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Communities are often made up of diverse populations, distinguished by their ethnic and cultural heritage. Within those populations, some health and wellness issues are specific to that group, while others apply to all groups. As you observe the following exchanges, consider how collaboration between patients and providers could address that group’s health needs, and how patient engagement could improve the quality of care that individuals in those groups receive.

At the Clinic

HIV and other STIs are preventable. But as you’ll see at the clinic, influencing people’s behavior choices in sexual situations isn’t easy, especially when a person’s culturally acquired beliefs about sexuality get in the way.

Martin: Hi, Hugo. My name is Martin Lewis. I’m a counselor here, and Dr. Rockwell has asked me to speak with you further about your test results.

Hugo: Yeah… the doctor told me I was positive on the blood test.

Martin: Do you understand what that means?

Hugo: I dunno… I guess I do. The doctor told me I came up positive and he was telling me all about, like, the differences between HIV positive and having AIDS. I don’t have AIDS, so that’s good, right?

Martin: Yes, that is good. How are you feeling about what you’ve learned?

Hugo: Okay, I guess. I wish I didn’t have it, but it’s not like it was before, where you would get sick and die no matter what.

Martin: That’s true. HIV infection isn’t a death sentence. In fact, it’s a chronic and manageable condition now. But before we get into what’s next for treatment, we need to confirm your status – it is possible to test positive for HIV when you don’t actually have it. But if you do have it, our job is to make sure that you don’t get AIDS. We’re going to have to talk about anti-retroviral treatment, and about the pros and cons of your choices.

Hugo: Okay.

Martin: But we also need to talk about how you were exposed to the virus and… and this is hard… who you have been with sexually. We need get any partners who might also have been exposed to get tested as soon as possible.

Hugo: Yeah… we need to find out where I got this from.

Martin: Well, to be honest, you probably won’t find that out. Even if one of your partners informs you that they are HIV-positive too, that won’t necessarily mean that you contracted it from them. Remember, it can be awhile before an HIV-positive person knows that they have the virus. So the reason we try to make sure that all of your previous partners get tested is to stop the spread of the virus and get people treated, nothing else. We can help you with that, if you don’t know how to tell your partners that you are HIV positive.

Hugo: What do you keep saying partners for, like I’m gay? I’m not gay, you know?!!

Martin: That’s just the way we put it when we’re talking about this kind of thing — sexual partners. Male, female…. I wasn’t implying anything.

Hugo: Good, cuz I’m not gay. I don’t want you thinking I am just because this happened to me. You can get it from women, right?

Martin: That’s possible. It only takes one vulnerable opportunity to contract HIV. In fact, some people have contracted HIV the first time they had sex. You could have gotten the virus from any sexual partner you had unprotected sex with. Do you wear condoms when you have sex?

Hugo: Yeah, man! I don’t want to get no lady pregnant. Besides, I don’t want to get the syph or something!

Martin: Okay, are you saying that you’ve always used a condom?

Hugo: Just about always, yeah.

Martin: Do you think you’ve always used condoms properly?

Hugo: Man, who knows? Those things are a pain.

Martin: I’m going to ask you a difficult question, then. I assume you were talking about women just now. Have you ever had unprotected sex with another man?

Hugo: Oh, man… come on! I like the women, I’m telling you.

Martin: I get it… I just have to ask. A lot of guys, they are very macho… total men, but you’d be surprised. Things happen… they get high or drunk… sometimes they just got here in this country and they’re farm workers living in a camp with no women around. Things happen. Sometimes it just feels good. It’s not abnormal.

Hugo: Well, yeah… things do happen. That doesn’t make you gay, though, right?

Martin: You are who you are… we don’t need to be worrying about labels or what other people say you are. Let’s just talk about who you might have been with.

Hugo: Look, I never did it before. And I only did it that one time. I was drunk, so I don’t remember much.

Martin: Is this a sexual experience with another man that we’re talking about?

Hugo: …yeah.

Please answer the following questions:

In this scene what type of care model is being discussed with regards to Hugo’s HIV positive test, a treatment or wellness model? Why?

Your response:

This question has not been answered yet.

Feedback: The care being discussed, anti-retroviral treatment, would fall under a treatment model approach. It is a treatment model approach because it is focused on treating a specific condition which has already manifested.

At the Market

No matter what their ethnic background, many people struggle with obesity today. As you’ll see in conversations at the market, many factors — some cultural, some not — contribute to the difficulties of changing eating habits.

