PRODUCT STRATEGY & DEVELOPMENT
SCOPE AND SEQUENCE
HLTH 2110: BEHAVIORAL AND CULTURAL ISSUES IN HEALTH CARE
Course Description
Behavioral and Cultural Issues in Healthcare (5 cr)
This course examines the cultural and behavioral issues that influence the management
and delivery of healthcare services and provides a framework for assessing the effect of
culture and behavior in a variety of settings and situations. Health disparities attributable to
diverse cultural and behavioral factors are identified and their implications for health care
policy are discussed.
ANDREA MACALUSO
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PRODUCT STRATEGY & DEVELOPMENT
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HLTH 2110: BEHAVIORAL AND CULTURAL ISSUES IN HEALTH CARE
Course Introduction
Welcome to the course, Behavioral and Cultural Issues in Healthcare!
It has long been known that the health behavior of individuals and populations are
influenced by cultural situation or background.
Often behavioral and cultural differences result in unequal or unjust treatment of vulnerable
individuals or population based on race, ethnicity, and socioeconomic status, to name a
few. Recent studies have detailed the extent of the problem. This is evidenced by the
following facts uncovered by the Agency for Health Care Research and Quality in 2009.

About 30 percent of Hispanic and 20 percent of black Americans lack a usual source
of health care compared with less than 16 percent of whites.

Hispanic children are nearly three times as likely as non-Hispanic white children to
have no usual source of health care

African Americans and Hispanic Americans are far more likely to rely on hospitals or
clinics for their usual source of care than are white Americans (16 and 13 percent,
respectively, vs. 8 percent).
This course will cover theories and applications associated with health behavior and
culture. It will also explore how health care professionals can incorporate those theories
into practice in order to avoid providing unequal treatment when they deliver health care.
You will also examine populations vulnerable to receiving unequal health care. Methods for
advocating for social and policy change, such as social marketing, the media, and
community organizing will also be discussed.
During the next six weeks you will:

Apply the Social Ecology Health Model to examine health issues

Apply a model or theory to a health condition / disease

Evaluate national initiatives that address the problem of health disparities

Analyze intervention programs or activities that address workforce disparities and health
care access issues for vulnerable populations

Examine how theories are applied to a health intervention in order to address a health
disparity locally, nationally, or globally

Apply advocacy principles to bring about a policy change that can improve the health of
individuals and populations
ANDREA MACALUSO
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While you complete your course assignments, reflect on how you might apply what you
learn to your current or future health career. Also, keep in mind that the Writing Center can
be an invaluable learning resource, and it is available to you at any time of day. For other
links to Walden University resources, refer to the Walden Links section located at the
Course Home section of the course.
You are encouraged to reflect upon your own professional future in light of the course
topics. This will enable you to have a successful learning experience and, ultimately, make
a difference in the health of individuals and communities.
ANDREA MACALUSO
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Course Information
Course Rubrics

Discussion Rubric

Application Assignment Rubric
General Information
Clicking a link will open a new browser window. From there, you will be able to save the
documents to your computer's hard drive.
To save any linked document to your Windows computer:
1. Right-click on the link, then select Save Target As... (Internet Explorer) or Save
Link Target As... (Netscape).
2. Make note of the folder in which you save the file.
To save any linked document to your Macintosh computer:
1. Hold down the control key and click on the link, then select Save Link As...
(Firefox), Download Linked File (Safari), or Save Link Target As... (Netscape).
2. Make note of the folder in which you save the file.
3. If you have any trouble opening the document in Word once it is saved to your
computer, please check our Macintosh FAQ at
http://www.onlinelearning.net/InstructorCommunity/faq.html?s=329.a000b382p.032
m507r60#usemac.
Researching the Walden Library
Click the link below for some tips on how to access information located in the Walden
Library.
Searching and Retrieving Materials in the Research Databases
ANDREA MACALUSO
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PRODUCT STRATEGY & DEVELOPMENT
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HLTH 2110: BEHAVIORAL AND CULTURAL ISSUES IN HEALTH CARE
Walden Links

Walden Academic Programs
http://inside.waldenu.edu/c/Student_Faculty/StudentFaculty_12439.htm

Walden Academic Calendar
http://inside.waldenu.edu/c/Student_Faculty/StudentFaculty_13721.htm

Walden University Services
http://www.waldenu.edu/Support-Services.htm

Walden Library
http://library.waldenu.edu/
o

Ask-A-Librarian: Walden Library Reference Service
http://www.questionpoint.org/crs/servlet/org.oclc.admin.BuildForm?&institution=13046&type=
1&language=1
Walden Writing Center
http://inside.waldenu.edu/c/Student_Faculty/StudentFaculty_562.htm
o
Ask a Writing Tutor
writingsupport@waldenu.edu

ESL Resources
http://inside.waldenu.edu/c/Student_Faculty/StudentFaculty_1455.htm

