Running head: COMPREHENSIVE HEALTH ASSESSMENT COMPREHENSIVE HEALTH ASSESSMENT FOR PATIENTS & POPULATIONS Anitha Madhu Western Governors University 1 COMPREHENSIVE HEALTH ASSESSMENT 2 COMPREHENSIVE HEALTH ASSESSMENT FOR PATIENTS & POPULATIONS The social determinants of health are the conditions in which people are born, grow, live, work and age. These factors are mostly responsible for health inequities, which are the unfair and avoidable differences in health status (World Health Organization [WHO], n.d). Specific resources can boost the quality of life and can have a substantial impact on population health outcomes. Resources include access to health services, safe and affordable housing, access to education, public safety, availability of healthy foods, and without a life-threatening toxin exposure in the environment (Office of Disease Prevention and Health Promotion [ODPHP], 2014). According to ODPHP, the five key elements in social determinants are economic stability, access to health care, education, community and social context, and the neighborhood and built environment. Strategy Interviewing is both a skill and an art. The approach I used to assess my patient's social determinants was face-to-face. Patient-centered interviewing emphasizes the personal and emotional context and encourages the patient to describe his or her symptoms spontaneously. The patient-centered interviewing allows the patient to lead to understanding their thoughts, ideas, concerns, without adding additional information from the clinician’s perspective (Bickley, 2016). The interview was conducted in a quiet place with privacy and confidentiality maintained. The interview skills I used with the patient were active listening with empathy and the openended questions. Active listening with empathy is essential in effective interaction, and openended questions allowed for detailed answers from the patient. During the interview with the patient, I observed the verbal and non-verbal communication as well. With these above techniques, I was able to collect a reasonable analysis of my patient’s social determinants. COMPREHENSIVE HEALTH ASSESSMENT 3 Key Question According to Healthy people 2020, health determined by access to social and economic opportunities, quality of schooling, safety in the workplace, and the resources and supports available in our homes, neighborhoods, and communities (ODPHP, 2014). Following are the five questions I used to assess my patient’s social determinants. • What are your age, occupation and economic stability? • Do you have health insurance and access to health care? • Do you feel safe in your home and neighborhood? • What is your highest level of education? • Do you participate in community church or any other organizations? Patient’s responses to key questions Mr. M is a 58-year-old naturalized citizen of the U.S. He has resided in the U.S. for the last 12 years, although he was born and raised in India. He possesses an Associate Degree and a professional certification in Air Condition and Heating System repair and is currently working as a technician. Mr. M stated that he is financially stable with the income from his job as a technician. He mentioned that he is able to maintain full coverage with his insurance with this income. His financial stability and full-time job allow him to afford an upper-middle-class house, moreover contributing to his overall well-being and his ability to remain healthy. However, he mentioned that he often works in extreme weather conditions and occasionally gets illnesses related to this exposure. I will consider adding an assessment and possible intervention to the plan of care regarding the risk of exposure to extreme heat and cold weather. COMPREHENSIVE HEALTH ASSESSMENT Mr. M is an Air Condition technician, and he has reasonable health insurance which covers the majority of his health care expenses. His health care plan includes both dental and vision plans, which covers his annual dental and vision check-ups. With his health insurance, he can get the yearly flu shot to prevent against the many strains of flu. Mr. M mentioned that occasionally he would miss medical appointments due to a lack of free time in his work schedule. Plan of care will include education about the importance of regular medical checkup with a primary physician. With Mr. M’s history of high cholesterol and obesity, I have asked about his exercise habits and hobbies. Mr. M stated that he likes to listen to music and watch television programs. The care plan will include the importance of an exercise program in controlling high cholesterol, preventing the risk of high blood pressure, and risk for diabetes, as well as to reduce his weight. Mr. M states that he feels very safe in his home and neighborhood. He lives in a twostory, well-maintained house in an area and community with a low crime rate. Mr. M stated that he is not actively engaged in any exercise or walking program, even though his community has resources such as a gym and walking area for daily walking. I would consider adding education and interventions in the plan of care about the dedicated time for relaxation to reduce the stress of work. Mr. M has an Associate Degree with a professional diploma from the technical institute of Air Conditioning and Heating System. Since Mr. M is not educated in health science, his health literacy is low, but he was still able to explain the medications, dosage, and routes of his current medications. The plan of care will include education regarding health science and interventions to improve health literacy. 