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Chapter 25 Working with Vulnerable People

Chapter 25 Working with Vulnerable People. Vulnerable Populations. Heightened risk of adverse health outcomes Higher mortality rates Less access to health care; disparities in quality of care Uninsured or underinsured Lower life expectancy Overall diminished quality of life.

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Chapter 25 Working with Vulnerable People

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  1. Chapter 25Working with Vulnerable People

  2. Vulnerable Populations • Heightened risk of adverse health outcomes • Higher mortality rates • Less access to health care; disparities in quality of care • Uninsured or underinsured • Lower life expectancy • Overall diminished quality of life

  3. Models and Theories of Vulnerability • Vulnerable populations conceptual model: resource availability, relative risk, health status • Lack of resources increases population’s exposure to risk factors & decreases ability to avoid illness • Feedback loop from health status to resource availability as higher morbidity and mortality further deplete community resources (see Fig. 25.1) • Behavioral model for vulnerable populations: population characteristics to explain health behaviors and health outcomes; variables: demographic, social, and health beliefs • Framework for studying vulnerable populations: macro and micro perspectives; differential vulnerability hypothesis; social capital & human capital

  4. Question Is the following statement true or false? • The vulnerable populations conceptual model includes demographic, social, and health belief variables.

  5. Answer • False • The vulnerable populations conceptual model addresses resource availability, relative risk, and health status.

  6. Prevalence of Vulnerable Populations & Causative Factors • Difficulty in measuring due to overlapping of populations • Root causes • Socioeconomic status/poverty • Insurance coverage: uninsured and underinsured • Race and ethnicity

  7. Vulnerability and Inequality in Health Care • Social determinants of health • Acknowledged conditions associated with health outcomes (economic, social, environmental, genetic) • Socioeconomic gradient: inverse relationship between social class or income and health • Health disparities • Poor access to care; quality of care • Overt discrimination • Levels and types of care and care settings

  8. Role of Public Health Nurse • Effective caring: assisting clients to develop capabilities to take charge of life and make own choices • “Opening the door” is difficult because clients are often disenfranchised and fearful of others • Engagement and rapport essential • Empowerment: client-centered approach, trust, advocacy, teaching and role-modeling, capacity building • Making a difference: protective factors; resilience

  9. Question Is the following statement true or false? • Measuring the prevalence of vulnerable populations is difficult.

  10. Answer • True • It is difficult to measure vulnerable populations because the populations are not distinct and overlap.

  11. Research with Vulnerable Populations • Change in focus: need for research into mechanisms of health disparities, and among diverse populations • Need for strict adherence to guidelines; balancing act between accessing or recruiting vulnerable populations and protecting them • IRBs a must; populations requiring greater scrutiny and additional procedures • Research: often fragmented and isolated; ethical issues

  12. Participatory Action Research • Often used among vulnerable populations around the world; uses expertise and perspectives of the community in identifying needs and developing appropriate interventions • Iterative cyclical process: problem identification & problem solving via reflection and analysis to empower vulnerable disadvantaged people to effect change in their neighborhoods • Three main components • Problem inquiry • Organization of participants • Awareness and action

  13. Question Which of the following would most likely be included in participatory action research? • Problem inquiry • Empowerment • Participant isolation • Ethical conflicts

  14. Answer • Problem inquiry • Participatory action research involves three components: problem inquiry, organization (not isolation) of participants, and awareness and action. Ethical issues are often raised when any research is conducted. However, they are not a component of PAR.

  15. Internet Resources • Centers for Population Health & Disparities: http://www.niehs.nih.gov/research/supported/centers/disparities/index.cfm • National Center on Minority Health & Health Disparities: http://ncmhd.nih.gov/ • Office of Minority Health (USHHS/CDC): http://www.omhrc.gov/ • Vulnerable Populations & Health Care Conference Proceedings: http://kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=2287

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