VULNERABLE POPULATION AND SELF AWARENESS

Vulnerable Population and self awareness

Vulnerable Population and self awareness

Vulnerability and vulnerable populations are significant concepts in today's health care system. Vulnerable populations are social groups who experience health disparities as a result of a lack of resources and increased exposure to risk (Anderson, Fullilove, Scrimshaw, Fielding, Norman, & Zaza, 2009; Flaskerud & Winslow, 2008). Diverse, vulnerable groups are most often comprised of people of colour, people living in poverty, and people marginalized by sexual preference, immigrant status, religion, or creed (Flaskerud, et. al., 2002). Vulnerable groups also include high-risk mothers and children, non-English speaking individuals, people with AIDS, and homeless families (Aday, 2007; Shi, 2000).

Sickle cell disease (SCD) and its manifestations offer a lifetime of pain and hospitalizations (Serjeant, 2005). SCD most often affects African Americans, a vulnerable minority population (Dorsey, Phillips, & Williams, 2001; Maxwell & Streetly, 2008). Although modern medicine is able to detect SCD, these patients often receive inadequate health care and may lack the skills needed to improve self-awareness and quality of life. SCD patients frequently report dissatisfaction with care they receive, which is often related to inadequate pain relief. Inadequate pain relief results in a poor quality of life (Osmen, Calder, Robertson, Friend, Legge, & Douglas, 2000; Strickland, Jackson, Gilead, McGuire, & Quarles, 2001).

Although prior conceptualizations of vulnerability are valuable, they do not address the role of individuals in self-awareness management. Neither the Vulnerable Populations Model nor the Stress-Diathesis Model consider quality of life as an outcome. The Theory of Self-awareness Management for Vulnerable Populations incorporates concepts from both theories and other influences on health status and quality of life among vulnerable populations.

The Theory of Self-awareness Management for Vulnerable Populations proposes an alternative approach to addressing the concept of vulnerability by addressing self-awareness management and the multiple intra-personal factors that are theorized to play a significant role in one's ability to manage illness. The major concepts in the model are contextual factors, vulnerability, intrapersonal factors, self-awareness management, health status, and quality of life. The concept vulnerability includes both modifiable and non-modifiable vulnerability factors. Intra-personal factors mediate the relationship between vulnerability and self-awareness management and include assertiveness, coping behaviours, knowledge, and social support.

Although the Theory of Self-awareness Management for Vulnerable Populations emphasizes the role of the individual in self-awareness management, self-awareness management is influenced by contextual factors, including community values and community resources. Community values refer to ideas and beliefs that are important or have worth in the community (Flaskerud & Winslow, 2008). Community resources are assets within a community such as money, political power, or cohesiveness (Flaskerud & Winslow, 2008). The Theory of Self-awareness Management for Vulnerable Populations acknowledges the influences of contextual factors, such as cost of health care.

Medical interventions for SCD are not always adequate, yet they are costly (Yang, Shah, Watson, & Mankad, 2005). Adults and children with SCD require more than 75,000 hospitalizations per year in the U.S. with total direct cost exceeding $475 million (Davis, Moore, & Gergen, ...