This post is a more refined version of " A Socio-Ecological Approach to Renal Failure" found here to satisfy the requirements of assignment two for the MHST601 course through Athabasca University.
An Overview of Health and Its Determinants
The understanding of health has evolved into a multi-factorial concept. It is a concept influenced by several determinants such as; the social and economic environment, the physical environment, and the person’s individual characteristics and behaviours (World Health Organization, n.d.).
 |
| (Social Ecological Model of Public Health, n.d.) |
- Microsystem- including direct interpersonal relationships
- Exosystem- includes the community and physical environment
- Macrosystem- including society, organizational and policy change.
 |
| ("Management of Chronic Kidney Disease (CKD)", 2018) |
Chronic kidney disease is
defined as the presence of kidney damage or reduced kidney function for more
than 3 months and requires either a measured or estimated glomerular filtration
rate (eGFR) of less than 60 mL/min per 1.73 m2, or the presence of abnormalities
in urine sediment, renal imaging or biopsy results.1 Between 1.3 million and
2.9 million Canadians are estimated to have chronic kidney disease, based on an
extrapolation of the prevalence of end-stage renal disease. (Arora et al.,
2013, para.1)
According to an online
document found through the Kidney Foundation of Canada, kidney disease is
difficult to detect because there are few symptoms. Age and gender, along with
a simple blood test, can determine valuable information about one’s kidney function.
Individuals at risk include:
-Those who suffer from diabetes or hypertension
-People over the age of 55
-Certain ethnic groups such as First Nations, Hispanic, African American, Asian and Pacific Islanders. (Aguzzi, n.d.)
-Those who suffer from diabetes or hypertension
-People over the age of 55
-Certain ethnic groups such as First Nations, Hispanic, African American, Asian and Pacific Islanders. (Aguzzi, n.d.)
The above-mentioned list
indicates a higher prevalence of this disease that are largely based on
presence of previously existing diseases, individual differences and
socio-economic status. The document further explains how persons may attempt to
reduce their risk factors against this incurable disease.
Social
Epidemiology and Influences of Health
“Social epidemiology is
the study of how social factors contribute to health and disease over a period
of time” (McGill University, Faculty of Medicine, n.d.).
Spheres of Influence and
socio-ecological models have long been used in economics, politics,
international relations and health to determine how interrelations amongst a
person and their physical and socio-economic environment can have particular
outcomes.
Table 1. A
Description of Social Ecological Model (SEM) Levels.
SEM Level
|
Description
|
Individual
|
· Characteristics
of an individual that influence behaviour change, including knowledge,
attitudes, behavior, self-efficacy, developmental history, gender, age,
religious identity, racial/ethnic identity, sexual orientation, economic
status, financial resources, values, goals, expectations, literacy, stigma,
and others.
|
Interpersonal
|
· Formal
(and informal) social networks and social support systems that can influence
individual behaviours, including family, friends, peers, co-workers,
religious networks, customs or traditions.
|
Community
|
· Relationships
among organizations, institutions, and informational networks within defined
boundaries, including the built environment (e.g., parks), village
associations, community leaders, businesses, and transportation.
|
Organizational
|
· Organizations
or social institutions with rules and regulations for operations that affect
how, or how well, for example, MNCH services are provided to an individual or
group.
|
Policy/Enabling
Environment
|
· Local,
state, national and global laws and policies, including policies regarding
the allocation of resources for maternal, newborn, and child health and
access to healthcare services, restrictive policies (e.g., high fees or taxes
for health services), or lack of policies that require childhood immunizations.
|
(UNICEF, 2014)
Using the
Bronfenbrenner’s Ecological Systems Theory (The Psychology Notes Headquarters,
2013), these can further be placed into three main systems beyond the
individual level.
These systems may be
applied to assess persons living with CKD.
The Individual
Unless a patient has some
medical knowledge, a new diagnosis of CKD may be very foreign to that
person. Patients newly diagnosed with CKD will have questions about how
the kidneys work and, even at the early stages, often fear that they will need
to begin dialysis soon. In the early stages, educate the patient and family
about what happens in CKD and the strategies that can slow its progression.
("Management of Chronic Kidney Disease (CKD)", 2018)
A person’s knowledge
about the disease, awareness of their disease progression and ease of access to
renal health services are all factors that contribute to the decision-making
process for that patient.
A multidisciplinary team
of clinical experts from SelectHealth and Intermountain Healthcare created a
diagram that outlined some of the many care related decisions that a patient
may have to make. They may also choose to seek advice and suggestions from
family members and friends which incorporates the ‘Interpersonal’ level
of influence on an individual.
Interpersonal Relationships
During illness and times
of need, it is normal for a person to seek support and comfort from their
family and friends with spouses and children often having direct involvement in
a patient’s care. Persons with CKD may decide on which facility (or particular
times and dates) to receive dialysis and other treatment based on the
availability of their family members to escort them.
Social relationships,
such as those found in close families, have been demonstrated to decrease the
likelihood of the onset of chronic disease, disability, mental illness, and
death… Prospective cohort studies have confirmed the direct beneficial
effects of various forms of social support on global mental health, incidence
of depressive symptoms, recovery from a unipolar depressive episode,
psychologic distress, psychologic strain, physical symptoms and all-causes of
mortality. (Unite For Sight, n.d.)
