Integrating Health and Wellness Programs in Low-Income Communities

Free «Integrating Health and Wellness Programs in Low-Income Communities» Essay Sample


Low-income communities experience sufficient disparities within multiple dimensions of social life, especially in terms of health-related concerns and opportunities to get the appropriate treatment. For instance, Mukherjee (2013) has identified a number of determinants of poor health in this category of general population. First, the issue is caused by the fact of unhealthy diet, whereas low-income individuals, working at part-time or low-paid jobs, cannot afford buying healthy food (Mukherjee, 2013). The scholars from the Food Research and Action Center (FRAC) (2010) have emphasized on the same risk factor along with a threat of food deprivation multiplied with frequent overeating for the future, so to speak. Moreover, low-income people are among the primary target market segments for obesity-provoking foods (FRAC, 2010). Such a circumstance negatively affects human health at large, and, besides obesity, can lead to other chronic diseases. Second, poor individuals are more likely to have harmful habits, such as smoking or other types of abuse (Mukherjee, 2013), as well as low-level of physical activity. Third, low-income communities mostly inhabit poor regions with low-quality living and environmental conditions, especially air quality, and experience high-degree stress, as a result (Mukherjee, 2013; FRAC, 2010). These conditions negatively impact both physical and mental health of individuals. Fourth, low-income communities have a limited access to primary healthcare provision, or this care delivery is usually of lower quality, as compared to the services offered to richer population (Mukherjee, 2013; FRAC, 2010).

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Regardless of that, the problem is acute and should be addressed from different perspectives, such as increasing overall quality of life for the target population, moreover, the issue of health education can greatly facilitate finding a win-win solution in this case. However, approaching the problem has to be thorough and holistic. On the one hand, one has to study the problem in-depth, given the evidence collected in scholarly research. In this way, argumentation of the issue, its background, and justification to possible interventions can be discovered. On the other hand, these findings will become a sufficient background for the development of a well-thought-out health education and wellness program, aimed at the betterment of general health of low-income individuals. The two identified paradigms are the centerpiece of the paper, which are further articulated and explicitly highlighted.

Literature Review

To start with, contemporary researchers have paid substantial attention to the issue of health disparities among low-incomers and specified ways to address the problem. Majorly, scholars discussed the narrowed aspects of the introduced research paradigm. This way, the obtained findings mostly supplement and add clarifications to one another, allowing broader and more in-depth coverage of the identified topic. Therefore, the review considers how the current academic research has presented an opportunity of effective integration of health and wellness programs in low-income communities, in accordance with the thematic classification of the obtained findings. Specifically, the paper structures the findings in accordance with three main research paradigms: (a) partnerships in addressing the issue; (b) worldview, as a primary determinant of change process; and (c) technological tools as mediators.


One of the key themes identified in the scope of the literature review was a necessity of arrangement of partnerships as a way to “go beyond the doctor’s office and into patients’ homes and communities” (Han et al., 2015, p. 1). Although Han et al. (2015) have not explored low-income population specifically, the factor of partnering with relevant stakeholders seems more than evident. In particular, the scholars have emphasized a critical role of organizations that are aimed to provide population-centered care with an accent made on the maximization of outcomes, rather than their volume (Han et al., 2015). Such an approach requires engagement and empowerment of a patient in the process of care delivery and recognition of social driving forces of health. It follows that the proposed framework clearly specifies a need for social equality as a way to balance health of individuals, in case it is not individual, but a social concept. The organizations that are community-based and target “coordinated” and “culturally tailored services” to be delivered, especially with relation to older adults, can be the most effective organizational modes with the most favorable outcomes’ maximization results for communities at large. A similar research implication is linked to a study by Fitzpatrick, Butler, Pitsikoulis, Smith, and Walden (2014). Apart from the community-oriented care with maximized outcomes, the researchers have stressed on specific importance of “sharing responsibility of treating a group of patients” between organizations that are accountable before communities, such as healthcare providers (Fitzpatrick et al., 2014, p. 93).

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The social character of human health was also identified as vital in overall health restoration and betterment with regard to the target population, in accordance with the findings by Bostic, Thornton, Rudd, and Sternthal (2012). The researchers have clearly distinguished an utmost goal of maintenance of a “health in all policies approach” as a great way to ensure not fragmented but thorough social health and well-being to the intended population. For instance, a specific significance was attributed to the issue of housing and spatial planning in terms of development of appropriate living conditions for the target audience. The results of this study resonated with the health risk factors identified by Mukherjee (2013) and FRAC (2010), which were enlisted and briefly overviewed earlier, explicitly highlighting the relevance of these aspects. Moreover, Erikson and Andrews (2011) have further expanded the scope of partnerships and referred to neighborhoods as one of the critical success factors in achieving holistic accessibility to quality care programs by low-income populations. To be more precise, the scholars have asserted “a strong potential for cross-sector collaborations to reduce health disparities and slow the growth of healthcare spending, while, at the same time, improving economic and social well-being in America’s most disadvantaged communities” (Erikson & Andrews, 2011, p. 2056). The factor of health-centered patient education and wellness promotion has been emphasized as vital in this respect.

