Introduction
Being aware of health threats and responding to them adequately is one of the fundamental skills that every person needs to possess in order to remain safe and secure. Unfortunately, due to the emergence of new health threats and the lack of accessibility to healthcare, as well as the absence of basic health literacy in an upsettingly large number of the U.S. population, changes have to be made to the current health management programs.
The Healthy People 2020 initiative was a rather noble endeavor that embraced a number of health concerns, including health literacy and accessibility, yet the outcomes have been less than satisfactory so far. Due to the problems in infrastructure, communication, and staffing, the issues of health education and accessibility remain unresolved (Office of Disease Prevention and Health Promotion, 2018). Thus, further efforts must be made in order to support vulnerable groups and increase overall health literacy and accessibility.
Thesis Statement
Despite the efforts made with the help of the Healthy People 2020 initiative to increase the accessibility of healthcare services, essential health support remains inaccessible for a large range of people due to the infrastructure issues, lack of financial support, absence of effective insurance, and low health literacy, which could be addressed with the help of an intervention that involves the use of IT and ICT tools for the dialogue between healthcare experts and communities.
Problem Description
Although the problem at hand cannot be considered as clearly visible as a specific disease or a disorder, it still has a clear and rather disturbing effect on public health. The problem of health accessibility and appropriate levels of health literacy has been quite prominent in the U.S. (Lyles, Fruchterman, Youdelman, & Schillinger, 2017).
Although several attempts have been made in order to prompt responsibility and the development of basic skills of self-care in patients, the recent outbreak of pandemics in the U.S. has shown that American citizens lack preparedness and the ability to apply the necessary skills. Moreover, the general levels of well-being in the U.S. also indicate that a substantial range of the American population does not have the access to decent healthcare (Office of Disease Prevention and Health Promotion, 2018). Thus, the key factors aggravating the situation and the main strategies for handling the problem need to be identified.
Literature Review
The burden of the Disease
Changes in Recent Years
Notably, there have been several important changes to the management of health inaccessibility and the promotion of health literacy to vulnerable groups. For instance, the introduction of new frameworks that healthcare workers could use to provide sufficient support to a larger number of people has been incorporated into the framework. For instance, the creation of the Synergy Model for nursing (SM), which was expected to increase the extent of collaboration in the cross-disciplinary environment and, thus, allow for better management of information-related needs in target audiences, can be considered an important change (Coleman, Hudson, & Pederson, 2017).
In addition, nurse administrators have included a plethora of new tools for boosting the efficacy of patient-nurse communication, both in the hospital setting and for outpatients. Specifically, the application of Telehealth and relevant technologies have become an important tool for handling the process of patient education (Wittenberg, Goldsmith, Ferrell, & Ragan, 2017). In addition, devices for remote monitoring of outpatients’ health status have been extraordinarily helpful in preventing issues such as heart attack or kidney failure from having a fatal impact on patients’ lives (Friis, Lasgaard, Osborne, & Maindal, 2016).
However, the specified technologies still remain unattainable for a range of facilities (Friis et al., 2016). In addition, extra tools have to be included so that the process of health education could start. Thus, the levels of accessibility to health-related information and crucial services will rise.
Concepts to Be Considered
When considering the problem of the lack of health literacy and the inaccessibility of health services to certain populations, one would consider that the notions of disease incidence, prevalence, and case-fatality are irrelevant. At first glance, there is indeed little connection to be made between the problem of health literacy and the notions in question since the absence of health awareness itself is neither a condition nor a disease.
However, one should remember that the absence of health literacy leads to the development of a plethora of issues that have a very high incidence rate, bear significant prevalence, and even lead to lethal outcomes in patients. For example, the lack of awareness about health-literacy-related issues has led to the subsequent rise in the incidence of myocardial infractions, the prevalence of the disease, and the number of fatalities (17,900,000 annually worldwide) (World Health Organization, 2020). Therefore, considering the concepts of incidence, prevalence, and morbidity in relation to the health topic at hand is necessary since it will give approximate information about the scale and scope of the problem.
Incidence
The notion of disease incidence is quite important to the estimation of its scale and the extent of the threat that vulnerable groups may face. Disease incidence represents a “proportion of newly developed cases divided by the number of individuals at risk for the same outcome during a specified time interval” (Inman & Sieper, 2016, p. 14). Therefore, the concept of incidence is typically used to characterize the development of a specific disease within a community, as well as the threat that it represents and the approximate level of contagion that it will imply. However, the phenomenon of incidence can also be used in relation to health awareness. Specifically, changes in the level of incidence will show the extent of health education in the target population and the effects that health literacy and access to health services have on their well-being.