4 COMPREHENSIVE HEALTH ASSESSMENT 5 Mr. M stated that he participates in community activities such as the local food drive, blood drive, fundraising events, and garage sale. Participation in the community is sporadic due to a lack of free time. I will educate him about the importance of social relations in maintaining a healthy and happy life. Economic stability and access to health care Mr. M is financially stable with his technical work and income, and he owns a company with few employees. Mr. M has an excellent socio-economic status with added benefits from his professional company. He has health insurance which covers his medical expenses, including prescription medications and therefore, easy access to healthcare. Mr. M has a two-story house, and he lives in that house with his wife and two kids. He also mentioned there are three hospitals and one emergency center near to his home. Educational status Education contributes to human capital by developing a range of skills and traits, such as cognitive skills, problem-solving ability, learned effectiveness, and personal control. These various forms of human capital may all mediate the relationship between education and health (Agency for Health Care Research and Quality [AHRQ], 2015). The ability to understand health needs, advocate for themselves and their families, follow or read instructions, and communicate effectively with health providers are imperative in keeping a healthy status for every patient. Mr. M has an Associate Degree and certification in his profession, and this, in turn, helped him to attain health insurance which covers his medical expenses, including his prescriptions. Mr. M has a stable economic status with his education and therefore, easy access to health care. Even though Mr. M has some primary science education, he is not fully literate with health science, which leads to a barrier to follow or to read instructions and to communicate effectively with COMPREHENSIVE HEALTH ASSESSMENT 6 healthcare providers. Mr. M is computer literate, and he stated that he uses his laptop and phone to search for the latest developments in healthcare and to access his health records from his primary care physician. During the health education session, Mr. M engaged in active listening and asked questions regarding the importance of exercise and a healthy diet program. However, Mr. M has hyperlipidemia and obesity, so he may need more education regarding weight control by proper intake of a healthy diet and regular exercise in order to prevent chronic diseases such as diabetes and hypertension. According to Zimmerman, Woolf, and Haley, the health benefits of education accrue at the individual level, the community level, and the broader social/cultural context (Zimmerman, Woolf, & Haley, 2014). Health Literacy According to the Center for Disease Control and Prevention [CDC], 2016, health literacy is the degree to which an individual has the capacity to obtain, process, and understand necessary health information and services needed to make appropriate health decisions. Health literacy of the patient and clear communication between health professionals and patients are vital in improving health and the quality of health care. My patient has adequate knowledge about his health, and he was able to tell the medical history, family history, and medications which he takes. Seldom does he have difficulty in comprehending the health information, and he makes sure that he clarifies the doubts with his physician by asking more questions. Mr. M showed interest in getting more health information during the education session. He stated that he uses the internet to learn more about health issues and seek medical information and attention if he has any other health issues throughout the year. Educational Opportunities and Barriers Opportunities COMPREHENSIVE HEALTH ASSESSMENT 7 Education is vital in social and economic development and has a profound impact on population health. The association between education and health is that knowledge itself produces benefits that later prompt the recipient to attain better health outcomes (AHRQ, 2015). Because of Mr. M’s education, he was able to obtain a good job and economic stability through that job. Education helped Mr. M to be in his current career with a high income, and the economic stability allows him to have good insurance which covers his medical expenses including prescription medications. His education helped him to purchase medication which is not covered by his insurance with his economic stability. Therefore, for Mr. M, his education and his job helped him to have access to health care. His knowledge of information and technology helps him in contacting his