Modeling Health Disparities and Outcomes in Disenfranchised Populations

Abstract

The Health Disparities and Outcomes (HDO) model originally created to explain the complexity of obtaining healthcare in rural settings has been revised and updated using emerging theoretical models of adversity and inequity and two decades of empirical work by the authors. With a strong orientation to explaining population-based health inequities, the HDO is applied to individuals with Serious Mental Illness (SMI), to explain their high rates of morbidity and mortality compared to the general population. Individual-, community-, and system-level factors that reflect an understanding of life-long risk, accrued hazards associated with multiple and intersecting disadvantages, and difficulty obtaining healthcare that meets accepted standards are described. The revised HDO can be applied to populations with disproportionate health challenges to identify multi-level factors that affect illness trajectory and overall health outcomes.

Self-Care Capacity and Its Relationship to Age, Disability, and Perceived Well-Being in Medicare Beneficiaries

“…The current findings support the HDO model's expanded definition of self-care by demonstrating how perceived health is uniquely tied to different elements of self-care capacity such as health literacy, self-care agency, and related health choices (Hauenstein et al, 2019). As considered in the HDO, individual characteristics, like educational status, also predicted perceptions of health.…”

“…The current study is part of a multisite research study funded by the National Institute on Minority Health and Health Disparities to determine factors associated with longitudinal morbidity and mortality trajectories observed in Medicare beneficiaries. Using data from the 2013 MCBS (CMS, 2013) and logistic regression models (Long & Freese, 2014), we determined associations between self-care capacity, including indicators of self-care ability, self-care agency and health behaviors, and their relationships to the two health perception outcomes described earlier, within domains of functioning (Medicare eligibility types: physical, mental, both physical and mental health disability without determination of the primary disabling condition, and age [65+ years]), using the definitions and multilevel associations described in the HDO model (Hauenstein et al, 2019). This study builds on previous studies in Medicare and other populations where self-care ability was represented by incremental gradients of diminished capacity in completing ADLs and IADLs considered as indicators of disability severity (Kurichi et al, 2016;Stineman et al, 2012Stineman et al, , 2014.…”

“…The HDO also includes individual, environmental, and other contextual factors that affect individual capacity to engage in self-care (Hauenstein et al, 2019;Stineman et al, 2012). Personal beliefs and values can minimize the effects of ADL and/or IADL limitations, salutary physical attributes of the immediate or neighborhood environment, and social structures and practices prevalent in the individual's family and social group (Barrett, 2015;Bird & Rieker, 2008;Gharaibeh et al, 2016;Schmutte et al, 2009).…”

“…Self-care capacity, the cornerstone of health, is the combined intent and ability to act on behalf of self to ensure physical and emotional well-being (Çiftçi et al, 2015; Gharaibeh et al, 2016; Hauenstein et al, 2019; Orem et al, 2001; Souza, 2002). Self-care ability, requisite knowledge, and structural and functional capability to act are key elements of overall self-care capacity (Adams, 2010; Hauenstein et al, 2019; Raynor, 2012).…”

Promoting resilience in persons with serious mental health conditions during the Coronavirus pandemic.

“…A significant number of these individuals, particularly those from a relatively low social class background, with low literacy levels, and limited social support, lack familiarity with key disease prevention self-care (e.g., physical distancing, hand washing, mask wearing), which in turn may increase their risk of contracting COVID-19 (Muruganandam et al, 2020). Persons with serious mental health conditions also are at increased risk for contracting COVID-19 and experiencing adverse health outcomes, given their disproportionate rates of medical comorbidities (e.g., asthma, obesity) and health behavior practices (e.g., smoking, substance misuse) associated with COVID-19 medical complications (Druss, 2020; Hauenstein et al, 2019; Novak et al, 2021; Wang et al, 2021).…”