Health Promotion Proposal, Essay Example

 Abstract

Pregnant women facing disparities that require prenatal care do not always receive the level of care that is necessary to support health and wellbeing for themselves and their unborn children. Therefore, access to prenatal care services is of critical importance in expanding knowledge and in identifying disparities that impact this population group. The implementation of educational programs and outreach must be explored in order to provide pregnant women from disadvantaged populations to experience fewer complications and poor outcomes for their unborn children. Prenatal education and service interventions that address cultural diversity and other differences must be explored in greater detail as an opportunity to reduce disparities and to demonstrate the importance of specific factors in shaping the lives of women from disadvantaged population groups.

Introduction and Description of the Problem

In the 21^st Century, there is an ever-increasing disconnect in accessing health care and treatment in many communities. Pregnant women seeking prenatal care, for example, are not always able to obtain these services due to lack of insurance coverage, limited service offerings, and limited knowledge regarding the importance of prenatal care for themselves and their unborn children. As a result, the racial, cultural, and ethnic divides in accessing prenatal care services is greater than ever and continues to expand in scope and significance across different population groups. Under these conditions, it is likely that expectant mothers will fail to obtain adequate care and treatment for their unborn children, who may face serious complications and poor health after birth. Therefore, it is essential to examine these disparities and to determine how to best approach lower income and disadvantaged populations without routine access to prenatal care in order to identify existing weaknesses in current models. For these expectant mothers, access to prenatal care is often limited to the extent that there are significant health disparities for children born to mothers without adequate prenatal care. The following discussion will address some of these disparities in greater detail and will establish a greater understanding of the challenges that many expectant mothers face in disadvantaged populations with respect to prenatal care. This discussion will also identify an intervention that is designed to improve access to prenatal care for pregnant women who otherwise would not be able to obtain this care on a routine basis.

Target Population and Setting

Existing challenges often limit access to prenatal care for many pregnant women without insurance, nearby services, and knowledge of how to access this type of care. Therefore, it is necessary to identify one or more disparaged groups in order to develop an intervention method that may lead to effective outcomes. For the purposes of this discussion, disadvantaged populations from two communities will be examined: 1) A predominantly African-American low income neighborhood where the poverty level is high, teen pregnancies are high, and level of educational attainment is low; and 2) A predominantly Latino community where families are connected, Spanish is the primary language, incomes are low, and there are significant language barriers which often prevent easy access to healthcare services. Each of these population groups faces significant disparities in access to prenatal care. Therefore, community-based approaches or interventions must be considered that are population-specific and culturally appropriate for the chosen population groups.

Theoretical/Conceptual Framework

In order to accomplish the objectives set forth in improving access to prenatal care in the chosen communities, it is important to identify a theoretical approach that is appropriate for the subject area and the chosen population groups. For this example, the cultural sensitivity/diversity theoretical framework is appropriate because it reflects upon the challenges that evolve when cultural diversity contributes to health disparities that are difficult to overcome due to customs, language barriers, limited incomes, and lack of knowledge regarding available services. This theoretical approach explores the key dimensions of healthcare practice that may be limited by cultural differences that are not always easily understood at the healthcare practice level. Therefore, cultural diversity and sensitivity often play an important role in limiting access to much-needed healthcare services, such as prenatal care. It is believed that access to prenatal care should not discriminate on the basis of culture, race, income, or ethnicity; rather, access to healthcare should transcend any cultural or racial boundaries that currently exist. This will enable healthcare providers to offer high quality healthcare services to all persons within their communities without reference to race, culture, ethnicity, or income status. These contributions will play an important role in determining how to improve access to prenatal care for the chosen population groups.

In exploring a cultural sensitivity/diversity framework, there should be no barriers to access for pregnant women requiring prenatal care. Under these conditions, access to these services is universal and unconditional because it is not based upon cultural, racial, or ethnic identity. On the contrary, access for all pregnant women must be available for disadvantaged populations. By allowing access to prenatal care for all pregnant women, the benefits for this type of healthcare outweigh the costs, and these services should not be based upon race, culture, or ethnicity. It is essential that members of disadvantaged populations, such as Latinos and African Americans, are provided with equal access to prenatal care in order to protect the lives of their unborn children and to preserve their wellbeing before and after birth. These elements are critical because they are likely to have a positive impact on the children born by mothers with adequate access to prenatal care throughout their pregnancies.

Review of Literature

In exploring the potential advantages of prenatal care for all pregnant women, regardless of race, culture, or ethnicity, it is important to recognize some of the disparities that exist and the reasons behind these disparities and how to overcome them. For example, an article by Bryant et.al (2010) explores the dimensions of racial and ethnic disparities and their impact on the outcomes of expectant and new mothers. This article evaluates the different challenges that many women from disadvantaged population face when they lack adequate access to prenatal care on a consistent basis (Bryant et.al, 2010). In this context, there is a behavioral component to these disparities that must be considered because it has a negative impact on the health of many pregnant women from disadvantaged population groups (Bryant et.al, 2010). In addition, women without regular prenatal care face the risk of obstetric complications and poor pregnancy outcomes; therefore, they must be provided with routine access to prenatal care in order to prevent these complications as much as possible (Bryant et.al, 2010). Typically, many women without access to adequate prenatal care are not Caucasian, thereby confirming that these women often face disadvantaged circumstances that lead them to limited or no access to prenatal care and limited knowledge regarding its importance (Bryant et.al, 2010).