primary care doctor via email, and also allows him to access his records and blood results from his home computer. Mr. M’s educational level improves his ability to communicate effectively with his primary care physician, and he asks appropriate questions to improve his understanding. He undergoes regular annual dental and vision checkup and receives the flu vaccine every season. Mr. M is eager to keep up with his health and partake in routine well-being care. My patient’s education leads to a better job and income, which allows him to buy good insurance, easily purchase healthy foods, buy exercise equipment and machines, pay for health services, and have access to transportation services. Barriers According to Healthy People 2020, being a college graduate has a positive impact in employment options in order to secure better-paying jobs. High income from the job leads to better opportunities to improve health by increasing the ability of people to achieve material resources such as higher-quality housing, as well as psychosocial resources and higher social status (ODPHP, 2018). Mr. M has a barrier of language in English; even though he speaks COMPREHENSIVE HEALTH ASSESSMENT 8 English with moderate efficiency, it is not his primary language. Additionally, he gained his associate degree from India, so he is not able to understand the vocabularies and medical terms which is common in the US. Furthermore, Mr. M did not have his associate degree in health science, which restricts his ability to comprehend the medical terms while communicating with healthcare workers Educated patients may be more able to understand their health needs, communicate effectively with health providers, follow instructions, and advocate for themselves and their families (Virginia Commonwealth University [VCU], 2013). Another barrier I observed in Mr. M is that in the summertime, he is very busy with work, and he is unable to do regular walking or exercise which is affecting his health negatively and this also related to the low educational level and carrier choice. He reported that at times he postponed his medical appointments with his primary care physician due to his workload in the summer. Mr. M’s inability to keep up with all appointments due to time constraints and not having enough free time have a close link with his career choice and his educational level. The limitation of having an Associate Degree has caused a barrier to his overall quality of health care. Effect of Health on Quality of Life Quality of life is essential to everyone. Health-related quality of life in an individual includes physical and psychological health perceptions such as energy level, mood, and their correlates—including health risks and conditions, functional status, social support, and socioeconomic status (CDC, 2016). Chronic diseases can lead to disability and unemployment and instability in socioeconomic status. Patients may develop anxiety and depression concurrently. COMPREHENSIVE HEALTH ASSESSMENT 9 Mr. M has been on treatment for high cholesterol for five years, and his cholesterol level is currently well-controlled. He has a family history of the peripheral vascular disease. Mr. M has a positive outlook and attitude towards life, and he is generally pleasant and satisfied with his life. Even though Mr. M is happy, he mentioned that he gets tired due to exposure to extreme weather conditions at his job. Another concern is his obesity and high cholesterol level. Overall, Mr. M’ s health status affects his quality of life with the fatigue due to heat exposure, lack of exercise, and lack of healthy eating. Mr. M understands that his health and health care status is affecting his quality of life and decided to lose weight and start eating a healthier diet. He has a good relationship with his family members. He also indicated that he is very active in his religious activities. He declined any distress, pain, and emotional distress in his life. Neighborhood and Environmental Impacts The neighborhoods shape people’s behaviors and influence their health. Social and economic features of communities have a link with general health status, mortality, and chronic conditions such as disability, birth outcomes, health behaviors, mental health, injuries, violence, and other essential health indicators (Cubbin, Pedregon, Egerter, & Braveman, 2008). Mr. M resides in a safe, upper-class neighborhood. In his housing area, he has excellent health care services: three hospitals in walking distance, including an emergency center. He fills his prescriptions at a nearby pharmacy which is within two miles from his house. His subdivision has a park, walking area, swimming pool, fire station, gym, and public transportation. Mr. M’s neighborhood and community have a low crime rate. The neighborhood is very friendly, and they have a group connection to share the community news. Two nearby supermarkets, situated within a two-mile radius, provide access to fresh vegetables, fruits, and other foods. Comparison of health care in the low and high-income area COMPREHENSIVE HEALTH ASSESSMENT 10 There are numerous problems in our health care delivery system. Low-income