Kia Si Moua: Hey, Pa Foua! I haven’t seen you in a long time!

Pa Foua Lee: I’ve been in Merced visiting my parents.

Kia Si Moua: Didn’t they feed you while you were there? You look like you’ve lost weight!

Pa Foua Lee: Ha ha! I ate like crazy, but I’m really focusing on eating better.

Kia Si Moua: How do you do it? I don’t know what I’d eat if I went on a diet!

Pa Foua Lee: It’s not so hard. I still eat traditional, just a different way. Lots of salads and stir fry. I don’t fry so much, and I’m trying to stay away from the junk.

Kia Si Moua: I wish I could say the same. Pheng and the kids go crazy if I don’t have snacks in the house. And if that stuff is there, I eat it too!

Pa Foua Lee: Yeah, I know. That was the first thing I changed! No snacks in the house for me! But it’s different for me. When my cousin found out she had diabetes, I got really scared. She’s been having such a hard time with it. The doctors tell her one thing, and her family wants her to just go to a shaman. They don’t understand why she has to change everything she does. I don’t want to deal with all that! I knew I weighed too much, and I thought I could do something before I get sick myself.

Kia Si Moua: Too bad… no more nab vam for you, huh?

Pa Foua Lee: Not as much, that’s for sure.

Kia Si Moua: Well, I’ll just take your share!

Gao Na Lor: Don’t you know anything about Ka Poon? You don’t need all that junk to make curry noodle soup! How many people are you trying to feed?

Bo Vang: I know! It’s crazy, isn’t it? I just have six people to feed, but it feels like I am cooking for a whole village. Thao’s mother likes it when I cook traditional foods. Thao and the boys want fried everything, and Mai has decided she won’t eat meat.

Gao Na: Thao’s mother is right. You should cook more traditional.

Bo: Well, except for the fact that her doctor says she has diabetes. They told her she is not supposed to eat rice or noodles.

Gao Na: What?

Bo: She told me that the doctor said she should stop eating rice. And no fried food, and no sweets! She doesn’t want to do it, though. She says it’s too hard, and she just wants to eat like she did back in Laos.

Gao Na: I would be the same way. That’s ridiculous… no rice? What kind of doctor tells a Hmong person she can’t eat rice?

Bo: You’re right, I guess. Maybe the doctor is right too, but it’s not easy to argue with your mother-in-law!

Please answer the following questions:

In the scene between Kia Si Moua and Pa Foua, they are discussing Pa Foua’s weight loss. Do the methods Pa Foua describes represent a treatment or wellness model with regards to her concerns about diabetes? Why?

Your response:
This question has not been answered yet.

Feedback: Pa Fuoa’s approach to eating better would be considered a wellness model approach. She is attempting to improve her overall quality of health, through her dietary choices. Preventing the development of diabetes and losing weights are positive outcomes of this wellness approach.

A Family Dinner

Biostatistics tell us that although diabetes is a risk for many Americans, it’s more of a risk for people of Latino descent. While the rate of diabetes in non-Hispanic whites is 10.2%, the rate of diabetes in the Latino community is approximately 16.9% (ADA, 2014). As the Arroyo family finishes up a family dinner, we can see that preventing and managing diabetes can be difficult for cultural and behavioral reasons.

Rosa: Who wants more buñuelos? I don’t want to take any leftovers home.

Ricardo: I would be happy to help out with that chore!

Regina: That’s a first!

Rosa: Pilar, more for you?

Pilar: No, I shouldn’t have had the ones I did already. My sugars are going to be crazy, I know.

Rosa: Are you still having trouble with that? I thought the doctors gave you medicine for the diabetes?

Regina: It isn’t that easy, Rosa… if you have diabetes, you have to pay attention to it every day for the rest of your life. There’s no magic pill.

Pilar: It’s true. And it’s too bad… your buñuelos are very good.

Victor: Pilar, how have you been doing with managing your diabetes?

Pilar: Eh… it’s hard for an old woman like me. I go to the clinic like they tell me, but every time I go in, it’s new nurses, new doctors and I have to tell my whole life story one more time.

Regina: But don’t they give you any help with what you’re supposed to do?

Pilar: Sure, sure… they have lots of advice. Lose weight. Exercise. Don’t eat so much fat. It’s easy for them to give me the advice but not so easy for me to take it. I’m an old woman… I can’t change everything all at once.

