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Chapter 9: Health Disparities

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Chapter 9: Health Disparities

14 problems · 0 figures

Case Study 9.3.1 §9.3 source ↗

Read the scenario, and then answer the questions that follow.

As part of her role as a registered nurse case manager for Medicaid clients, Marinelle works with pregnant clients to coordinate their prenatal care. These clients are part of a group that has been identified as high risk for pregnancy-related complications. For the past few months, Marinelle has tracked her clients’ prenatal appointments and detects a trend in missed appointments. Most clients who miss appointments live in the same area of the county. It is a small rural neighborhood located in the vicinity of an abandoned factory. All the clients are Black women.

Which of the following factors should the nurse consider as most likely contributing to the clients’ poor pregnancy-related outcomes?
  1. a.
    Genetics
  2. b.
    Biological factors
  3. c.
    Cultural environment
  4. d.
    Physical environment

Answer

D. Physical environment
The clients’ physical environment is most likely hindering their ability to attend their appointments, resulting in inadequate prenatal care and ultimately poor outcomes.

Case Study 9.3.2 §9.3 source ↗

Read the scenario, and then answer the questions that follow.

As part of her role as a registered nurse case manager for Medicaid clients, Marinelle works with pregnant clients to coordinate their prenatal care. These clients are part of a group that has been identified as high risk for pregnancy-related complications. For the past few months, Marinelle has tracked her clients’ prenatal appointments and detects a trend in missed appointments. Most clients who miss appointments live in the same area of the county. It is a small rural neighborhood located in the vicinity of an abandoned factory. All the clients are Black women.

One aspect of health care access is clients’ ability to attend scheduled appointments. Which of the following factors is most likely to facilitate clients’ ability to access health care?
  1. a.
    Having a chronic disease
  2. b.
    Having adequate insurance coverage
  3. c.
    Having strong social support
  4. d.
    Having the ability to take time off work for appointments

Answer

B. Having adequate insurance coverage
All of these choices could potentially affect someone’s ability to access health care, but having adequate insurance coverage is most likely to facilitate clients’ access to health care.

Case Study 9.4.3 §9.4 source ↗

Read the scenario, and then answer the questions that follow based on all the case information provided in the chapter thus far. This case study is a follow-up to Case Study Part A.

Marinelle contacts the clients who have missed the most prenatal appointments. These clients report difficulty finding transportation to the appointments. Many clients feel stressed about not having enough money and resources to support their families after their infants are born. One client describes her difficulty trying to find a home closer to town and in better condition than her current home. Marinelle works to find reliable transportation for the clients to help them make it to their appointments. She also arranges for a social worker to visit the clients to discuss their economic concerns.

What should Marinelle consider as a factor influencing clients living in this neighborhood?
  1. a.
    Racial discrimination
  2. b.
    Residential segregation
  3. c.
    Environmental injustice
  4. d.
    Gender differences

Answer

B. Residential segregation
Residential segregation is a form of systemic racism that keeps minority groups living in certain disadvantaged areas.

Case Study 9.4.4 §9.4 source ↗

Read the scenario, and then answer the questions that follow based on all the case information provided in the chapter thus far. This case study is a follow-up to Case Study Part A.

Marinelle contacts the clients who have missed the most prenatal appointments. These clients report difficulty finding transportation to the appointments. Many clients feel stressed about not having enough money and resources to support their families after their infants are born. One client describes her difficulty trying to find a home closer to town and in better condition than her current home. Marinelle works to find reliable transportation for the clients to help them make it to their appointments. She also arranges for a social worker to visit the clients to discuss their economic concerns.

Which of the following is the best indicator for Marinelle to use to evaluate the effectiveness of her interventions to address maternal health disparities in this population?
  1. a.
    Client satisfaction
  2. b.
    Provider satisfaction
  3. c.
    Rate of pregnancy-related complications
  4. d.
    Number of missed appointments

Answer

C. Rate of pregnancy-related complications
Tracking pregnancy-related complications is a more accurate measure of the effectiveness of interventions to address maternal health disparities.

9-1 §9.RQ source ↗

A public health nurse is reviewing data that shows that families living closer to an industrial plant have higher rates of cancer. Which of the following determinants should the nurse consider in this situation?
  1. a.
    Epigenetics
  2. b.
    Sociocultural environment
  3. c.
    Biological processes
  4. d.
    Physical environment

Answer

D. Physical environment
Health determinants are nonmedical factors that influence health outcomes. Individuals can be exposed to environmental factors such as pollution that affect their health.

9-2 §9.RQ source ↗

A nurse researcher has found that clients living in rural areas tend to have higher rates of hospitalization for chronic lung disease than those living in affluent urban areas. Which of the following terms describes what the nurse researcher has identified?
  1. a.
    Health disparities
  2. b.
    Health determinants
  3. c.
    Intersectionality
  4. d.
    Socially disadvantaged populations

Answer

A. Health disparities
A health disparity is a health difference that adversely affects disadvantaged populations in comparison to a reference population based on one or more health outcomes.