Prevalence
Similarly, the concept of prevalence is traditionally used to characterize the extent of the spread of a particular disease. However, unlike incidence, which requires defining the number of new cases within a specific time period, disease prevalence is “The number of existing cases of disease at a particular point in time” (Woodward, 2013, p. 9). The analysis of prevalence helps to evaluate the extent of the present problem and calculate the number of resources needed to address it. Thus, the phenomenon of prevalence is closely connected to the concept of health accessibility and health literacy as the indicator of the current levels of it and the extent of changes that have to be made to increase it.
Case-fatality
Another important ratio that allows determining the scale and progression of a disease and the rates of health accessibility and health literacy within a community, the case-fatality formula implies “the number of people who die of a disease divided by the number of people who have the disease” (Celentano, Hopkins, & Szklo, 2018, p. 125). Thus, the case-fatality ratio will help to identify the urgency of a problem and the speed at which a health accessibility program needs to be created.
At the same time, one should give credit to some success in the target area. For instance, a recent article shows that the incidence, prevalence, and case-morbidity associated with CVD has dropped (Mensah et al., 2017). When considering the changes that have occurred in the levels and extent of health accessibility and health literacy over the past decade, a rather depressing trend can be noticed. Although the usage of new media and innovative technology for communication has helped to advance the conversation between a nurse and the American community, the increase in the amount of false information has also risen (Klein, Quisenberry, Shoben, Romer, & Peters, 2019). As a result, a larger number of people have embraced health-related myths despite their absurdity, thus increasing the threat to their health and well-being.
Consequently, although the current trends in prevalence, incidence, and case-fatality across different disorders and diseases in American citizens vary to a great extent, the fact that some of the health issues are still characterized by high rates of at least one of the described characteristics is quite worrisome (Klein et al., 2019). Moreover, addressing some of the most recent health issues, one should mention that the absence of health accessibility and literacy poses a tremendous threat to the lives of millions of people. Specifically, the astounding rise in prevalence, incidence, and case-fatality of COVID-19 across the U.S. and especially in New York indicate that people need to be instructed in detail about crucial health management strategies.
Main Issues
When approaching the previous frameworks for the promotion of health literacy and defining why they did not work, one should mention the absence of detailed and easily understandable clarifications on the mechanisms of the virus contraction, disease development, and its prevention. Therefore, it will be critical to providing explanations about the reasons for particular health management measures to be imposed on citizens, as well as the reasons why the proposed strategies work.
In addition, the issue of health accessibility needs to be addressed in greater detail. While there are currently several reasons for American citizens not to be able to use health-related services, some of the obstacles are more prominent than others. For example, the presence of the language barrier can be deemed as the foundational obstacle in increasing health literacy rates among the representatives of ethnic minorities living in the U.S.
According to the study performed by Martínez-Delgado (2016), the promotion of oral health literacy in the target population has been failing so far due to the challenges in dispersing information among the target audiences. Moreover, even with the increased dissemination of data and better understanding, the threat of misconceptions, and the inability to communicate with the target groups freely implies a drop in the overall health literacy levels. Thus, strategies for handling the language barrier need to be introduced.
The lack of competent nursing experts, who could engage in the active education of vulnerable groups and promote the dynamic development of basic health management skills in Americans is another problem that has to be addressed on the nation-wide level. According to Vermeir et al. (2017), the issue of nurse shortage has risen drastically in its scale and effects over the past decade, causing the efficacy of healthcare to drop. As a result, the quality of communication between nurses and patients has been faltering, leading to massive gaps in people’s health awareness (Vermeir et al., 2017). The outcomes of the shortage of nursing experts can be observed currently as the U.S. is facing the pandemics of COVID-19 (Lee, Ng, & Khong, 2020).
According to the latest data, despite the tremendous efforts put into the management of health needs of vulnerable populations and the improvement of communication, a vast number of American citizens remain oblivious to the importance of taking appropriate precaution measures.
The cost of healthcare services is another factor that prevents many U.S. citizens from getting the health support that they require. Specifically, a staggering number of Americans cannot afford Medicaid as a personal choice, which is why their options for addressing health issues or even receiving preventive health services, are very limited (Bhatt & Bathija, 2018). The specified issue outlines the problems of private insurance and emphasizes the need to provide high-quality care for all individuals, which may require deviating from the income-based approach.
In turn, the Medicare framework requires the approval of the Social Security Disability service, which is why it may be complicated for some people that have reached the age of retirement to receive appropriate financial support. The problem of financing is one of the foundational issues with contemporary U.S. healthcare. While private health insurance as one of the possible suggestions cannot be accepted due to the lack of consistency and certainty in their framework, the current public ones do not provide sustainable finances for supporting retirees.