patients have to make hard choices between their health and the financial well-being of their family. Most people who live in the low-income area are uninsured or underinsured. Underinsured people had difficulty in paying a high amount of money from their pocket for a copay and prescription medications. Patients living in low-income areas have limited access to health care for different reasons. There is the central unavailability of good insurance which adequately covers medical expenses due to low-income, which may, in turn, be due to a low level of education. Secondly, there is a lack of hospitals and pharmacy availability in these neighborhoods. The low-income areas provide a minimal amount of essential services which are covered by insurance. In lowincome areas, the primary care physician may be the only accessible physician. There may be a minimal amount of specialty doctors available for referral purposes, and people may have to travel a long distance to see a specialist, which limit the people’s access to comprehensive healthcare. The government assisted clinics to have minimal staff due to an inability to pay competitive salaries. Lack of political support also observed in low-income neighborhood areas. Economic instability may allow the community to have a high crime and violation rate, which can lead to anxiety and depression in the population. A shortage of public parks, gyms, pools, and sidewalks will be a barrier for socialization and regular exercise, and this can lead to the development of an unhealthy population. Low-income areas also tend to have fast food restaurants, which promote poor diet habits. People who live in low-income areas may be subject to increased rates of illnesses due to exposure to sickness, air pollution, water pollution, and other environmental contaminants. There are a higher number of highly educated people living in high-income areas, and they have good insurance coverage for medical care and expenses. In high-income areas, due to COMPREHENSIVE HEALTH ASSESSMENT 11 the availability of hospitals, pharmacy, and transportation, people get better medical care and improved outcomes and reduced number of unplanned admissions. Within high-income areas, there are primary care physicians and specialty doctors available within short distances, which leads the people living in these areas to have easy access to health care. In high-income areas, there are health care providers who focus on elective treatments such as cosmetic surgery, laser eye surgery, liposuction, orthodontia, and in vitro fertilization. Physician offices may provide extra services, are well staffed, and are better maintained. Due to the resources around the highincome areas, costs also decreased. In these areas, people have more access to group communication and to get more information while gathering in the park. The availability of parks, gyms, sidewalks, and pools allows the population to lead a healthier lifestyle. In highincome areas, the economic stability will keep the crime rate low and allows for a stress-free environment where people can be free from anxiety and worry. Similarities in both the high-income area and low-income area are that all patients the U.S. have the right to be treated the same way, and no patient is denied the right to treatment because of inability to pay. Both the high-income area and low-income area has access to emergency medical care and medications, to call a medical emergency vehicle, and to call police officers. All emergency ambulances respond to calls regardless of the area or standard of living, and all clinical guidelines are the same for all of the population. The Emergency Medical Treatment & Labor Act (EMTALA) ensures public access to emergency services, regardless of ability to pay (Center for Medicare &Medicaid Service [CMS], 2012). Another similarity is the availability of primary care physician and primary care centers in high income and low-income areas. Rural Versus Urban Healthcare Access COMPREHENSIVE HEALTH ASSESSMENT 12 According to Centers for Disease Control and Prevention (CDC) studies, in the U.S., 15 % of American who live in rural areas are likely to die from heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke (CDC, 2017). Access to health care is critical for a population's well-being and optimal health. The patient may experience difficulties in accessing health care due to the unavailability of specialty doctors and emergency centers in the rural area, with extended travel distances to specialty and emergency care. In urban areas, access to health care is more comfortable with the ready availability of primary care physician, specialty doctors, emergency centers and major hospitals. The inadequacy of healthcare workforce affects access to care in rural communities. In a rural area, only one pharmacy may be available, whereas an urban area has multiple pharmacies to access medications. People living in rural areas have barriers to access healthcare, resulting in not meeting their health care needs for screening services and immediate treatment of illnesses. In rural areas, most people are uninsured or