The Meaning of Health to the Low-Income Patients in a Primary Care Center

Brief communication 267 THE MEANING OF HEALTH TO THE LOW-INCOME PATIENTS IN A PRIMARY CARE CENTER Health behaviors account for more than 50 percent of the variability seen in mortality and morbidity rates in Americans. In addition, previous research has found a strong correlation between low income and high mortality and morbidity. Because a majority of nurse practitioners work with lowincome families, nurse practitioners have an opportunity to improve this population's health by facilitating change in health behaviors. To accomplish this goal, information is needed about the ways in which low-income families view health and health-promoting behaviors. This article describes a study in which a focus group interview was used to explore how low-income clients who use a nurse-practitioner-managed clinic describe personal health behavioral characteristics and perceptions of health. Research suggests that low socioeconomic status is associated with poor health, and some authors have suggested that low-income functions as a key health hazard. They further note that it is often associated with other health hazards such as substandard housing, pollution, and poor social support systems . Nurse practitioners who serve as primary care providers can improve these conditions if they can influence behavior. In 1992, a partnership was formed in Nashville, Tennessee, between Vanderbilt University School of Nursing and the Vine Hill Community to develop a primary care clinic for this underserved population. A survey of this population showed that the mean income was less than $5,000 per person. In January 1994, TENNCARE was formed, and these patients also used the community care clinic, which is a nurse-practitioner-managed primary health care center. Although measures of health belief and behavior have been developed, it is not clear whether any of these adequately represent the beliefs and behaviors of low-income individuals . There is a clear need for further investigation to address the links between economic impoverishment and health status and need. A related issue in the study of low-income populations is whether existing health belief measures adequately represent this population's views about health-issued and health-promoting behaviors. Studies have rarely included low-income participants' views on health beliefs and health-promoting behaviors. Concepts of health. Health categories are divided into social, psychological , and physical.1 Included among the categories are social interaction, social support, interpersonal support, solitude, stress management, selfJournal of Health Care for the Poor and Underserved · Vol. 11, No. 3 · 2000 268 The Meaning of Health actualization, personal growth, self-concept, emotional status, conflict resolution , rest, exercise, nutrition, personal health habits, pain, spiritual health, and meaning of life. This model identifies cognitive-perceptual factors that are modified by situational, personal, and interpersonal characteristics that result in participation in health-promoting behaviors. Few studies conducted during the past two decades have used tools developed specifically for low-income population and designed to measure healthpromoting behaviors. Kerr and Ritchey2 measured the health-promoting lifestyle of Mexican American low-income migrant farm workers. They had decreased access to health resources, knowledge deficits for certain health-promoting behaviors, and language barriers related to food labels and health education information. Additional studies are needed that capture culturally sensitive data and also consider persons with low income, diverse cultures , little education, and substandard social environments. Intervention studies to improve behaviors of low-income individuals. No specific studies have been found that investigate low-income individuals' concept of health or health-promoting behaviors. Focus groups have been used to identify desirable features of nutrition programs for low-income mothers of preschool children.3 During home visits, nurses developed and implemented a program designed to help low-income mothers change healthrelated behaviors related to nutrition. The study attempted to define healthrelated behaviors of low-income populations. Designing and carefully conducting focus groups can provide valuable insights in situations in which quantitative techniques are suboptimal or even inappropriate. Focus groups can ascertain subjects' opinions about what constitutes health, health promotion, and behavior changes. Methods The purposes of this study were to identify characteristics of health promotion behaviors and to examine the meaning of health in low-income clients who attend a nurse-practitioner-managed primary care clinic. A focus group method was used to promote...