Social Determinants Of Health: A Case Study

The World Health Organization (WHO) delineates the social determinants of health as the circumstances, in which people are innate, nurtured, exist, employed, mature, and incorporates their health-care organization (Centers for Disease Control and Prevention [CDC], 2013, p. 3). According to WHO, “the social determinants of health are mostly responsible for health inequities as well as as ethnic group and culture, gender, sexual orientation, maturity, and disability all influence health " (CDC, 2013, p.3).
Background information and Social Significance
Reports have indicated that cultural philosophies affects how a patient conceptualize diseases, adapt to illness, and develop coping mechanism that will enable them to manage chronic illnesses. Approximately three million mature African Americans have diabetes, and
one in four African American women fifty-five years of age or older have been diagnosed with diabetes (Wagner et al., 2011, p. 1). As the growing life expectancy of women and the precipitous evolution of indigenous of minority populace, the amount of African American women in the United States with diabetes will continue to intensify and are more likely to suffer chronic issues such as retinopathy, blindness, coronary artery disease, stroke, tissue injuries necessitating amputations, or nephropathies (Wagner et al., 2011, p. 1). Regardless of substantial improvements in diagnosing and treating diabetes, the continuance of inadequate metabolic control exists. Reduced glycemic control may be indicated by both the collapse of diabetic patient self-care management as well as interventional stratagems by clinicians (Nam, Chesla, Stotts, Kroon, & Janson, 2011, p. 1)

Aim of project and improvement needed in clinical practice
The aim of this project is to attempt to eliminate a barrier associated with African American women's adherence to their therapeutic regimen, philosophies, viewpoints, and knowledge level that may affect diabetes self-management by utilizing effective cultural communication skills. Authors Nam, Chesla, Stotts, Kroon, & Janson, (2011) speculate, "Ethnicity and linguistic abilities impact the client's health beliefs, approaches, health literacy, and thereby affects diabetes self-management" (p. 1). The authors proposed that clinicians can affect client's opinions by utilizing effective communication skills to enhance the quality of diabetes care, glycemic control, and diabetes self – management (Nam, Chesla, Stotts, Kroon, & Janson, 2011, p.1). Empowering clients to manage their diabetes is significant, and an effective tactic to augment diabetic health sequels (Peek et al., 2012, p. 1). However, doing so in the clinical setting continues to be an obstacle, specifically for ethnic minority people and those from lower socioeconomic environments who are affected excessively from diabetic associated morbidity and mortality, and whom the diminution of heath care disparities has reached a nationwide urgency (Peek et al., 2012, p. 1).

PICOT Question
The PICOT question is as follows: Does culturally linguistic communication skills (I) influence self- care management, glycemic control, and diabetic care (O) in African American women who have diabetes (P) over a period of six months. (T)

Process Model
Patient –Centered Culturally Sensitive Health Care Model enhances Nurse practitioners' awareness of providing care for culturally diverse patients. This model was culturally established to describe and advance health care for ethnically diverse clients seen in community -based primary care health care organizations (Renzaho, Romios, Crock, & Sønderlund, 2013, p. 1). Tucker, Herman, Ferdinand et al. (2007) established a Patient-Centered Culturally Sensitive Health Care (PC-CSHC) Model to clarify the association between patient-centered culturally sensitive health care and clients' therapeutic adherence, health stimulating activities, and wellness sequels. The authors contended that their paradigm could influence investigations and clinical activities of health professionals concerned about endorsing culturally sensitive health care with the crucial goal of enhancing health care and reducing health inequalities among culturally diverse clients. The model was acquired from an wide-ranging literature review and from an continuing database of inquiries that monitored patient identification of culturally sensitive health care; data inventoried for assessing patient-centered culturally sensitive health care that was used their investigation (Tucker, Marsiske, Rice, Jones, & Herman, 2011, p. 1)

Desired Outcome
The desired outcomes of this project is to see an increase in patient self-care management of diabetes ( by monitoring the HbA1c levels, lipid profile levels, systemic blood pressures, dietary habits, and physical activity) and patient empowerment through effective communication. Shared decision-making will allow the patient to become an equal partner with the clinician when communicating and making evaluations regarding treatment and clinical care. Peek et al, stipulates " When patients and physicians set diabetes self-care agendas together, patients are more able to make the lifestyle changes needed to manage their condition Shared decision-making is associated with better control of diabetes and hypertension, higher ratings of self-reported health, and shorter hospitalizations" (Peek et al., 2012, p. 1) .

References
Centers for Disease Control and Prevention. (2013). CDC Health disparities and inequalities Report —United States, 2013. Retrieved from https://www.cdc.gov/mmwr/pdf/other/su6203.pdf
Nam, S., Chesla, C., Stotts, N.
A., Kroon, L., & Janson, S. L. (2011, July). Barriers to diabetes management: Patient and provider factors. Diabetes Research and Clinical Practice, 93(1), 1-9. http://dx.doi.org/http://dx.doi.org/10.1016/j.diabres.2011.02.002

Peek, M. E., Harmon, S. A., Scott, S. J., Eder, M., Roberson, T. S., Tang, H., & Chin, M. H. (2012, Apr 7). Culturally tailoring patient education and communication skills training to empower African-Americans with diabetes. Translational Behavioral Medicine, 2(3), 296–308. http://dx.doi.org/ 10.1007/s13142-012-0125-8
Renzaho, A. M., Romios, P., Crock, C., & Sønderlund, A. L. (2013, 22 January). The effectiveness of cultural competence programs in ethnic minority patient-centered health care—a systematic review of the literature. The International Society for Quality in Health Care, 25(3), 261–269. http://dx.doi.org/ http://dx.doi.org/10.1093/intqhc/mzt006
Tucker, C. M., Marsiske, M., Rice, K. G., Jones, J. D., & Herman, K. C. (2011, May). Patient-centered culturally sensitive health care: Model testing and refinement. Health Psychology, 30(3), 342-350. http://dx.doi.org/
10.1037/a0022967
Wagner, J. A., Osborn, C. Y., Mendenhall, E. A., Budris, L. M., Belay, S., & Tennen, H. A. (2011, Mar 1). Beliefs about racism and health among African American women with Diabetes: A qualitative study. Journal of the National Medical Association, 103(3), 224–232. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3082367/