underinsured. Whereas in urban areas, people are mostly insured and have good socioeconomic status to take care of their health. In an urban area, people have easy access to hospitals, pharmacies in short distance and transportation is readily available. How neighborhood affects access to healthy food options Accessibility of healthy food in neighborhood community stores may be a significant consideration in developing food environments that support the prevention of obesity and cardiovascular disease. However, healthy foods, including fruits, vegetables, low-fat milk, and high fiber bread tend to be less available in areas of lower income communities. The low-income neighborhood may have access to small stores, and there will not be any availability of fresh food or fruits, and people might depend on canned food to feed the family. The high-income COMPREHENSIVE HEALTH ASSESSMENT 13 neighborhood has access to big shopping centers with organic products, meats, fruits, and vegetables. Mr. M lives in a high-income neighborhood and has access to healthy food. Discussion of Social determinants Health is a state of complete physical, mental and social well-being, and not merely the absence of disease (WHO, n.d). Social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks (ODPHP, 2018). According to Healthy People 2020, social determinants are designed to identify ways to create social and physical environments that promote good health for all (ODPHP, 2018). Healthy People 2020 recommends that all Americans deserve an equal chance to make the selections that lead to good health. Addressing social determinants in a comprehensive assessment is essential due to the impact of social determinants in health outcomes. Factors such as a patient's income, level of education, and the environment must be considered when providing care to the patient, as these factors have a direct effect on the patient’s health. With the assessment of social determinants, the healthcare worker can identify the risks and prevent the problems early. According to Healthypeople2020, the social determinants of health organized around five key domains: Economic Stability, Education, Health and Health Care, Neighborhood and Built Environment, and social and community context A collaborative team effort is required to address the unique needs of the community (ODPHP.2018). By focusing on social determinants, we can improve health and well-being for all ages and the society in which we live. Identification of Social Determinants Health and Healthcare COMPREHENSIVE HEALTH ASSESSMENT 14 Mr. M has health insurance which covers his medical expenses, including prescription medication, and therefore he has easy access to health care. He maintains his health with regular follow up and blood work through his primary physician. Mr. M mentioned during the interview that he checks his blood pressure at home occasionally with his machine. He possesses the knowledge about his hypercholesteremia, his medication, and its side effects. He is also aware of when to take medication and what he should avoid with his medication. Neighborhood and Built Environment Mr. M lives an upper-class block with the availability of hospitals, pharmacy, an emergency center, and a supermarket, which stocks fresh vegetables, poultry items, fruits, and other food. His residential area has a low crime rate. Public transportation is also available in the neighborhood. The neighborhood includes a park, gym, community pool, and a fire station within a two-mile radius. Mr. M prefer to cook and eat at home than going to restaurants. Social and Community Context Mr. M is active in his religious activities. Mr. M is not very active in his neighborhood activities. Mr. M helps the church maintenance crew as a technician as part of his charity work. Mr. M has good family support from his wife and two children. In his free time, he likes to listen to music and watch television inside his house. During the weekends, he likes to watch more programs on video. Plan of Care Health and Health Care Based on the assessment and diagnosis, I will set measurable and achievable short- and long-range goals for this patient. Mr. M will continue to check his blood pressure and go for regular follow-up and blood work with his primary physician. He will continue to follow a COMPREHENSIVE HEALTH ASSESSMENT 15 healthy diet and an annual flu shot. I will ask Mr. M to use a food diary to record his all meals including snacks and drinks for a three week period. This diary will help him to review and see where he can work around to control his calories (Williams, 2018). I will educate him about the importance of active walking or regular exercise for a minimum of thirty minutes daily, or at least four days a week, to reduce his weight. I will ask Mr. M to use an activity diary to record his all activities for three weeks. Activity diary is one of the best things people can do to improve their health. Active people typically live longer and are at less risk for serious health problems like type 2 diabetes, heart disease, obesity, and some cancers (CDC, 2018). I will teach him regarding the importance of