Regina: I know… it’s very hard. My doctor tells me I have to start making changes or I will get diabetes myself.

Ricardo: I didn’t know that… is that why you have been dieting all of a sudden?

Regina: Yes, I’m taking it very seriously. I even got a new cookbook and have been cooking a lot of new things. My aunt had a terrible time with diabetes. It was very bad for her—her vision went bad and she even lost a leg.

Pilar: Dios mio! Can we talk about something else, please?

Regina: Oh, Pilar! I didn’t mean to upset you. That won’t happen to you. I’ll even come over and cook for you myself!

Pilar: You can do that anytime — I like your cooking! Maybe I’d even like your healthy cooking!

Ricardo: Maybe that’s what we need. A dinner club! Rosa, maybe you could start cooking the way Pilar’s doctor says she should. We’ll have a dinner once a week and everybody will go home with leftovers!

Please answer the following questions:

Think back to the diabetes struggles and the cultural dimensions that may be impacting some of those struggles in this scene. What is one treatment model and one wellness model approach that you could apply to help improve the health of the individuals in this scene?

Your response:
This question has not been answered yet.

Feedback: There is no one right answer to this question.

An example of a wellness model strategy could be an educational outreach program that focuses on teaching people how to shop for healthy foods in an economic way. This is a wellness model approach because a healthier diet will not only help with type 2 diabetes, but also the general health of the person.

An example of a treatment model would be to prescribe a medication, such as Glucophage or other appropriate drug, to treat and control blood sugar levels in type 2 diabetes patients.


Conclusion: Activity complete!

How could patient-provider collaboration improve the health and wellness of the individuals and groups you saw in this activity?

Create a 3-5-page report presenting three or more specific high-priority health improvement needs in a community of your choosing.


Each of us belongs to multiple populations: our neighborhood community, workplace, family, and so on. In the workplace, employers recognize the positive benefits of a healthy lifestyle such as reduced absenteeism, improved productivity, and fewer health insurance claims. In the community, health care organizations, community health centers, health districts, and other key stakeholders promote wellness and a healthy lifestyle in hopes to improve the overall health of the community. Reducing obesity, the harmful effects of smoking, drug, and alcohol use, or the transmission of HIV may be the focus of community-wide health initiatives. Overall improvements in health status across a given population are an important goal of politicians, legislators, employers, and community leaders.

The Affordable Care Act (ACA) has emphasized the importance of these initiatives, and health care leaders are tasked with building cultures of health and wellness for their communities (Nash, Fabius, Skoufalos, & Clarke, 2016). Population health initiatives have been widely impacted since the passage of the law as new programs are introduced to achieve the key objectives. These programs have evolved from a focus on a single illness to more robust, comprehensive interventions that seek to improve the overall health of the population (Nash, Fabius, Skoufalos, & Clarke, 2016). Collaborative efforts between health care providers, politicians, and community organizations are beginning to form as stakeholders recognize the wide variety of services necessary to treat an entire population (Nash, Fabius, Skoufalos, & Clarke, 2016).

At the highest level, the United States Congress and the U.S. Department of Health and Human Services (HHS) establish health care policy while individual health care workers are tasked with implementation at the lowest level. As of this writing, the Trump administration is making efforts to repeal and replace the Affordable Care Act. Although the new administration indicates that it has many of the same goals and objectives of improving population health as the previous administration, the far-reaching effects and final policies remain unknown.

An important concept in community and population health is epidemiology, which is defined as the study of the distribution and determinants (causes and risk factors) of health-related states and events in specified populations (CDC, 2017). It is a method used to find the causes of health outcomes and diseases in populations (CDC, 2017). Public health announcements, such as news of flu outbreaks, are based on epidemiology studies. Epidemiology is an important part of public health, as it helps to identify specific risk factors for diseases to improve preventative healthcare outcomes. Epidemiology is data driven and quantitative in design (CDC, 2017). It relies on sound research, as it tests hypotheses grounded in biology, behavioral sciences, and physics (CDC, 2017). Epidemiological studies can cover a wide variety of public health concerns including smoking, obesity, maternal health, HIV, influenza, vaccine use, and outcomes.


Centers for Disease Control and Prevention. (2016). What is epidemiology? Retrieved from https://www.cdc.gov/careerpaths/k12teacherroadmap/epidemiology.html

Nash, D. B., Fabius, R. J., Skoufalos, A., & Clarke, J. L. (2016).
 Population health: Creating a culture of wellness (2nd ed.). Burlington, MA: Jones & Bartlett Learning.