From a provider-based perspective, there are considerable efforts required to overcome racial and ethnic disparities in relation to prenatal care (Franks). Some argue that these disparities are often rooted in limited education and knowledge regarding the benefits of prenatal services (Franks). Pregnant women of disadvantaged socioeconomic status often face the most significant risks and are often racially or ethnically diverse (Franks). Therefore, it is important to identify the nature of these disparities and to determine how to improve access to these services while also considering their long-term benefits so that pregnant women from disadvantaged populations have access to prenatal care throughout their pregnancies (Franks).

Many women from disadvantaged populations simply do not possess the knowledge and understanding of the importance of prenatal care in the lives of their unborn children (Boerleider et.al, 2013). Under these conditions, it is important to note that many women from lower income population groups do not have health insurance or their benefits are inadequate, they do not understand the importance of prenatal care, or they do not have easy access to healthcare facilities (Boerleider et.al, 2013). Therefore, many pregnant women go without routine prenatal care and the lives of their children are at risk (Boerleider et.al, 2013). Prenatal care for pregnant women should not be an option; rather, it should be a requirement so that the lives of these unborn children do not face unnecessary risks (Boerleider et.al, 2013). If access to prenatal services is limited or nonexistent, there is a much greater potential for serious complications or side effects that could be otherwise preventable with adequate prenatal care (Boerleider et.al, 2013). Therefore, it is essential for healthcare providers to consider methods to educate pregnant women and to emphasize the importance of adequate prenatal care for expectant mothers (Boerleider et.al, 2013). For many women ,there is a clear lack of knowledge and education regarding the critical nature of prenatal care and its positive impact on unborn children, which must be expressed in a more definitive and thoughtful manner (Boerleider et.al, 2013).

Access to prenatal care services also requires an effective understanding of the disparities that exist between the disadvantaged and those with regular access to these opportunities, as birth risk is also related to these conditions (Schlenker et.al, 2012). From this perspective, it is important to evaluate disparities that also exist with respect to infant mortality rates because these factors are often a result of limited access to these services and their subsequent impact on infant wellbeing (Schlenker et.al, 2012). It is evident that the challenges of developing new approaches to prenatal care require a breakdown of the barriers that currently exist for disadvantaged population groups so that their needs are met more effectively and without conditions (Schlenker et.al, 2012). Premature births and other factors are often a result of inadequate prenatal care; therefore, it is necessary to address these findings and to make sense of the disparities that exist in order to minimize their impact on a gradual basis (Schlenker et.al, 2012). When pregnant women are provided with an opportunity to obtain greater access to prenatal care, the outcomes for their unborn children often grow significantly in their favor, which is best represented in lower numbers of complications and reduced statistics regarding premature births (Schlenker et.al, 2012).

For expectant mothers from disadvantaged populations, there are significant disparities that exist that contribute to high risk pregnancies, births, and serious complications in many low income communities (Ward et.al, 2010). An evaluation of the conditions in a study conducted on the population of Milwaukee, Wisconsin revealed that there are consistently higher rates of infant mortality, preterm births, and low birth weight children born to mothers from disadvantaged populations, far above their middle and upper class counterparts, particularly in African American communities (Ward et.al, 2010). These statistics demonstrate that it is important to identify the reasons behind these significant racially motivated disparities as a means of exploring new outcomes and other factors that might contribute to new directives and approaches to reduce these disparities over time (Ward et.al, 2010). When socioeconomic status is taken into consideration, there is a much greater potential to access the appropriate prenatal care for those groups with higher socioeconomic means than those classified as disadvantaged, and this is critical in the development of new perspectives and approaches to improve outcomes and to evaluate the impact of programs to reduce these disparities for populations without routine access to prenatal care services that could reduce their rates of infant mortality, low birth weight, and preterm births (Ward et.al, 2010).

Finally, for expectant mothers who require public assistance, their use of Women, Infants, and Children (WIC) programs are more likely to reduce infant mortality rates when they are eligible for and take advantage of these programs on a consistent basis (Khanani et.al, 2010). In this capacity, it is important to demonstrate that public assistance programs are beneficial to members of disadvantaged populations because they reflect upon the challenging nature of disparities, but would be even more beneficial if they explored the potential for expanded access to prenatal care so that expectant mothers across all age groups are able to achieve these benefits throughout their pregnancies (Khanani et.al, 2010). For many expectant mothers, however, WIC services are not always taken advantage of until the later months, such as the second trimester and beyond, which may impact births in different ways (Khanani et.al, 2010). Therefore, it is necessary to explore the options available for expectant mothers when they obtain WIC services in the earlier stages of pregnancy (Khanani et.al, 2010).

