Exam 2 flashcards
1
Q
What is literacy?
A
The ability to comprehend written and oral messages and includes the ability to apply received information
2
Q
National Assessment of Adult Literacy (2003) found that ___ of adults age ___ and over have either inadequate or marginal literacy skills
A
66%; 60
3
Q
Literacy represents what?
A
A fundamental skill necessary to fully enjoy life and function in today’s information society
4
Q
What is health literacy?
A
The result of a symbiotic relationship of health care system, educational systems, and the social and cultural factors that take place at home, at work, and in the community
5
Q
Health numeracy
A
the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions
6
Q
National Assessment of Adult Literacy was conducted in 2003 to assess what?
A
The English literacy of adults in the US
7
Q
National Assessment of Adult Literacy conducted in 2003 was administered to how many people
A
more than 19,000 adults (ages 16+) in households or prisons
8
Q
The National Assessment of Adult Literacy of 2003 measured what?
A
literacy directly through tasks completed by adults rather than subjective evaluations suck as self-report
9
Q
what were the 4 literacy levels that were reported in the National Assessment of Adult Literacy (2003)
A
below basic
basic
intermediate
proficient
10
Q
What were the findings in the National Assessment of Adult Literacy for each literacy level
A
below basic = 14%
basic = 22%
intermediate = 53%
proficient = 12%
11
Q
Who have higher health literacy - women or men?
A
women
12
Q
What minority had higher health literacy than other minorities?
A
White and Asian/Pacific islanders
Asian/Pacific islanders have higher socioeconomic status
13
Q
Average health literacy increased with what
A
each level of educational attainment
14
Q
Adults living below the poverty level had ____ average health literacy than adults living above the poverty threshold
A
lower
15
Q
What minority has the lowest health literacy?
A
Hispanic adults
16
Q
Health literacy impact - who is at risk?
A
older adults, racial/ethnic minorities, people with less than a high school degree (or GED), low-income, non-native speakers of english, people with compromised health status
17
Q
Low health literacy was consistently associated with what?
A
More hospitalizations, greater use of emergency care, lower receipt of mammography screening and influenza vaccine, poorer ability to interpret labels and health messages
18
Q
Poor health literacy partially explains ____ in some outcomes
A
racial disparities
19
Q
___ of adults lack the health literacy to practice primary prevention
A
90%
20
Q
What diseases cause more than 2/3 of deaths each year
A
heart disease, stroke, COPD, cancer, diabetes
– most or all of these diseases can be prevented
21
Q
What is a key domain for health educators to reduce preventable diseases?
A
primary prevention
22
Q
National Prevention Strategy was created to do what
A
To further address the relationship between health literacy and prevention
– creates a foundation to increase life expectancy by incorporating some of the best practices to address health literacy in order to increase life expectancy
23
Q
The National Prevention Strategy listed ways to increase life expectancy by what?
A
a. Building health and safe environments
b. Expanding quality preventive services
c. Empowering people to make choices
d. Eliminating health disparities, using preventions strategies that use appropriate health literacy levels
24
Q
Health literacy must be understood in the context of…
A
race, culture, and language
25
Cultural background encompasses what
communication patterns, behavior, language preference, customs and beliefs, and self-care
26
Numerous health literacy tools are available to determine what
patient health literacy levels
27
Plain Writing Act of 2010
requires all levels of the federal government to develop written materials in easy-to-understand language
-- does not include private sector
28
What are some ways we can improve health literacy?
Assess needs, assets, and capacity for health educational programs
-- Use a literacy assessment tool in clinical practice
29
What are some of the recommendations to follow when using plain language?
large font, use clear headings, simple words, white space with pictures, bright contrasting colors
30
What are some recommendations designed to ameliorate the impact of culture and language on health literacy levels?
