Healthy Communities: Research Findings to Guide Nursing Interventions By Addressing Culture, Geography and Economics

Purpose: The World Health Organization has called for researchers to close socioeconomic-driven health-related gaps, within the next generation in order to mitigate the carryover of disparities from this generation to the next. The purpose of this presentation is to present a body of research data that provides an answer to this call by identifying culturally relevant nursing intervention points that can be tailored to the unique social and economic situation within each vulnerable community. This funded nursing research identifies how the compounding effects of culture, economy, and geographical location intersect and form a gestalt triad determining health-related disparities in vulnerable populations. This deterministic triad is unique to underserved communities, and even if two communities experience the same health disparity, each community is likely to have a discretely different composition of cultural, economic, and geographic determinants. This creates a challenge for nurse researchers, policy makers and nurse practitioners trying to develop health-related interventions that are equitable, efficacious, and practical in low resource communities.  In this presentation data will support the description of the role of culture, economy, and geographic location in determining current health-related disparities in vulnerable areas and the identification of culturally relevant nursing intervention points that can be  tailored to the unique social and economic situation within each vulnerable community, whether rural and urban.

Methods: Community Engagement approaches and ongoing community partnerships were developed to conduct studies focused on health promotion behaviors such as immunization and interactions with primary care services in areas with challenges of geography, economy and culture.  Both Quantitative (N = 1800) and qualitative (N =40) methods were used to assess health promotion attitudes, beliefs and behaviors. Quantitative research utilized psychometrically validated surveys focused on health promotion practices in two states including six separate counties. Qualitative research including interviews and focus groups (N= 40) with parents followed quantitative descriptive research studies. Findings from 5 consecutive studies have been evaluated for correlating and contrasting findings.

Results: Quantitative and qualitative results will be shared from 5 consecutive studies. Descriptive statistical procedures, logistic regression and structural equation modeling were used in this analysis of survey data.  Geographic location, economic status, ethnicity and enculturation varied as predictors of participation in health promotion activities such as immunization, screenings and annual physical exams. Religious practice did not correlate with health promotion activities or access to health care. These results varied from county to county. Qualitative data analysis was completed in several steps beginning with the digital audio recordings were transcribed and checked for accuracy. In addition, notes taken during focus groups were utilized to verify participants by their individual anonymous codes so answers to questions and any additional comments that were made were verified. Transcripts were then preliminarily analyzed by an expert in qualitative analysis and a trained graduate research assistant who were not present during data collection to ensure rigor and eliminate bias.  Constant comparative analysis was completed and this systemic approach laid a foundation for concept analysis.  The results indicate that Religiosity (i.e., participation in religious social structures) was a recurring and important theme when discussing health promotion. Spirituality (i.e., subjective commitment to spiritual or religious beliefs) was found to influence the ways in which individuals perceived their control over and how they are coping with health issues. In addition, individuals described the barriers to health promotion that influenced their resolve to seek health care or maintain health promotion activities. These barriers included geography and economic challenges in their community.

Conclusion: Health disparities, along with the barriers to overcoming them, have their roots in the triad of culture, geographic location, and economic factors in vulnerable communities. These communities experience health disparities that are often worsened by limited opportunities for employment, thus propagating cultural norms that further reduce access to healthcare and opportunities for sustainable health promotion.  Understanding of each individual cultural, geographic, or economic element as a triad is necessary, but not sufficient unless the compounding effects of all three elements are also accounted for in the developing nursing interventions to improve health promotion outcomes.  Efforts are underway in to respond to this triad through health promotion education and interventions tailored specifically to the sociocultural, geographic, and economic determinants of each unique community’s health-related disparities. Early responses to recruitment and engagement during our research studies show promise and the ability to be expanded these approaches to other communities. Similar leadership and partnerships are necessary across health promotion priorities in order to equitably close the health disparity gap. Ongoing research is being conducted to replicate these findings and verify these conclusions. These data will also be presented.