Role of the Nurse Educator

Nurse educators play an important role in conducting interventions for pregnant women from disadvantaged populations. This role includes the development of programs to educate women regarding pregnancy and the need for prenatal care, as well as the services themselves. It is important to recognize these challenges and to identify methods of intervention that may lead to successful outcomes for women receiving these services on a more consistent basis. Nurse educators must perform outreach within communities, identify women who do not have regular access to prenatal care, and provide them with opportunities to obtain access and to achieve healthier lifestyles. This intervention engages nurse educators directly with the general public and enables them to work proactively in order to achieve the desired results. Pregnant women in disadvantaged populations require additional resources because they are often uninsured or do not possess sufficient knowledge to obtain prenatal care on a regular basis; therefore, the nurse educator fills this void by bridging the gaps between pregnant women and their ability to obtain adequate prenatal care.

Research-Based Intervention

Conducting an intervention with disadvantaged population groups requires an understanding of the disparities that exist so that access to prenatal care is achieved more cohesively and effectively. Therefore, it is important to develop an intervention that recognizes the need and how it might impact pregnancy and birth at all stages. The proposed intervention would explore the impact of expanded prenatal care services for selected African American and Latino pregnant women under the age of 25 who otherwise would not have routine access to prenatal care services on their own. This intervention would offer these services in different forms, including examinations, nutritional supplements and guidance, prenatal vitamins, ultrasounds, and other services as required to determine the state of pregnancy and to identify any potential risks. In addition, knowledge regarding the critical nature of prenatal services would also be explored so that the chosen population groups are fully aware of the risks associated with poor prenatal care for their unborn children. It is expected that knowledge-based interventions would be effective when they are conducted within the communities themselves where access is simpler and participation rates are likely to be higher because women will be able to share their experiences with others facing similar conditions. The intervention would also provide some of the most important medical benefits of prenatal care and how they might directly impact the health of their unborn children if these services are utilized on a regular basis.

Intended Outcomes

With the proposed intervention, it is expected that there will be sufficient opportunities for the selected participants to obtain adequate knowledge regarding the impact of prenatal care on their unborn children. When the intervention is conducted in familiar surroundings, participants are likely to experience a greater sense of comfort regarding the effort and may recognize its true impact on their lives. These efforts will also demonstrate that pregnant women who are classified as disadvantaged are able to receive the benefits that many other women receive to protect their unborn children from unnecessary risks or complications. These efforts will also provide a greater understanding of the importance of prenatal care and compliance so that unborn children receive optimal benefits. The proposed intervention would be interactive and would allow participants to ask questions to expand their knowledge base and their ability to secure these services because they recognize the extent of their benefits.

Evaluation Plan to Measure Efficacy

The proposed intervention must be evaluated in order to determine its effectiveness for the selected population groups, and this would be best accomplished by using an approach that examines knowledge acquisition, the number of questions that are asked by participants, and the utilization of available prenatal care services as provided through the intervention. If participants take advantage of these offerings they are more likely to experience greater benefits and will recognize the importance of prenatal care in protecting the health and wellbeing of their unborn children without serious complications. These contributions will play a critical role in achieving positive outcomes with the intervention and in enabling expectant mothers from disadvantaged populations to have the same access to prenatal care as women from other groups.

References

Boerleider, A.W., Wiegers, T.A., Mannien, J., Francke, A.L., and Deville, W. (2013). Factors affecting the use of prenatal care by non-western women in industrialized western countries: a systematic review. BMC Pregnancy and Childbirth, 13, retrieved from http://www.biomedcentral.com/content/pdf/1471-2393-13-81.pdf

Bryant, A.S., Ayaba, W., and Washington, A.E. (2010). Racial/ethnic disparities in Obstetrical outcomes and care: prevalence and determinants. American Journal of Obstetrics and Gynecology, 202(4), 335-343.

Franks, A. Providers’ perspectives on the role of race in maternal health. 115-151, Retrieved from http://biowww2.biology.yale.edu/sociology/yjs/yjs_fall_2011.pdf#page=115

Khanani, I., Elam, J., and Maseru, N. (2010). The impact of prenatal WIC participation on Infant mortality and racial disparities. American Journal of Public Health, 100(Suppl 1), S204-S209.

Schlenker, T., Dresang, L.T., Ndiaye, M., Buckingham, W.R., and Leavitt, J.W. (2012). The effect of prenatal support on birth outcomes in an urban Midwestern county. Wisconsin Medical Journal,111(6), 267-273.

Ward, TCS, Mori, N., Patrick, T.B., Madsen, M.K., and Cisler, R.A. (2010). Influence of socioeconomic factors and race on birth outcomes in urban Milwaukee. Wisconsin Medical Journal,109(5), 254-261.