Demonstration of Proficiency

By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

· Competency 1: Integrate principles of epidemiology, population health, and community engagement to plan interventions.

. Identify salient characteristics that define a community.

. Assess engagement of community stakeholders.

. Identify specific health improvement needs of a community by using epidemiological information.

· Competency 2: Differentiate and evaluate evidence-based treatment models and prevention models designed to promote wellness and disease management for population health.

. Evaluate a treatment model and a wellness model.

· Competency 4: Communicate in a manner that is scholarly, professional, and respectful of the diversity, dignity, and integrity of others and is consistent with expectations for health care professionals.

. Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.

. Write following APA style for in-text citation, quotes, and references.

Note: It is recommended that you complete the assessments in this course in the order they are presented.


For this assessment, you will be discussing high-priority health improvement needs in a community of your choice. These needs could relate to any number of areas related to the health of populations in the community. Some examples for potential areas include nutrition, smoking, diabetes management, drug use, or other concerns.

To prepare for this assessment, it is recommended you complete the following:

· Use the Internet to locate a health needs assessment for your local community and explore websites with a .gov, .org, or .edu extension. You may find multiple community needs assessments depending on where you live.

. Feel free to download several reports and compare them; you may find it interesting to review both similarities and inconsistencies among the reports.

· Identify the salient characteristics of your community, such as geography and demographics. Also, identify qualitative information that characterizes the community, such as common perspectives and interests or other bases of social ties. Information of this kind may be provided in the community needs assessment, or you may cite it from other sources.

· Conduct a second search for epidemiology trends in your community focusing on government, nonprofit, and educational Web sites. You may find multiple sources depending on where you live.

. Are the trends identified in the epidemiology reports consistent with the needs identified in the community needs assessments you read?

· Use the information you have gathered to identify three, specific, high-priority health improvement needs of your community.

· Assess how government, community agencies, and other stakeholders are currently addressing each problem.

. Refer to the 


 on the Trust for America’s Health website, for potential solutions.

· Complete the Vila Health: Community Health Mission and included questions to develop your knowledge around best-practices in researching population health data and applying models.


Based on the community needs assessment and your research, write a 3–5-page report discussing three or more specific high-priority health improvement needs in your community. As mentioned above, these could relate to nutrition, smoking, diabetes management, drug use, or other concerns. The goal of your report is to describe the needs of the community and how the community is currently addressing them.

Consult the scoring guide to ensure you address all criteria at the level you desire.

Include the following in your report:

· Identify salient characteristics that define a community.

. These characteristics include considerations such as geography, demographics, and qualitative information that characterizes the community, such as common perspectives and interests, or other bases of social ties.

· Identify specific health improvement needs of a community by using epidemiological information.

. Be sure to identify three, specific, high-priority health improvement needs of your community.

. Support your choices by citing epidemiological information from your research.

· Assess the current engagement of community stakeholders.

. Stakeholders could include government, community agencies, private citizens, and health care organizations.

. These stakeholders may be involved in programs to address your identified health improvement needs or may be directly impacted by them.  

. How are these stakeholders involved or impacted by your identified health improvement needs?

· Describe treatment or wellness models that address an identified community health need.

· Identify treatment or wellness models that are currently being used to address at least one of the high-priority health improvement needs of your community.

· Describe these strategies or approaches currently being used.

· Examine each strategy to determine if it is based on a treatment model or a wellness model.

. How you can determine which kind of strategy is employed?

. Note: You must identify at least one strategy based on a treatment model and one based on a wellness model. This may require you to look at more than one of your identified community health improvement needs. Also, it is possible you may need to do more research to meet this requirement.

· Briefly discuss general advantages and disadvantages of treatment models versus wellness models from these examples.

Additional Requirements

· Written communication: Ensure writing is clear and well organized to support orderly exposition of content, with correct spelling, grammar, and syntax.

· Length: Submit 3–5 typed and double-spaced content pages set in Times New Roman, 12 points, not including title page and reference page.

· References: Cite at least three current scholarly or professional resources.

· APA formatting: Use APA style for references and citations. You may wish to refer to the following APA resources to help with your structure, formatting, and style:


APA Style Paper Tutorial [DOCX]



APA Style Paper Template [DOCX]


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