- Differentiate among culture, race, ethnicity
- avoid stereotypes
- be cognizant of language preferences
- understand what translation and interpretation are
- incorporate CLAS standards
- avoid jargon
- ascertain acculturation levels
- use narratives
31
The older population are members of a generation who share a unique what?
culture and life experiences that shape their individual identities as older adults
32
The overall aging process can create significant challenges for who?
health educators
33
What is important when addressing the challenges the older population presents to health educators
inter-professional collaboration are important to address those challenges
34
What are some losses that many older adults face?
loss of independence, economic status, social position, and loss of one's spouse, family and friends
35
Adults age 65 and over are expected to reach ___ million by 2040
74.4 million
36
What trends are we seeing in the older adult populations
becoming more racially and ethnically diverse
37
Current and future demographic changes among the population of older adult require and examination of what
examination of that racial and ethnic composition
38
majority of older adults in the US right now are what race
non hispanic whites
39
is the older population evenly distributed over the US
no
40
What are some states that the older adults are more concetrated?
california, FL, NY, TX, ohio, and illinois
41
the non hispanic white race is the only race out of black, asain, hispanic and other races that show a _____ in the distribution of adults age 65 and up
decline -- all other races is going to increase by 2050
42
what are the issues facing older adults
1. Loss of independence
- - not being able to perform ADL
2. Loss of economic or social position
- - as older adults retire, they may feel like they are losing status within the hierarchy of a company they used to work for
- - many adults are on fixed income based on pension or SS
3. Changes in marital status
- - death of spouse
4. Changes involving loss of family and friends
- - family members living positions
- - friends moving to assisted living so they may not get to see them
- - social isolation
5. Challenges to healthy aging
- higher prevalence of chronic diseases
- limited transportation
- limited housing options (fixed income)
- personal care
43
Ageism
The negative stereotypes and discrimination based on age
| --> based on negative assumptions about the expected biological slowdowns that occur with advancing age
44
How are some examples that ageism is certainly not the case with a majority of Americans aged 65 and over report having good to excellent health?
- increasing years of active life
- increasing participation in prevention activities
- fewer complications from previously fatal health conditions
45
What are some health care models for considerations for building culturally appropriate programs for individuals of older age?
1. Medical Model (biomedical model of health)
- views health care as a sickness
- provider examines pt., makes a diagnosis and established treatment
- looks at individual specifically
2. Social Model
- focuses more on an individual's ability to function with the support of family and community
- what is that individual most comfortable with?
- person-specific
3. Health Promotional Model
- disease prevention and delaying disability
46
Which models for considerations for building culturally appropriate programs for individuals of older age is the BEST?
all across a continuum is the best choice
| - more holistic approach is the best
47
According to the National Assessment of Adult Literacy (NAAL), which age group has the lowest health literacy?
adults 65 years and older (compared to other age groups)
48
What are some recommendations strategies to improve the health literacy of older adults?
- create a shame free atmosphere
- create and environment conducive to learning and good communication
- make spoken information concrete and concise
- engage in short trips "down memory lane"
- incorporate social activities into health education and promotion programs
- use a good geragogy model of teaching
49
The field of ethnogeriatrics refers to
Health care for older adults from diverse ethnic backgrounds; intersection of the studies of aging, ethnicity, and health
50
How can healthcare practitioners improve their cultural competency when working with older adults?
Healthcare practitioners need to expand their knowledge to learn more about the unique cultural, social, psychological, and economic needs of the aging population
51
Foundations for targeted programming for working with diverse older populations started in what year? what is this legislation called?
1965 -- Older Americans Act
52
Administration on Aging published a toolkit that addressed four areas -- what are the 4 areas
a. Assessments
- - provider can take questionnaire for their patient that will give their patient the best services for their individual needs
b. identifying community resources
- - most bigger communities have agencies that provide resources for caregivers
- - "senior centers"
- - safe space where older population comes in to play cards etc. to make sure their socialization needs are met
c. tailoring services
- - make sure the services are sensitive and inclusive to each individual
d. program evaluation
- - do this to ensure the programs are good for an individual; what did they get out of it?
53
Individuals with disabilities are more likely than people without disabilities to report what
- poor overall health
- less access to adequate healthcare
- smoking and physical inactivity
54
What are the 3 main overarching goals when working with people with disabilities?
- stay well
- be active
- be part of community
55
Secondary conditions that people with disabilities face?
- bowel / bladder problems
- fatigue
- injury
- mental health and depression
- overweight and obesity
- pain
- pressure sores or ulcers
56
Intellectual disability (ID)
A disability characterized by significant limitations in both intellectual functions and adaptive behaviors, which covers many everyday social and practical skills
57
What are primary health conditions what people with intellectual disabilities may experience?
Epilepsy and mobility and sensory difficulties
58
What are secondary health conditions what people with intellectual disabilities may experience?