follow up regularly, as Mr. M mentioned that he misses the appointments in the summertime because of his busy work hours. Neighborhood and built environment. Mr. M has available resources for getting fresh food and fruits in his neighborhood. Still, he is, obese, and his BSA was 27.6. Mr, M needs a plan for, a healthy diet regimen to control his weight. I will educate Mr. M regarding the importance of making healthy food choices and following a balanced diet to improve his health. According to the Dietary Guidelines for Americans 2015-2020, a healthy diet plan highlights fruits, vegetables, whole grains, fat-free milk products, and also lean meats, poultry, fish, beans, eggs, and nuts (CDC, 2016). I will provide printed material of healthy food to Mr. M, and usage of a food diary will also help him to keep his healthy eating habits. Social and Community Context Research shows that social support positively influences morbidity, mortality, and quality of life in chronic disease populations. CDC research reflects the connection between the characteristics of the contexts within which people live, learn, work, and play, and their health COMPREHENSIVE HEALTH ASSESSMENT 16 and well-being (CDC, 2017). I will educate my patient, Mr. M, regarding the importance of social support from the neighbors and friends, and how he can be more supported and feel a sense of belonging and security. I will emphasize getting more contact with his friends and gathering them for a walk, and in that way, he will increase his physical activity to reduce his weight and to improve his health. Plan Implementation Physical activity includes a set of behaviors that seem to play a unique role in health and well-being because of its benefits. Physical activity is a strong protective factor from premature mortality, risk factors for chronic diseases, depression, anxiety, Alzheimer's disease, and other common mental health problems (Carlson, A. J., & Sallis, J. F,2015). I will discuss with Mr. M the importance of keeping his weight within reasonable limits of his BSA as 26. Weight reduction programs will be implemented with regular walking for a minimum of 30 minutes daily, after his work. Since he has an exercise machine at home, he can use the device for exercise daily, or whenever he is unable to go out for a walk outside. The second plan implementation is to keep Mr. M on a healthy diet. I educated him on how obesity can lead to chronic diseases such as diabetic and hypertension, and I reminded him that he has a family history of cardiovascular diseases. I will give printed materials regarding diet and a food diary to record his all meals, snacks, and drinks. Also provide him with an activity dairy which he can record all his daily exercise or walking time that he can review at the end of the week and to continue for three weeks. Since Mr. M has computer and internet access and he is literate with the computer, I will give information on the website which discusses the benefits of a healthy diet and the importance of walking and exercise. Mr. M will be educated to continue with follow-up on his cholesterol problem every three months with his primary care physician, even COMPREHENSIVE HEALTH ASSESSMENT 17 during the summertime. I will discuss the importance of checking blood cholesterol and liver function test every three-month period, to evaluate the serum cholesterol level, as well as to monitor the liver function due to the possibility of his medication side effects. Social support is essential to keep a person healthy and happy. Research shows that those deprived of social support have a link to depression and loneliness has been shown to increase the risk of suicide, alcohol use, depression, altered brain function, and cardiovascular diseases (Cherry, 2017). I will educate Mr. M about the importance of having more social support, other than family support, to make him stress-free and healthy. I will encourage him to involve his friends in family celebrations to broaden his support system. Implementation Barriers Barriers in implementing the plan of care mainly are Mr. M ‘s work schedule; he does not have regular work hours in his profession. He stated that he is getting calls for work at any time during the day and the evening, and this may affect his exercise or walking schedule. Another barrier he mentioned is that accessing healthy food from the store due to his busy schedule hours, especially in the summertime. Occasionally, he works in places far from home and may not have access to a good store in that neighborhood, leading to eating unhealthy food. The barrier in social interaction is his family. He is not sure about the view of his wife and children about the social support from his friends. Individuals Involved in Interventions Patient Individuals are expected to decide whether and when to seek care, how to manage their health, which plans and providers meet their needs, and how to cope with sometimes conflicting advice from friends and family and providers (Clancy, 2011). Patient engagement in their health COMPREHENSIVE HEALTH ASSESSMENT 18 contributes to improved health outcomes and the knowledge in