9-3 §9.RQ source ↗

A community health nurse educates a group of families on healthy eating habits to reduce their risk of diabetes. The nurse encourages them to share healthy meal ideas with each other. Which domain and level of influence does this intervention address?
  1. a.
    Behavioral and community
  2. b.
    Behavioral and individual
  3. c.
    Sociocultural environment and interpersonal
  4. d.
    Sociocultural environment and societal

Answer

C. Sociocultural environment and interpersonal
Encouraging families to share healthy recipes with one another incorporates the effects of the families’ sociocultural environment and their interpersonal levels of influence on their health.

9-4 §9.RQ source ↗

A community health nurse is working with a group of gay Black clients who are describing some of the negative social interactions they have experienced. This group is likely affected by which of the following:
  1. a.
    Intersectionality
  2. b.
    Entitlements
  3. c.
    Gender disparities
  4. d.
    Racial disparities

Answer

A. Intersectionality
Intersectionality occurs when one type of discrimination intersects with other factors of discrimination, such as gender, ethnicity, socioeconomic status, disability, age, geographic location, gender identity, and sexual orientation, among others.

9-5 §9.RQ source ↗

A home health nurse notices that, among clients who were recently released from the hospital, female clients were more likely than male clients to report experiencing uncontrolled pain while hospitalized. What contributing factor should the nurse consider in this situation?
  1. a.
    Gender roles
  2. b.
    Gender biases
  3. c.
    Biological differences
  4. d.
    Environmental differences

Answer

B. Gender biases
Discrimination results from prejudices. Prejudice can contribute to members of disadvantaged groups experiencing poor health outcomes—in this situation, poor pain control.

9-6 §9.RQ source ↗

A public health nurse determines that a non-English-speaking Hispanic client needs additional medical evaluation and treatment for cancer. Which of the following statements best describes the nurse’s assessment of this situation?
  1. a.
    This client is insured and should be able to receive treatment accompanied by a medical interpreter.
  2. b.
    This client has a primary care provider who should be able to help the client navigate the system.
  3. c.
    This client’s access to health care may be limited by the ability of the health care system to provide services when they are needed.
  4. d.
    This client’s access to health care may be limited by the availability of culturally competent providers.

Answer

D. This client’s access to health care may be limited by the availability of culturally competent providers.
Inadequate availability of culturally competent providers can limit health care access for non-English-speaking clients.

9-7 §9.RQ source ↗

Which of the following statements by a nursing student would indicate the need for further education?
  1. a.
    “A difference in health status between older adults and the young may indicate a health disparity.”
  2. b.
    “Race is not a determinant of health.”
  3. c.
    “Individuals who live in high-poverty areas may need assistance accessing health care services.”
  4. d.
    “If I don’t have a high school diploma, my risk for chronic disease rises.”

Answer

B. “Race is not a determinant of health.”
Race is a determinant of health that can lead to health disparities. For example, Black people are at a greater risk of developing certain diseases than their non-minority counterparts because they have less access to health care and experience greater levels of poverty.

9-8 §9.RQ source ↗

A nurse studying the percentage of the population that reports having a regular source of health care notices that some states have significantly higher rates of care than other states. Which of the following factors is most likely the reason for the difference?
  1. a.
    Differences in health literacy rates
  2. b.
    The geographic distribution of health care providers
  3. c.
    The income requirements for Medicaid eligibility
  4. d.
    Availability of public transportation

Answer

C. The income requirements for Medicaid eligibility
Medicaid expansion, part of the Affordable Care Act, expanded the number of people eligible for Medicaid. Insured clients are more likely to report a regular source of health care. Differences in Medicaid eligibility vary among the states, which can account for differences in insurance coverage–related outcomes.

9-9 §9.RQ source ↗

A nurse educating a group of men on the importance of performing testicular self-exams recognizes that which of the following factors influences the likelihood that they will adhere to this recommendation?
  1. a.
    Low health literacy levels
  2. b.
    Poor social support
  3. c.
    Gender bias related to health care access
  4. d.
    Gender norms related to masculinity

Answer

D. Gender norms related to masculinity
Gender norms are social and cultural principles that influence ideas on how different genders are supposed to behave in society. Among these factors, social norms related to masculinity are most likely to affect the adherence rates of men performing testicular exams.

9-10 §9.RQ source ↗

A nurse working in a rural public health clinic recognizes that which of the following risk factors for poor health outcomes is prevalent in the community?
  1. a.
    An increased likelihood of engaging in risky behaviors
  2. b.
    A decreased risk of experiencing chronic lung disease
  3. c.
    An increased likelihood of wearing seat belts
  4. d.
    A decreased risk of cancer

Answer

A. An increased likelihood of engaging in risky behaviors
Rural residents are more likely to engage in riskier health behavior and have poorer health outcomes than residents of urban areas.

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Problems and answers are adapted from Population Health for Nurses by Jessica Ochs, Sherry L. Roper and Susan M. Schwartz, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/population-health/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.