Walden Financial Aid Services
http://inside.waldenu.edu/c/Student_Faculty/StudentFaculty_12825.htm
o

Contact Financial Aid
finaid@waldenu.edu
Walden Disability Services and Resources
http://www.waldenu.edu/c/Services/UniversityServices_385.htm
o
Contact Disability Services
disability@waldenu.edu
ANDREA MACALUSO
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HLTH 2110: BEHAVIORAL AND CULTURAL ISSUES IN HEALTH CARE
Week 1: Health Perspectives
Introduction
This course, Behavioral and Cultural Issues in Health Care, explores behavior and culture
in health care as characterized by the Social Ecology Health Model.
First, you will revisit the three methods of prevention (primary, secondary, and tertiary) that
were outlined in the first course of your Health Studies program, Concepts in Health
Promotion. This week you will review it within the context of the Social Ecology of Health
Model.
Second, the five hierarchical levels of influence depicted in the model (intrapersonal,
interpersonal, organizational, community, and societal levels) will be closely examined.
Your Discussion Assignment for this week will give you the opportunity to discuss the
model with your colleagues.
You will also become acquainted with the Healthy People 2010 objectives and focus areas.
You will search for a news article about a focus area then analyze the ways in which the
news story pertains to this week’s topics.
Looking Ahead: The Healthy People 2010 objectives are currently being updated to Health
People 2020. Keep your eyes open for new information on the site.
Objectives
This week you will:

Analyze biomedical (downstream) and prevention (upstream) perspectives of a
specific health issue

Discuss the advantages and challenges of using the Social Ecology of Health Model
to examine health issues

Explore social reactions to disease
Please proceed to Introduce Yourself.
ANDREA MACALUSO
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HLTH 2110: BEHAVIORAL AND CULTURAL ISSUES IN HEALTH CARE
Introduce Yourself
A great way to build relationships with your colleagues in the Health Studies program is to
interact with them in the Class Café. The Class Café is an informal discussion board that is
useful for discussions that do not relate to the formal content of this course.
To meet your colleagues, visit the Class Café on the first or second day of the course.
Introduce yourself by posting your name (first name and last initial) and a brief statement
about your background. If you would like, share a picture of yourself with your colleagues
so they can see who you are.
NOTE: If your posting is of a personal nature or involves issues that are of concern only to
you and require an individual response from the instructor, please e-mail your instructor
directly.
After you’ve introduced yourself to your colleagues, please proceed to the Learning
Resources.
ANDREA MACALUSO
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HLTH 2110: BEHAVIORAL AND CULTURAL ISSUES IN HEALTH CARE
Learning Resources
Required Resources

Course DVD: Behavioral and Cultural Issues in Health Care, Health Perspectives
The scholars in this video, Dr. Betancourt and Dr. Mickalide, provide their perspectives
on culture and health. In addition, they address national efforts to solve health
disparities.

Documentary Trailer: “Unnatural Causes… Is equality making us sick?”
http://www.unnaturalcauses.org/video_clips_detail.php?res_id=80]
This is an informative 5-minute trailer from an acclaimed PBS series. It postulates that
poor health is more than bad habits, poor health care, or unlucky genes. Our social
circumstances can actually disrupt our physiology as much as germs and viruses.

Video: Beyond Health Care: New Directions to a Healthier America, Robert Woods
Johnson Foundation http://www.rwjf.org/pr/product.jsp?id=41008
This video attempts to answer the following questions: Do we know what good health
means or how to achieve it? Is it all about medical care, insurance, our doctors, nurses,
and hospitals?
Readings

Course Text: Coreil, J. (2009). Social and Behavioral Foundations of Public Health, (2nd
Ed). Thousand Oaks, California: Sage Publications.
o Chapter 1: “Why Study Social and Behavioral Factors in Public Health?”
The first chapter in the text describes the importance of studying culture and
behavior. It provides a historical perspective of the field of behavioral and social
sciences. The chapter sets the stage for the course with its overarching framework,
the Social Ecology of Health Model, and explores the levels of social influence on
health issues.
o Chapter 2: “Historical Perspectives on Population and Disease”
This chapter delves deeper into the history of health, from the perspectives of
disease and the cultural evolution.
ANDREA MACALUSO
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It also touches upon the health problems that generally occur at different stages of
life. The next course in your curriculum, Aging Throughout the Lifespan, will
significantly expand on this discussion.
o Chapter 5: “Health Illness Behavior”
This chapter reviews the levels of prevention that was covered in the first course in
the program and lays the groundwork for the course by reviewing the relationship
between health and illness behavior.
o Chapter 7: “Social Reactions to Disease” (pp. 134 – 136)
In this chapter you will study the concepts of medicalization and hygienization with
respect to disease behavior.
o Chapter 8: “Comparative Health Cultures” (pp. 145 – 154)
The authors introduce the concepts of ethnomedicine as well as the various
“sectors” of medicine. It also explores cultural models of illness.
Web Sites

