot
of people to access and purchase individual coverage, and created a structure for exchange to
facilitate comparison shopping. The act which led to increase in individual seeking for insurance
led to increase in premium rates in the private sector and public sector providers (Kominski al.,
2017). Because of the increased number of insurance consumer’s insurers have been forced to
implement high-deductible health plan.
The surge in numbers of people seeking health services will lead to increase in demand of
service. For population based nursing this means there will be greater commitment and work due
to the increase of the target population and nurse-to-patient ratios. A common theme that arose
from the surge was population healthcare coordination. This involves the principles of case
management, care coordination, and population health to maximize resource utilization and
health outcomes for populations and individuals in them (Edmond et al., 2017).
Question 5: health promotion theory
identifying a theory to guide a health promotion plan depends on a range of factors which will
make the theory suitable for the plan. This factors include the health problem to be addressed, the
context where the program is implemented, and the population to be served. For the DPI project
the social cognitive theory is essential in helping plan and promote the program. the social
cognitive theory (SCT) defines the influence of an individual’s experience, the action of others,
and the environmental factors affecting individual’s health behavior. The theory provides
prospects for social support through self-efficacy, instilling expectations and using observational
learning to achieve behavior change. The SCT is a great theoretical framework to guide behavior
change interventions and how individuals interact with their environment (Korin, 2016).
Additionally, the framework can be used to understand how social determinants influence the
health of a person. An example of this theory in use is the HoMBReS program, a community
based health intervention designed to reduce HIV risk and other STI in Latino Men.
Before determining the program evaluation model to be used, its practical to determine the need
for evaluation, and a logic model which helps to guide the evaluation design and methodology.
The core function of evaluating the program is to determine the overall quality and outcomes of
the program, and assessment of the processes adapted tin the program. the results are intended to
help improve the program and help determine whether the program has met its intended
outcomes. The CIPP model is a social system program evaluation model which stands for
context evaluation, input evaluation process evaluation and product evaluation (LeBlanc, 2020).
This model helps us achieve a comprehensive evaluation of what is the program plans to do,
what is occurring, and what are the specific outcomes compared to the anticipated outcomes.
Question 6: health need in the community.
Some of the persistent health related problems in my community is drug and substance abuse
and obesity. Most adults identify obesity as the biggest health problems affecting most people in
the city. To reverse the obesity epidemic, the efforts of the community should focus on active
living and supporting healthy eating in different settings. A suitable program is a nutrition
assistance program or a fruit and vegetable project. The program uses nutrition education
workshops environmental strategies, food demonstrations to improve the community’s access to
healthier foods and physical activities (NAS, 2017). The program aims to help low income
families eat nutritious food and make the most of their budgets allocated to food. The workshop
provides the community with practical nutrition information using approved lesson plans, and
provide cooking demonstrations and recipes focusing on vegetables and fruits, and low fats
ingredients. The essence of this intervention program is to help the community to develop better
eating lifestyle which will reduce obesity issues in the community This program can run for a
repeated 2-month period in different locations and places.
Collaboration processes normally involve many people with different sets of skills. When
implementing evidence based changes on community-based health programs APNs should take
the following measures: ensure that other nurses understand their roles and have the necessary
knowledge and tools to carry them out (correa-de Araujo, 2016). Additionally, it’s important to
apply basic safety design principles and measuring quality of care in the program intervention.
This measures will lead to the effective implementation of the program.
Question 7: Cultural Competence Self-Assessment Checklist
Cultural competence requires that healthcare organizations and their staff have the capacity to:
(1) conduct self-assessment. (2) Value diversity, (3) manage the dynamic of difference, (4)
institutionalize cultural knowledge, and (5) adapt to cultural and diversity context (Buttler et al.,
2016). Completing the self-assessment checklist helped me to determine areas of collective
strengths in cultural competence and areas where growth is needed. Because of a clear sense of
self knowledge and identity the checklist helped me understand diversity value as an area of
strength. I view human difference and ethnic diversities as positive and a cause of celebration.
Additionally, I am aware of social justice issues i.e. the impact of social context on a culturally
diverse population. This is an important component in offering quality services to people. The
checklist helped me reflects on my own stereotypes and biases due to culture. This is an area
which needs more growth because I identified some potential stereotypes which may cause harm
to patients. I will also have to improve in listening and analytic skills in order to fully understand
different views and cultural diversities.
Social, cultural and families influence and shape our attitudes and beliefs towards certain issues
in the community (Ring et al., 2018). In our community, LGBT community is still regarded by
many as sin and unacceptable in the society. Through the years, awareness study and competence
training has helped improve my personal worldview towards sexual orientation and identity.
Additionally, different cultures when seeking healthcare provision practice different cultural and
religious practices which seem irrelevant or uncouth in our culture and potentially hazardous to
the patient’s health. I personally believe a person culture and beliefs should be respected when
administering quality service. This will help in improve collaboration and patient integrated care.
Question 8: health literacy relation to health promotion
Health literacy Is the degree to which individuals in the community have the capacity to obtain,
understand and process the health information in order to make health decisions for themselves.