- obesity
- bone fractures
- poor oral health
- constipation and gastroesophageal reflux
- poorer health outcomes related to health disparities
59
An article for module 10 talks about Attributes characterizing health promotion for people with intellectual disabilities -- what are the attributes?
- supporting a healthy lifestyle (most dominant attribute)
- providing health education
- involving supporters
- being person-centered
60
An article for module 10 talks about Antecedents and consequences -- what are they?
a. Antecedents (what happened before health promotion for intellectual disabilities was practiced?
- having health care access
- lack of sensitized healthcare providers
b. Consequences (following the occurence of the concept of health promotion of ID)
- improved health
- being empowered
- enhanced quality of life
- reduced health disparities
61
What are the findings from concept analysis from the article for module 10 talks about people with intellectual disabilities
1. health promotion activities - both in research practice - have to be better adapted to the target individual
2. Research focused needs to be expanded to other health aspects such as avoiding stress or learning about stress relief techniques
3. Include the perspectives of people with ID in health-promotion research
a. how do they comprehend life and health?
b. what is their perception of a high quality of life?
62
The concept analysis of "health promotion for people with ID" represents what?
A starting point that provides useful insights and a better understanding of how this concept currently being used in literature
63
There is a clear need for further research to develop an understanding on health promotion for people with ID -- why is this important?
this is important since healthcare practitioners will be encountering patients with ID
64
What is the most significant health disparity that LGBTQ community faces
lack of research, especially in the areas of transgender health
65
Why is the health care research for the LGBTQ community inadequate
because the LGBTQ population has separate subgroups with unique needs
66
What were the health needs for the LGBTQ community included for the first time in Health People
2020
67
What does sexual orientation mean?
attraction, behavior, and identity that patterns for all three can range along a continuum
68
Why is it difficult to determine demographics for the LGBTQ community
Because the data collection on sexual orientation and gender identity has only been collected since 2013
69
What are some health issues of the LGBTQ community?
Physical, mental and social health issues:
- HIV/AIDs
- substance abuse
- depression and mental health issues
- suicide
- violence
- access to affordable healthcare
- heterosexism and homophobia
70
homophobia
irrational fear or hatred of LGBTQ individuals
71
Heterosexism
The belief that heteorsexuality is the only natural sexuality
- perceived healthier and more superior to any other types of sexuality
72
Most prevalent health issues: LGBTQ youths
depression, family rejection, suicide, substance abuse, homelessness, prostitution, truancy
73
Most prevalent health issues: Lesbian and Bisexual Women
Reproductive cancers, less likely to receive regular care, inadequate providers, obesity, heart disease
74
Most prevalent health issues: Gay and bisexual men
HIV/AIDs, STIs, substance use and abuse, stress, eating disorders
75
Most prevalent health issues: Transgender
lack of access to healthcare, attempted suicide, high unemployment, risks from injection silicone use (ISU), risks from illegally acquired sex hormones
76
Most prevalent health issues: Racially and ethnically diverse communities
subjected to racism and stigma, limited access to healthcare, low SES, cultural factors, legislation
77
Massachusetts Report: Among the LGBTQ population, the health of bisexual and transgender people is what compared their the heterosexual and non-trans counterparts
somewhat worse
78
Massachusetts Report: Who is less likely to have routine pap tests
lesbian
79
Massachusetts Report: explain how Transgender persons has worse health outcomes with respect to self-reported health
Transgender persons has worse outcomes with respect to self-reported health, disability status, depression, anxiety, suicide ideation, and lifetime violence victimization
80
Massachusetts Report: Who were more likely to obtain health insurance through their spouses employer
Legally-married same sex couple were more likely to obtain health insurance through their spouses employer than non-legally same sex couples
81
What do many people do in regards to their doctors visits are a result of perceived or real homophobia and discrimination on the part of health professionals and institutions?
avoid or delay care, or receive inappropriate or inferior care
82
How can health educators increase cultural sensitivity to the LGBTQ community?
- strive to provide a welcoming, supportive, and inclusive environment
- use culturally sensitive language
- address their own attitudes and behaviors about gender identity and sexual orientation
83
When was the UIHC LGBTQ clinic founded?
2012
- every member of the clinic staff has had LGBTQ-specific cultural humility training
- multidisciplinary team
84
What are some of the LGBTQ Medical Services that the UIHC clinic provides?