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While low-income families face sufficient financial challenges, as noted earlier, an opportunity to improve health and well-being of the identified population group through employers and worksites at large should be taken into account. This aspect was carefully explored by Baron et al. (2014). The scholars have found that low-income workers encounter such difficulties, as compared to higher-income staff, as “lower life expectancy rate,” “greater chronic disease” vulnerability, and “hazards at the workplace and their communities,” to list a few (Baron et al., 2014, p. 539). In this respect, workplaces should become primary sites of establishment and maintenance of employee and community-wide wellness and well-being. Harris, Hannon, Beresford, Linnan, and McLennan (2014) have analyzed how small workplaces, namely, firms involving less than 1,000 employees, can contribute to improvement of their staff’s wellness and increase the rates of harmful habits, such as smoking and unhealthy diet. The aforementioned stakeholders in health promotion and wellness, including specified organizations, healthcare providers, and government agencies, emphasize on the socio-ecological approach to low-incomers’ health betterment. The procedure implies a reference to individual, organizational, interpersonal, community-based and policy-centered domains. In contrast, workplace involvement in the process should be seemingly limited to the organizational level. Simultaneously, the scholars ascertain that the above described programs are likely to address the multiple levels of the socio-ecological model at once (Harris et al., 2014). Smaller working sites are of particular interest in the given context because they more frequently employ low-income professionals, which is the central population target group. In accordance with this exploration, the percentage of low-wage workers comprises of 60% and above (Harris et al., 2014). Table 1 is a summary of how employers contribute to specified aspects of their employees’ health and wellness. In this regard, employers can also be considered sufficient actors in addressing healthcare-related needs of low-income population.

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What is more, Anderko et al. (2012), have proposed that they can expand the scope of employee wellness further than implementation of a single program, reaching a particular aspect of their health, such as smoking cessation (see Table 1). On the contrary, well-thought-out workplace-focused wellness projects may thoroughly change the entire lifestyles of staff members and transform organizations into cultures of health, thereby extending their potential impact on whole communities (Anderko et al., 2012). Whereas each employee in the organization has a family, the aforementioned connection can transit gained healthy lifestyle skills and knowledge to other family members. In this respect, Drummond et al. (2014) have asserted that “a consistent relation exists between family socioeconomic status and engagement/ retention rate of families in health, social, educational, leisure and cultural activities” (p. 2). Properly managed and positioned workplace-related wellness and health improvement aspirations will result in the betterment of psychological and mental health condition of employees, their families and communities.

Finally, researchers have also identified and rationalized a number of direct implementers of health and wellness frameworks for the target audience. To illustrate, Peek, Ferguson, Bergeron, Maltby, and Chin (2014) have emphasized on the importance of community health workers (CHWs) in low-incomers’ health education, given the example of addressing diabetes concerns. These are individuals capable to develop trustworthy, friendly and, thus, productive relationships with the intended population, involving “patients, peers of patients, and other lay community members” who are specifically trained in order to educate the target audience (Peek et al., 2014, p. 467). Such a method is likely to facilitate the change process. This is due to the fact that identified individuals are already in a trustworthy connection with the population segment in question. Therefore, the educational process will be smoother, friendlier and, hence, with a high-level likelihood of achievement of the projected outcomes. Regardless of that, the aforementioned research was aimed at diabetes-oriented education of the population, the framework can work out for health education of low-incomers as a target audience. The key role will be played by the previously described mechanism of the educational procedure.

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Approaching through the Worldview

Any change is impossible without transformation of the mindset of the target audience, as a core to successful problem solution. In this case, development of appropriate worldview on the issue in question seems relevant. Drawing upon a definition by Tilburt (2010), a worldview should be referred to as a set of “beliefs and assumptions that express how cultures interpret and explain their experience” (p. 178). Undoubtedly, cultural norms and misconceptions, prejudices and stereotypes as elements of any worldview substantially effect perception of health as such and insights in terms of its accessibility within social constraints. Based on the fact that life, health and well-being of low-income individuals is greatly stereotype- and prejudice-driven, this component of change process should be regarded as vital for positive outcomes in future.