Individual with inadequate level of health literacy doesn’t have the ability to take responsibility
of his own health and the health of the community. Limited health literacy is associated with
poor participation in health promotion programs, disease intervention strategies, and disease
detection activities. This leads to riskier health choices, poor adherence to medication, poor
management of chronic diseases, increased hospitalization and morbidity (Batterham et al.,
2016). This stalls the success of health promotional programs put in place. Healthy literate
communities are characterized by high participation in community based health promotion
activities and commitment and adherence to better health choices. Incidentally, health literacy is
an essential outcome of health education for which health promotions are legitimately held
accountable (Alberti & Morris, 2017).
The complex concept of health literacy in healthcare systems and primary care setting
acknowledges the need addressing health literacy for patients in every healthcare encounter.
This involves ensuring patients understand what they have to do after the healthcare encounters
to mantin and improve their health (Loan et al., 2018). AS a DNP we should advocate and
promote a nursing focus on health literacy as a crucial component of all patient care this focus
will improve collaboration, provision of person centered care, patient safety, and general
outcomes. Additionally, it’s the role of the DNP to design and evaluate programs and
interventions set to improve health literacy, this includes advocating and participate in promoting
policies and research which facilitate improved health literacy. proffesiona
References
Loan, L. A., Parnell, T. A., Stichler, J. F., Boyle, D. K., Allen, P., VanFosson, C. A., & Barton,
A. J. (2018). Call for action: nurses must play a critical role to enhance health literacy. Nursing
outlook, 66(1), 97-100.
Batterham, R. W., Hawkins, M., Collins, P. A., Buchbinder, R., & Osborne, R. H. (2016). Health
literacy: applying current concepts to improve health services and reduce health
inequalities. Public health, 132, 3-12.
Alberti, T. L., & Morris, N. J. (2017). Health literacy in the urgent care setting: What factors
impact consumer comprehension of health information?. Journal of the American Association of
Nurse Practitioners, 29(5), 242-247.
Butler, M., McCreedy, E., Schwer, N., Burgess, D., Call, K., Przedworski, J., ... & Kane, R. L.
(2016). Improving cultural competence to reduce health disparities.
Ring, J., Nyquist, J., & Mitchell, S. (2018). Curriculum for culturally responsive health care:
The step-by-step guide for cultural competence training. CRC Press.
National Academies of Sciences, Engineering, and Medicine. (2017). Driving Action and
Progress on Obesity Prevention and Treatment: proceedings of a workshop. National Academies
Press.
Correa-de-Araujo, R. (2016). Evidence-based practice in the United States: Challenges, progress,
and future directions. Health care for women international, 37(1), 2-22.
Correa-de-Araujo, R. (2016). Evidence-based practice in the United States: Challenges, progress,
and future directions. Health care for women international, 37(1), 2-22.
Adler, N. E., Glymour, M. M., & Fielding, J. (2016). Addressing social determinants of health
and health inequalities. Jama, 316(16), 1641-1642.
Artiga, S., & Hinton, E. (2019). Beyond health care: the role of social determinants in promoting
health and health equity. Health, 20(10), 1-13.
Cooper, R. S., Kennelly, J. F., Durazo-Arvizu, R., Oh, H. J., Kaplan, G., & Lynch, J. (2016).
Relationship between premature mortality and socio-economic factors in black and white
populations of U.S. metropolitan areas. Public health reports.
Young, M. (2020). Current debates in health care policy: A brief overview. Brookings. Retrieved
24 August 2020, from https://www.brookings.edu/policy2020/votervital/current-debates-in-
health-care-policy-a-brief-overview/.
Frieden, T. R. (2014). Six components necessary for effective public health program
implementation. American journal of public health, 104(1), 17-22.
Edwards, N. E., Coddington, J., Erler, C., & Kirkpatrick, J. (2018). The Impact of the Role of
Doctor of Nursing PracticeNurses on Healthcare and Leadership. Medical Research
Archives, 6(4).
Fernandez, M. E., Ruiter, R. A., Markham, C. M., & Kok, G. (2019). Theory-and evidence-based
health promotion program planning: intervention mapping. Frontiers in public health, 7, 209.
Edmonds, J. K., Campbell, L. A., & Gilder, R. E. (2017). Public health nursing practice in the
Affordable Care Act era: A national survey. Public Health Nursing, 34(1), 50-58.
Kominski, G. F., Nonzee, N. J., & Sorensen, A. (2017). The Affordable Care Act's impacts on
access to insurance and health care for low-income populations. Annual review of public
health, 38, 489-505.
Korin, M. R. (2016). Theory and fundamentals of health promotion for children and adolescents.
In Health Promotion for Children and Adolescents (pp. 9-21). Springer, Boston, MA.
LeBlanc, V. (2020). Evaluation, Metrics, and Measuring ROI/VOI. In Comprehensive
Healthcare Simulation: Program & Center Development (pp. 123-129). Springer, Cham.