information technology can support commitment. Mr. M is highly engaged in his health, and he has enough expertise in information technology to, access the health information. Family The family is an integral part of patient care. Family significantly impacts health in both positive and negative ways. The supportive family provides emotional support, economic wellbeing, and increases overall health. Family member support in delivering care is very crucial, and they can support the patient and offer encouragement in areas such as nutrition, physical exercise, social gathering, transportation, and to help in buying healthy food from the store. Mr. M’s family can also encourage him to walk in the evening, remind him about his appointments, and help him to buy healthy food choices from a store in the summer season. Health Practitioner Health professional play a central and critical role in improving access and quality health care for the population (WHO, nd). A good doctor-patient relationship starts with the trust between them. Once good faith is developed between the patient and the health practitioner, the patient follows the directions accurately, and he will be able to lead a healthier life. The health practitioner has a significant role in providing health education to the patient to improve the patient’s health literacy. Mr. M has a good relationship with his primary care. Plan Effectiveness Evaluating the effectiveness of nursing care is necessary, and the evaluation plan should be an integral part of patient care (AHRQ, 2016). I will make a follow-up appointment with Mr. M within three weeks to evaluate the success of the plan of care, and during that visit, I will check his cholesterol and liver function. People with elevated levels of cholesterol are at COMPREHENSIVE HEALTH ASSESSMENT 19 increased risk of having a heart attack or stroke (AHRQ, 2016). The short-term goal was weight reduction of a minimum of three to five pounds in three weeks with the exercise or walking, and the use of a healthy diet. To find the effectiveness of a healthy diet care plan, I will check his food journal or a diary in which he recorded all his meals and snacks for a three week period. Evidence supports that weight loss is double when people use the food diary. A food journal, or food diary, allows people to look at the food intake over a period, and which allow the people to identify areas that they can work on, which will benefit their health (Williams, 2018). I will also check Mr.M’s activity diary for his daily activities, which includes his exercise and walking for three week period. I will assess the effectiveness of community activities also through activity diary by observing the walking pattern Mr. M did with his neighbors, exercise in the gym and any special activities he involved in this three week. Long- time goal for Mr.M is that he will not show any signs and symptoms of any other chronic diseases such as diabetes, hypertension or any other cardiovascular diseases in the next six months. I will educate him about the importance of continuing the activities in the neighborhood, exercise, walking, and healthy eating. I will continue to reinforce his goals, to keep the blood pressure checking occasionally, continue to take the yearly flu shot, yearly screening, keep his body mass index in 26, and to keep the regular checkup with his primary physician. The use of patient-reported measures of patient experience as part of the systematic measurement and performance monitoring in healthcare backgrounds would improve the extent of patient experience and would heighten our understanding of the patient experience, metrics, measurement, evaluation, patient-reported outcomes(LaVela & Gallan, 2014). Summation of the Impact of Social Determinants COMPREHENSIVE HEALTH ASSESSMENT 20 Social determinants have a high impact on the population’s health. Mr.M has very positive feelings about his life and health. Mr. M’s social determinants are very convincing and favorable for his condition. Mr.M has access to health care by having good insurance, which covers his medical expenses. He is financially stable, well educated and has standard health literacy. Mr. M lives in an area with all healthcare facilities, large shopping centers, pharmacy and supermarket which provide fresh fruit, poultry, and vegetable. His neighborhood is safe and free from environmental hazards and with the low crime rate. His block has a park, gym fire station, community pool, and public transportation. However, Mr.M has to continue to see his healthcare provider regularly, continue to eat healthy food, engage in exercise, and to be more active in his community activities and neighborhood. Additionally, he should be using his social resources such as a park, gym and side walkway for walking and at the same to interact more with friends and family. In conclusion, Mr.M’s social determinants are favorable and have a positive effect on his health and well being. . COMPREHENSIVE HEALTH ASSESSMENT 21 References Agency for Healthcare Research and Quality. (2016). Elements of an evaluation plan. 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