1. Chronic disease management
- anxiety, depression
2. Contraceptive management
3. Gynecological services
- breast exams
- pelvic exams
- menopause care
- obstetric care
4. HIV testing and prevention
5. Hormone therapy
6. Immunizations
7. Post-surgical care for those who have undergone gender affirming surgery
8. Routine physical health and wellness
9. Same-day urgent care services
10. STI/STD testing and treatment
85
What was one of the first clinics in the state of IA that started offering LGBTQ health services
Unity Point Health - Cedar Falls, Iowa
86
how does that US Department of Veterans Affairs contribute to the health needs of LGBTQ population
clinics to meet needs of LGBTQ
87
What is policy according to the CDC?
A law, regulation, procedure, administrative action, incentive, or voluntary practice of governments and other institutions
88
What are some examples that explain how the health of our nation is influenced by public health policies?
tobacco control policies and school nutrition policies for healthier meals in schools
89
What are public health achievements that we have had in the 20th century?
A. vaccination
- kids before school
B. motor vehicle safety
- seat belt, speed limit, drinking and driving laws
C. workplace safety environmental safety
- est. of OSHA
D. safer and healthier foods
E. environmental safety
F. fluoridation of drinking water
G. recognition of tobacco as a health hazard
- by the Surgeons general report of 1969
90
Law: School Entry vaccination laws
What was the public health issue?
How does the law work?
Public Health issue: Herd immunity or individual immunity
How law works: requires parental behavior
91
Law: Smoking bands or restrictions
What was the public health issue?
How does the law work?
Public Health issue: Exposure to environmental tobacco smoke
How law works: Requires behavioral change to alter environment
92
Law: Child safety seat use laws
What was the public health issue?
How does the law work?
Public Health issue: unintentional injuries of children
How law works: requires direct behavioral change
93
Fluoridation of community water supplies
What was the public health issue?
How does the law work?
Public Health issue: Dental caries
How law works: Directly changes physical environment requiring to action on part of target population
94
Law
Rules that are subject to the enforcement power of a government entity.
The structure, norms, and rules that a society used to resolve disputes, govern itself, and order the relations between members of society
"the enterprise of subjecting human conduct to the government of rules"
95
The US Constitition
"Supreme law of the land" (drafted in 1787)
96
What are the 3 branches of federal government established in the Constitution?
legislative - members of congress; responsible for enacting the laws of constitution
executive - enforces laws; president and other federal agencies
judicial - interprets the law in resolving disputes; different court systems
97
Is the term "public health" mentioned in the constitution?
no
98
What are some areas of the Constitution that somewhat implies to the health of our nation?
when it discusses interstate commerce or taxation and spending -- otherwise there is no mention of who should be guiding public health laws
99
The primary responsibility of who should be in change of public health was left up to who?
The states -- The primary responsibility for public health was left to the states (stated in the 10th Amendment)
100
The Tenth Amendment:
The Tenth Amendment framed the powers of the states:
"The powers no delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the States respectively, or to the people"
101
What is the impact of the 10th Amendment?
States retain police powers and other powers not expressly enumerated to the US federal government
-- states have the power to accept or modify federal laws
102
Most public health activities are carried out at what levels of government?
state and local levels
103
Why is utilitarianism important in the creation of laws?
Policies should be evaluated to ensure they are protecting ALL persons
104
What are some recommendations in regard to ensuring utilitarianism
Authors support the trend in PH for greater consultation, engagement, and dialogue with marginalized populations.
Great emphasis on teaching ethics and the philosophy of science in PH courses
The the health equity impact assessment (HEIA) as a tool to evaluate the disproportionate impact that proposed PH programs and policies have on particular populations
105
Practices to improve cultural competency: Language barriers
Be create and open about addressing language barriers
a. patient safety is compromised when a language barrier makes it impossible to make an initial assessment or diagnosis
b. be aware of special challenges
c. Be aware of the limitations of using family or non-medical staff as interpreters
d. Identify patients with limited English proficiency; use plan language and other methods to demonstrate points
106
Practices to improve cultural competency: Be alert
Be alert for, and responsive to, mental health challenges
a. lessons learned from the response to Hurricane Katrina
b. Health care responders did not properly screen for mental illness
c. Geopolitical pressures also affect populations disproportionately
d. be proactive
e. lack of access to mental health care services
107
Practices to improve cultural competency: Be mindful
Be mindful of stereotypes
a. People may feel anxiety or withdraw if they feel they are perceived negatively
b. this threat impedes successful treatment
c. offers ways to reduce stress
d. providers should also explore policies and practices that enhance treatment for people from different communities
108
Does cultural competency training improve patient satisfaction? -- results from a systemic review of literature. What was the aim?