Nonetheless, one should be able to choose appropriate means to effectively change the mindset of target population segment and develop an appropriate positive worldview and attitudes. In particular, an interesting approach has been proposed by Johnson and Pelser (2012) who have emphasized on a key role of religious guidelines, specifically, Christianity, in this respect, with an accent made on positive emotions in the process. To illustrate, the scholars have succinctly stated that, “it is sometimes permissible and even quite appropriate to mock, ridicule, satirize, and otherwise make fun of people for holding obviously false beliefs” by means of evoking emotions, including “amusement, embarrassment, guilt” (Johnson & Pelser, 2012). The researchers have reasoned over the central role of self-recognition and self-understanding of a variety of misbelieves which individuals may discover within their personal worldviews, as a result. On the next phase of a procedure of self-initiated worldview change, the analysts have referred to an existing religious worldview, Christianity, as a vivid example of a successful rationale to be persuaded in credibility of the above assumptions. To be more precise, Johnson and Pelser (2012) have aptly noted that, “Our ability to believe and act for reasons – our possession of rational intellect and will – is one of the primary ways that we bear the image of God; when we act and believe rationally (i.e., for the right reasons), we glorify Him by reflecting his perfect rationality.”  Such an approach can become a notable stance for justification and directing of the individuals in a lifestyle change and education process.

Technologies as Mediators

An important research domain of technological implications should not be underestimated by both researchers and practitioners. Modern population is substantially technology-driven despite the age, though youth and adult generations are among the most frequent online users. Hence, this factor can be used as a valuable source of healthcare education and interventions, if implemented properly. For instance, Nollen et al. (2013) have provided an interesting insight into how technology use may be helpful when sophisticatedly incorporated in health promotion and education strategy. The scholars have asserted that “mobile technologies hold promise for improving diet and physical activity” and developed a personal digital assistant program targeting young girls (Nollen et al., 2013, p. 249). The main purpose was to encourage fruit and vegetable intake among youth population that is one of the serious risk factors for developing chronic diseases, if overlooked, as it was indicated earlier. While the research sample involved African American females, the problem is relevant, and an approach can be justified with respect to any other low-income minority or mainstream group. Drawing upon the statistics revealed in the study, approximately 93-95% of young individuals use online social networks for communication and socialization activities (Nollen et al., 2013). Hence, the Internet-mediated education strategy was evidenced to be an effective tool for reaching this target audience in terms of “goal setting, self-monitoring, personalized feedback, and acquisition of behavior change skills” as more effective means, as compared to traditional health education techniques (Nollan et al., 2011, p. 250).

Research Summary and Application Prospects

In accordance with the findings of literature review, several important points can be identified, asserting both the relevance and topicality of the issue and availability of the theorized and practical evidence to develop a potentially successful health education framework. First, while health of low-income individuals is dependent on a number of intertwined characteristics and factors, any strategy created to address the situation should be complex. Of course, a nurse or another healthcare practitioner cannot provide improved or proper living conditions to a low-incomer. At the same time, one can increase his/her awareness on the issue among the representatives of the target audience or refer to relevant stakeholders, such as business and public organizations, with a request for mutually-beneficial partnership for common good.

The above assumption regarding partnering different stakeholders is not bold. In contrast, the studies by Baron et al. (2013), Bostic et al. (2012), Erikson and Andrews (2011) among others have clearly demonstrated that such frameworks are applicable and effective. Therefore, the reviewed evidence-based-practice explorations can serve as valuable patterns of the good examples to follow in order to address the issue. In light of educational program development, these studies may be used as case study scenarios or frameworks for analytic assignments and decision-making. Simultaneously, these can be used as means for the development of critical thinking skills. Namely, the resources are useful for gaining evidence-guided understanding of pathways of implementing a change. However, each of the researches can be critically evaluated, in order to determine which flaws were omitted by the authors, which shortcomings may exist in scope of research design and procedure. These actions should be performed in order to make sure that the results are not blindly replicated but thoroughly adopted to particular circumstances of each low-income community.

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What is more, the aforementioned aspect of the issue is important in terms of an opportunity to organize guest lectures in the context of specifically developed curriculum for these purposes. To be more precise, one may use the review results as a hint of searching for real-life implementers of either narrowed or broadened programs, aimed at wellness and healthy lifestyle promotion among low-income communities. As a result, learners will be likely to observe the real-life cases of successful outcomes of stories to learn from these strategies. On the contrary, the negative experiences will also be good samples to consider. In this way, they will be able to identify omissions in organizational strategies or partnership initiatives in order to adjust them accordingly and address the problem in an efficient and effective manner.

Third, drawing upon the research reviewed in the paper, one will be enabled with a possibility to develop a specified and comprehensive theoretical foundation of the whole project. In particular, the majority of studies have chosen a socio-ecological paradigm as a centerpiece to be taken into account in this respect. In this context, the target audience will be taught within such a multidimensional framework, involving increasing awareness not only regarding health alone, but also its critical constituents. This approach is more than justified, since low-income population does not live isolated. In contrast, social and ecological, along with economic implications are the pillars determining their all-embracing well-being. While the above theoretical background implies a complexity of the educational program, it will be a holistic framework with maximized learning outcomes, as argued above.


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