Though overall,
interpersonal relationships for persons with a chronic disease such as CKD are
beneficial, they can be harmful to the patient as well. A patient may choose
treatments according to the requests of their families vs. a treatment they
would prefer to undergo, or one recommended by their physician. A person may
miss appointments due to a family member or friend not being able to provide
transportation and/or support. Additionally, persons experiencing stress due to
family issues (such as a divorce) may worsen their health.
“Problematic and
non-supportive familial interactions have a negative impact on health. There is
increasing evidence that poor-quality relationships can actually harm physical
and mental health." (Unite For Sight, n.d.)
Community
A person’s physical and
cultural environment (including acceptable social norms) play a role in a
person’s health. Within a community, adequate health care services such as
hospitals or clinics for diagnostic testing, pharmacies, as well as dialysis
services prove to be critical in the management of CKD.
Overall, the studies in
this section show a clear connection between neighborhood factors (such as
housing access and quality, exposure to environmental toxins, access to grocery
stores and recreation centers, and community social relationships) and health
outcomes (such as asthma, heart disease, depression, self-reported health, and
mortality). (Flournoy & Yen, 2004)
Dialysis (particularly
hemodialysis) remains the key treatment in the management of CKD, however, as
there is no cure, it is a life-long treatment option. Persons normally require
dialysis three times a week which therefore means, they need available and
affordable transportation to receive this service. "On average about
29% of Canadians who required health care reported difficulty accessing these
services" (Clarke, 2016).
Relating to the
Interpersonal level, if a patient does not have a family member or friend
available to take them, it can increase their likelihood of missing
appointments due to their living in a more rural area, high cost of public
transportation (twice a day, three times a week), being too weak to walk the
distance or a lack of provided transportation for patients by the healthcare
facility.
Organization and Society
Health institutions and
healthcare policies indirectly influence a person with CKD. The Registered
Nurses Association of Ontario (RNAO) published a best practise guideline with
this purpose:
To help nurses recognize
patients with CKD experiencing decisional conflict related to situations in
which there is more than one option available for managing their condition. To
help nurses support patient involvement in reaching quality health decisions.
Quality decisions are made using the best available evidence about the options
and are consistent with the patients’ values. (RNAO, 2009, p.7)
Guidelines such as these
help to provide training and evaluation for nurses who care for patients with
CKD and improve overall patient care.
Organizational,
provincial and local government policies in regard to healthcare in a province
or city can determine ambulance availabilities, wait times and staff
scheduling. According to Nicholas, Kalantar-Zadeh & Norris (2015),
“Increased awareness of social and environmental factors that contribute to CKD
disparities must be followed by cost effective policies to improve CKD/ESRD
prevention and care, especially in the setting of increasing diversity and
increasing disparities in wealth and educational attainment."
Adaptations of the socio-ecological
model incorporates not only the determinants of health but provides an overview
of the inter-relation of several health influences as they apply to a
particular population, context or disease. We can only gain better
understanding after exploring the connections between them.
References
Aguzzi,
I. (n.d.). Kidney Disease: Quick Facts and Stats. Retrieved from https://www.kidney.ca/document.doc?id=620&erid=0
Arora,
P., Vasa, P., Brenner, D., Iglar, K., McFarlane, P., Morrison, H., &
Badawi, A. (2013). Prevalence estimates of chronic kidney disease in Canada:
results of a nationally representative survey. Canadian Medical Association
Journal, 185(9), E417-E423. doi: 10.1503/cmaj.120833
Carleton
University. (n.d.). Social Ecological Model of Public Health. [Image].
Retrieved from https://apps.carleton.edu/ccce/issue/health/public-health-in-practice/?module_api=image_detail&module_identifier=module_identifier-mcla-ImageSidebarModule-mloc-sidebar-mpar-da9af63edc444779df2c954dfc8d4d40&image_id=1286677
Clarke,
J. (2016). Difficulty accessing health care services in Canada. Retrieved from
https://www150.statcan.gc.ca/n1/pub/82-624-x/2016001/article/14683-eng.htm
Flournoy,
R., & Yen, I. (2004). The Influence of Community Factors on Health.
Retrieved from https://www.policylink.org/sites/default/files/ANNOTATEDBIBLIOGRAPHY_FINAL.PDF
Management
of Chronic Kidney Disease (CKD). (2018). Retrieved
from https://intermountainhealthcare.org/ext/Dcmnt?ncid=521395847
McGill
University, Faculty of Medicine. Social Epidemiology. Retrieved from https://www.mcgill.ca/epi-biostat-occh/research-0/social-epidemiology
Nicholas,
S., Kalantar-Zadeh, K., & Norris, K. (2015). Socioeconomic Disparities in
Chronic Kidney Disease. Advances In Chronic Kidney Disease, 22(1),
6-15. doi: 10.1053/j.ackd.2014.07.002
The
Psychology Notes Headquarters. (2013). What is Bronfenbrenner’s Ecological
Systems Theory?. Retrieved from https://www.psychologynoteshq.com/bronfenbrenner-ecological-theory/
UNICEF.
What are the Social Ecological Model (SEM), Communication for Development
(C4D)?. (2014). Retrieved from https://www.unicef.org/cbsc/files/Module_1_-_MNCHN_C4D_Guide.docx
Unite
For Sight (n.d.). Family Dynamics and Health. Retrieved from http://www.uniteforsight.org/gender-power/module1
World
Health Organization. (n.d.). The determinants of health. Retrieved from http://www.who.int/hia/evidence/doh/en/
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