Aim: to evaluate the effectiveness of cultural competence training of healthcare providers on improving patient satisfaction of clients from minority groups
seven studies met the inclusion criteria for the study
109
Does cultural competency training improve patient satisfaction: Results - healthcare providers
Six of the seven studies concluded that cultural competence had a positive impact on the healthcare providers
The physicians' scores in coding accuracy test on nonverbal cross-cultural expressions were correlated with patient satisfaction scores
physicians who completed a medical Spanish course were more likely to collect patient data without the use of an interpreter
Out of 15 nurse practitioners...
- 2 culturally proficient
- 7 culturally competent
- 6 culturally aware
- 0 culturally incompetent
110
Does cultural competency training improve patient satisfaction: Results - patient satisfaction
Cultural competence training was significantly associated with increased patient satisfaction in 5 of the 7 studies
Patient satisfaction increased with trained vocational dental practitioners compared to untrained
Latina patients' satisfaction was greater with NPs who had received training compared to those who did not
Patients felt like they are receiving individual care
Training increased patient family satisfaction
111
An increasing racial and ethnic diversification makes it essential to incorporate the concept of cultural and linguistic competence into health promotion activities, what are the activities that can be used?
evaluation, planning, implementation
112
Based on the belief that providing health information and skills through planned learning experiences will enable individuals, groups, and communities to do what?
make informed decisions.
113
What are theories used to help with health education to ensure a culturally competent workforce?
Individual --> stages of change model
interpersonal --> social support model
community level --> diffusion of innovations theory
114
explain how health promotion is more than just theories?
It is more of a population health perspective because you are trying to encourage behavior change within entire communities and not just one persons
115
What other mechanism can support the actions of healthy individuals other than theorys?
organizational mechanisms
education
environment
policies/regulations
116
Why do we need cultural and linguist competence in healthcare and health education?
1. to respond to current and projected demographic changes in the US
2. Eliminate long-standing disparities in the health status of diverse individuals
3. improve the quality of services and health outcomes
4. meet legislative, regulatory and accreditation mandates
5. gain a competitive edge in the marketplace
6. decrease the likelihood of liability or malpractice claims
117
how are we going to continue to achieve cultural competence/
impossible and unrealistic expectations for an organization to serve all cultural groups in a cultural competent
complex process --> interventions at multiple levels --> lifelong journey
118
how can health educators (and health practitioners) understand intricacy of linguistic competence and be able to communicate effectively in a matter that is understood?
- bilingual staff
- cross - cultural communication approached
- foreign language interpretation services
- sign language interpretation services
- easy to read print materials
- materials in alternate formats
- ethnic media in languages other than English
119
history of cultural and linguistic competence:: Guidelines for Health Educators (AAHE, 1994)
AAHE = American Association of Health Educators
The first organization to publish guidelines on how health educators should be thinking about cultural and linguistic competence and sensitivity
120
history of cultural and linguistic competence: Official position paper on cultural competency and health education (AAHE, 2006)
health interventions for one culture may not be appropriate for another culture
--> one size does NOT fit all
121
history of cultural and linguistic competence: Resolution to Eliminate Racial and Ethnic Health Disparities (SOPHE, 2002)
SOPHE = society for public health education
published it to eliminate racial and ethnic disparities; they invited individuals from schools, policy, etc. and established this resolution
122
history of cultural and linguistic competence: Patient protection and affordable care act (ACA) (2010)
Passed under Obama; our current health reform today
Within the ACA, there are things that address cultural and linguist competence --> ex. is collecting data on different demographics, races and ethnicities ---> this helped health educators learned more about patients to ensure the right services were being applied to each ind. person
allows for cultural competency training (funded through APA)
123
strategies to incorporate competence into health education
1. learn to recognize the importance of culture and respect diversity
2. Maintain a current profile of the cultural composition of their communities
3. continued cultural and linguistic competence training
4. involve cultural brokers form the target population in the development of health education programs
5. ensure that health education programs are culturally and linguistically appropriate
6. continuously assess and evaluate the level of culturally and linguistically competence in programs and in the workplace