Recent Strategies
In order to address the problem of health accessibility, several notable efforts have been made. Among the key strategies that have been developed to manage the lack of health accessibility and health literacy, the increase in the number of primary care providers can be seen as an important, even if somewhat mishandled, attempt. An endeavor at raising the number of primary care providers and reinforcing their role in health education among patients has recently been undertaken, yet the problems with staffing have been preventing the proposed strategy from being implemented (Huh, Shin, & Peck, 2020). Indeed, with the services of primary care providers, patients would have easier access not only to key health services such as vaccinations, regular health examinations, and other opportunities, but also relevant literature.
Another important step that has been taken in the direction of increasing healthcare accessibility is the need to address disparities in the management of citizens’ healthcare needs. Unfortunately, even with a plethora of programs launched to address the instances of discrimination or negligence of minority groups’ needs, the specified populations still suffer from significant underrepresentation and the lack of access to basic healthcare services (Lee & Vang, 2010). As a result, the levels of mortality, disease development, incidence, prevalence, and case-fatality are particularly high among the specified demographics (Lee & Vang, 2010).
Therefore, cross-cultural strategies for addressing the health concerns of vulnerable populations have been created recently (Rudd, 2019). As emphasized above, language issue represents a particularly strong obstacle to overcome along with false health-related beliefs, yet economic and financial issues also take the toll on representatives of ethnic and racial minorities in the U.S. (Bhatt & Bathija, 2018). Consequently, the programs such as the National Prevention Strategy have been launched to improve the current situation (Rudd, 2019). To their credit, the programs in question have delivered certain results, yet further improvements are still needed.
Proposed Measures
Although the existing frameworks for managing the problems of patients who have few opportunities for accessing health services are quite impressive, further adjustments will be needed to ensure that these programs are culturally inclusive and accessible to people from all social backgrounds. In order to increase the process of spreading health accessibility, nurses have to use innovative tools and techniques, including modern media and ICT devices. For instance, the use of Telehealth, telemedicine, and health portals as the main resources for patients to derive crucial information and support from deserving a mentioning (Rouleau, Gagnon, & Côté, 2015).
In addition, the tools for evaluating the efficacy and overall coverage of insurance offered to American citizens will be strongly needed. Since the current coverage rates leave much to be desired, it is imperative to monitor them more closely to locate the opportunities for increasing them and removing the factors that prevent people from getting the required insurance.
Therefore, a communication system between American residents, in general, and vulnerable groups, such as people living in poverty, people belonging to multicultural backgrounds, and other disadvantaged members of the U.S. population, has to be introduced. The application of innovative communication tools for receiving feedback and providing crucial guidance to target audiences will be needed. Specifically, the use of social media is highly encouraged as a means of communicating key principles of health management to patients.
In addition, to address the linguistic and cultural barriers, healthcare facilities will have to consider hiring nurses from different cultural backgrounds. Thus, the issues of cultural miscommunication or misunderstanding will be addressed. Moreover, multiple myths about health and healthcare will be removed from the discourse, encouraging patients to follow the provided guidelines. As a result, patients will be able to recognize threats and utilize the available tools to respond to these threats promptly.
The problem of insurance is another concern that has to be managed in order to increase e healthcare accessibility. The use of mobile clinics can be considered a solution for assisting those that live in remote areas (Rudd, 2019). The specified approach has been utilized in several states, yet further support will be needed to manage the transition to a new framework for tending to the needs of patients with low healthcare accessibility options.
Finally, tools for monitoring the application of appropriate measures and especially the use of newly developed communication channels will be needed. In order to improve communication between nurses and their communities, one may consider using the Telehealth option (Bhatt & Bathija, 2018), Although not being a recent introduction into the healthcare context, the Telehealth framework offers quite a number of opportunities for increasing the efficacy of communication between patients and nurses. For instance, the adoption of Telehealth services has been considered as a response to the current coronavirus pandemic (Lee & Wang, 2010).
However, while some hospitals have deployed the specified strategies, the lack of homogeneity in their approaches and the fact that very few other healthcare facilities have followed suit indicate that changes have to be made on a fundamental level. Therefore, health promotion policies must be instated to deploy Telehealth techniques as the means of building awareness, educating patients, monitoring their progress, and controlling their exposure to health threats.
Conclusion
The problem of health accessibility has been building over the past decade to reach a truly grandiose form presently despite the efforts to increase awareness among the target audiences, which means that improved information channels have to be used to address the issue. Namely, the introduction of the strategies based on dismantling the existing stereotypes concerning the management of health issues in individuals.
It is believed that the creation of additional communication channels that will help nurses in managing the process of patient education will help in building awareness concerning emergent health threats. As a result, the overall rates of health accessibility and preparedness toward health concerns will increase. Moreover, the change in question will affect the levels of health literacy and contribute to the management of the low levels of health education among general audiences. Thus, the levels of public health, health literacy, and accessibility of healthcare services will increase.
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