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UNIT II ■ Community Health Across Populations: Public Health Issues
■ EVIDENCE-BASED PRACTICE Hózhó: Promoting Healthy Sleep for Your Family Practice Issue: People need 7 to 9 hours of sleep per 24-hour period to achieve adequate sleep duration. Sleeping fewer than 7 hours or experiencing poor sleep quality can cause cardiovascular disease, diabetes, obesity, immunodeficiency, hormonal abnormalities, pain, and mental health disorders. 1 Many groups, including Navajo caregivers of children with developmental disabilities, experience sleep disorder symptoms and poor health-related quality of life. Practice Statement: Sleep hygiene programs need to be culturally relevant to yield a meaningful impact. Targeted Outcome: Reduce sleep disorder symptoms and improve health-related quality of life. Supporting Evidence: Russell and colleagues conducted a quasi-experimental study with 15 Navajo caregivers of children with developmental disabilities. 2 Study participants were at high risk for poor outcomes related to sleep because of their increased burden, with challenges to their SDOH including economic stability (i.e., 41% of the Navajo Nation live below the federal poverty level), built environment (i.e., living in substandard housing), and health-care access (i.e., nearest medical specialist is over 3 hours away). The researchers implemented the “Hózhó: Promoting Healthy Sleep for Your Family” program with 15 participants. The program consisted of two educational modules adapted from other programs to address the social context and community of the Navajo Nation. Program findings were positive: Participants overall reported fewer sleep disorder symptoms (although not statistically significant), significantly increased number of hours of sleep per night from 5.82 hours to 7.83 hours, and significantly improved physical and mental health-related quality of life. Recommended Approaches: Russell and colleagues modified existing programs with demonstrated effectiveness to account for the social context and community of the Navajo Nation. 2 As public health nurses implement programs in other communities, it is important to consider not only the social context but also the unique aspects of the community that could be driving the existence of the problem. For example, Russell and colleagues leveraged community strengths for the implementation of their program, which included cultural beliefs for getting sunlight early in the
day and accessing family support to assist with care of the child with a disability. References 1. Suni, E., & Dimitriu, A. (2022, March 18). Sleep depriva- tion. https://www.sleepfoundation.org/sleep-deprivation 2. Russell, M., Baldwin, C. M., & Quan, S. F. (2020). Hózhó: Promoting sleep health among Navajo caregivers. Sleep Health, 6, 220–231. https://doi.org/10.1016/j.sleh.2019 .12.008
BOX 7–2 n Healthy People: Examples
of the Impact of Social and Physical Determinants of Health
Social Determinants • Availability of resources to meet daily needs (e.g., safe housing and local food markets) • Access to educational, economic, and job opportunities • Access to health-care services • Quality of education and job training • Availability of community-based resources in support of community living and opportunities for recreational and leisure-time activities • Transportation options • Public safety • Social support • Social norms and attitudes (e.g., discrimination, racism, and distrust of government) • Exposure to crime, violence, and social disorder (e.g., presence of trash and lack of cooperation in a community) • Socioeconomic conditions (e.g., concentrated poverty and the stressful conditions that accompany it) • Residential segregation • Language and literacy • Access to mass media and emerging technologies (e.g., cell phones, the Internet, and social media) • Culture Physical Determinants • Natural environment, such as green space (e.g., trees and grass) or weather (e.g., climate change) • Built environment, such as buildings, sidewalks, bike lanes, and roads • Worksites, schools, and recreational settings • Housing and community design • Exposure to toxic substances and other physical hazards • Physical barriers, especially for people with disabilities • Aesthetic elements (e.g., good lighting, trees, and benches)
Source: Reference (56).
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