Building A Health History With Cultural And Diversity Awaren

Building a Health History With Cultural and Diversity Awareness

This assignment requires analyzing the socioeconomic, spiritual, lifestyle, and cultural factors related to a specific patient case, and developing a comprehensive health history interview plan that demonstrates sensitivity to these factors. It involves identifying potential health risks, selecting appropriate risk assessment tools, formulating targeted questions, and employing effective communication strategies suited to the patient's background.

Paper For Above instruction

The case study involves a 46-year-old African American male who recently experienced alcoholic withdrawal seizures, was treated in the Emergency Department, and is now being followed up in a clinic for hypertension. The patient is currently homeless, living in a shelter, has run out of his prescribed Norvasc, and reports that he no longer consumes alcohol but smokes cigarettes to manage his anxiety and function. This scenario highlights critical socioeconomic, cultural, and health factors that a healthcare provider must consider when conducting a health history assessment.

Socioeconomic, Spiritual, Lifestyle, and Cultural Factors

The patient’s homelessness and lack of stable housing significantly influence his access to consistent healthcare, medication adherence, and overall health management. Homelessness is associated with increased risks of chronic illnesses, mental health issues, and substance use disorders (Fazel et al., 2014). His recent treatment for alcohol withdrawal indicates a history of alcohol dependence, which can be intertwined with socioeconomic stressors. The fact that he smokes cigarettes to calm himself suggests ongoing stress and possibly trauma, which are common among homeless populations (Hwang, 2001). Lacking a stable environment may also impact his capacity to adhere to treatment regimens and maintain lifestyle modifications.

Spiritually, the patient's cultural background as an African American may influence his health beliefs and behaviors. Cultural attitudes towards medication, mental health, and substance use could affect his willingness to engage fully in treatment. Additionally, reliance on cigarettes for stress relief reflects coping mechanisms rooted in his cultural and social environment. Recognizing these factors is essential for providing culturally competent care that respects his worldview and health beliefs.

Sensitivity Considerations and Communication Techniques

When interacting with this patient, it is imperative to use a non-judgmental and empathetic approach. The social stigma associated with homelessness, substance use, and chronic illness requires careful sensitivity to avoid reinforcing negative stereotypes or causing discomfort. Open-ended questions that allow the patient to share his story without feeling judged can foster trust and facilitate honest communication (Klingberg et al., 2019).

Employing culturally sensitive language, maintaining eye contact, and active listening are key techniques. Utilizing motivational interviewing strategies can help explore his readiness to engage in health-promoting behaviors, addressing ambivalence or resistance gently and respectfully (Rubak et al., 2005). Also, adjusting the communication to accommodate potential health literacy challenges—using simple language and visual aids if necessary—can enhance understanding and engagement.

Health History Interview and Targeted Questions

The health history should focus on understanding the patient's past medical conditions, medication adherence, substance use, stressors, mental health, and social support. Key questions include:

1. “Can you tell me about your current health conditions and how you've been managing them?”

     Rationale: Establishes an overview of his health status, medication adherence, and self-management skills, considering his homelessness and recent medication discontinuation.

2. “What challenges do you face in accessing healthcare or medications?”

     Rationale: Identifies barriers related to socioeconomic status that might affect his health management.

3. “How do you usually cope with stress or anxiety?”

     Rationale: Understands his coping mechanisms, including cigarette smoking, and explores alternative stress management strategies.

4. “Can you tell me about your alcohol and tobacco use—from when you started to now?”

     Rationale: Assesses substance use patterns, history, and potential dependence issues, informing risk management and treatment planning.

5. “What are your goals for your health, and what support do you think you need?”

     Rationale: Emphasizes patient-centered care, exploring his motivation and available support systems.

Risk Assessment and Justification

The Patient Health Questionnaire-9 (PHQ-9) is a suitable risk assessment instrument for this patient, as it screens for depression, which is common among homeless populations and those with substance use issues (Kroenke et al., 2001). Depression can negatively impact medication adherence and management of chronic illnesses like hypertension. Using PHQ-9 can uncover underlying mental health issues that need addressing as part of a holistic care plan. Furthermore, integrating screening for social determinants of health ensures that interventions are comprehensive, addressing both medical and social needs (Centers for Disease Control and Prevention, 2020).

Conclusion

In summary, a culturally sensitive health history for this homeless African American male with hypertension and substance use issues requires understanding his social, economic, and cultural context. Employing empathetic communication techniques—such as motivational interviewing, active listening, and language adjustments—can foster a trusting relationship. Focused questions tailored to his circumstances help elucidate health risks and barriers. Utilizing validated tools like PHQ-9 enables comprehensive risk assessment, guiding effective, culturally competent interventions that respect his background and circumstances.

References

• Centers for Disease Control and Prevention. (2020). Social Determinants of Health. https://www.cdc.gov/socialdeterminants/index.htm
• Fazel, S., Geddes, J. R., & Kushel, M. (2014). The health of homeless people in high-income countries: Descriptive epidemiology, health consequences, and clinical and policy implications. The Lancet, 384(9953), 1529–1540.
• Hwang, S. W. (2001). Homelessness and health. Canadian Medical Association Journal, 164(2), 229–233.
• Klingberg, G., Andersson, L., & Östberg, V. (2019). Building trust during health interviews with vulnerable populations: Strategies and challenges. Journal of Clinical Nursing, 28(19-20), 3403–3413.
• Kroenk, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ‑9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613.
• Rubak, S., Sandbæk, A., Lauritzen, T., & Christensen, B. (2005). Motivational interviewing: A systematic review and meta-analysis. British Journal of General Practice, 55(515), 305–312.