How does the region of the United States in which one lives affect the quality of health care one has access to? What are the reasons for this? Provide an example of this disparity
A large aspect of this disparity is socioeconomic circumstances and risk. For example, affluent and urban areas like New York are more likely to have better and modern hospitals rather than rural areas of North Dakota. This is due to the market system of US healthcare which inherently leads to fewer funds for regions with smaller or poorer populations. Geography is a vital domain of healthcare delivery. Regional differences with the consideration of local culture and politics combine to create disparities that transcend state borders. Regional healthcare structures are developed through sometimes significantly varying programs and policy initiatives which leads to disparities in health status and access.
What were some of the factors that led to the rapid growth in the number of hospitals from 1873 to 1900?
In the late 19th century, medical and nursing science had undergone rapid growth and development after decades of disarray. Urbanization increased population demand for healthcare and specialized medical skills. Medical science and technology, including diagnostic techniques, understanding of diseases, and improved drugs led to healthcare becoming more effective. Institutionalization occurred as medical resources were pooled into common areas of care, aided by urbanization which led to an organized delivery of healthcare that prompted hospital numbers to rising and healthcare to become professionalized. Teaching and research were later transferred to hospitals as well which provided credibility and funding to the institution.
What are some of the key factors that contribute to the complexity and diffuse responsibility for public health in the U.S.?
One factor is the lack of centralization in healthcare. Public health policy is often instituted at the state level rather than the federal which leads to discrepancies. Varying levels of authority contribute to a lack of accountability for public health care outcomes in many cases. Second, the market model of health care providers has led to most facilities, including hospitals, operating at a private practice model. There is a high reliance to achieve public health goals on private practices instead of government organizations. Unlike most countries in the world, there is no unified system in the United States.
Describe early behavior change efforts in the 1970s and 1980s, including the methods used, theories implemented, and the results
This period is known for the development and implementation into the practice of various behavior modification procedures. These arose to the potential need for their application, particularly in the fields of education and criminology. Multiple models of behavior change exist, attempting to explain the undeniable causal mechanisms to human behavior. Many of them share the concept of self-efficacy – an aspect of an individual that perceives one’s ability and can be predictive of the effort and behavior a person exemplifies.
A common theory that arose and became popular as a result of Skinner’s studies is learning theory, which states that an individual learns through a gradual process by modifying simpler behaviors. In turn, reinforcement over time and duplication of example behavior ensures a desirable outcome. Another theory is known as the social cognitive theory states that behavioral change depends on environmental and personal factors, that are all intertwined. Personal thoughts guide behavior and individual traits are elicited in a social environment.
A method developed and utilized based on these theories is tailoring. It is intended to personalize communications in various contexts to lead to behavior change. Tailoring focuses on improving preconditions for message processing mechanisms. These elements include attention, emotional processing, self-reference, and effortful processing. In combination, influencing attitude self-efficacy, and perception of the process, tailoring influences behavioral determinants with the purpose of optimal outcomes. Tailoring has experienced moderate success, with experts believing it has a positive impact on behavior, particularly in health.
Identify and describe each of the six stages of the stages-of-change model of health behavior change
- Precontemplation – individuals are not ready to take action or remain uninformed about the consequences of their behavior.
- Contemplation – stage with the intent for behavioral change and higher awareness of the health benefits that come with it.
- Preparation – intent to take action within the immediate future and taking concrete steps towards it such as consulting a doctor or purchasing a gym membership.
- Action – the stage of specific modifications to lifestyle and behavior. It is the observable stage which is most commonly equated with health modification.
- Relapse – a form of regression where the individual returns from the action or maintenance stage to one of the previous ones.
- Maintenance – making specific and overt modifications to lifestyles to prevent relapse. Maintenance is meant to instill confidence and promote habits.