Healthy People 2010 Goals and Focus Areas
http://www.healthypeople.gov/About/hpfact.htm
You’ll become extremely familiar with the Healthy People 2010 Campaign during this
course. Healthy People 2010 is a national effort to solve unequal and unjust health
treatment of populations. You will use the Healthy People focus areas throughout the
course.
This site will be used for the In the News assignment as well as many other
assignments in the course.
Supplemental Resources
Media

Film Documentary: Sicko. (2007). Dog Eat Dog Productions
You may want to rent Sicko. It provides a fascinating and controversial view of the
health care system in the United States today. The documentary also compares the
American health care system with other nations, illustrating the differences in reactions
to disease based on the health care system of other countries.
Readings
ANDREA MACALUSO
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
HLTH 2110: BEHAVIORAL AND CULTURAL ISSUES IN HEALTH CARE
Course Text: Coreil, J. Social and Behavioral Foundations of Public Health
o Chapter 10: “Reproductive Health”
o Chapter 11: “Adolescent Health”
o Chapter 12: “Public Health and Aging”

Article: Lytle, L., & Fulkerson, J. (2002). Assessing the dietary environment: examples
from school-based nutrition interventions. Public Health Nutrition, 5(6a), 893-899.
Retrieved from
http://proquest.umi.com.ezp.waldenulibrary.org/pqdlink?did=1452924591&Fmt=6&client
Id=70192&RQT=309&VName=PQD

Article: World Health Organization (2008). The World Health Report 2008, Primary
health care now more than ever. Retrieved from
http://www.who.int/whr/2008/whr08_en.pdf
Web Sites

World Health Organization http://www.who.int/en/

Prevention: Upstream, Midstream, and Downstream Examples
http://www.cdc.gov/nczved/framework/features/prevention.html
Please proceed to In the News.
ANDREA MACALUSO
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In the News
The In the News assignment has been designed to give you the opportunity to review
current news articles about one of the focus areas addressed by the Healthy People 2010
program Healthy People 2010 Goals, Objectives and Focus Areas
http://www.healthypeople.gov/About/hpfact.htm
In the first few days of Week 1, your instructor will assign one of the following Healthy
People 2010 focus areas to you based on last name. For example, the first focus area,
“access to Quality Health Services” would be assigned to “Aaronson, Robert”.

Access to Quality Health Services

Arthritis, Osteoporosis, and Chronic Back Conditions

Cancer

Diabetes

Chronic Kidney Disease

Disability and Secondary Conditions

Environmental Health

Heart Disease and Stroke

HIV

Immunization and Infectious Diseases

Injury and Violence Prevention

Maternal, Infant, and Child Health

Mental Health and Mental Disorders

Nutrition and Overweight

Oral Health

Respiratory Diseases

Sexually Transmitted Diseases
ANDREA MACALUSO
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
Substance Abuse

Vision and Hearing
HLTH 2110: BEHAVIORAL AND CULTURAL ISSUES IN HEALTH CARE
You can prepare for this assignment by keeping your eyes open for an article in an online
news-related publication that relates to your assigned focus area. The news article should
be intended for the general public. Examples of such sources are:

Magazines and newspapers (e.g., The New York Times)

Health news websites (e.g., National Public Radio’s (NPR’s) Health section)

News updates from Government sites, such “In the News” at the National Institute of
Health site http://www.nih.gov/ or “Science News” at the National Institute of Mental
Health http://www.nimh.nih.gov/index.shtml/
When you find an article:

Consider how it relates to your focus area

Review the current statistics stated in the article
To complete this assignment, post a summary of the article and a comprehensive response
to the following.

Does the article address a biomedical perspective, a prevention perspective or both?
Please explain.

What level(s) of the Social Ecology of Health Model is addressed in the topic? See p.
15, Figure 1.1 of your text.
Include a hyperlink to the web site to the article that informed your response.
You can post your response any time on or before Day 6 of Week 5.
You may find additional news articles of interest. If so, share the news stories from the
other article(s) with your colleagues in the Class Café. This might provide you with
additional insights about the course content and allow you another opportunity to interact
with your colleagues informally. Be sure to provide a link to the article so your colleagues
can review the article if they would like more information.
Looking ahead
Many of the assignments in this course will be based on your assigned focus area.
After you’ve completed In the News, proceed to the Discussion.
ANDREA MACALUSO
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Discussion: The Social Ecology Health Model
The Social Ecology of Health Model provides a strong framework for comprehending the
influence of the culture and behavior associated with health. This Discussion explores the
model with respect to the Healthy People 2010 focus area assigned during the In the News
assignment.
To prepare for this Discussion:

Review the Social Ecology of Health Model by completing the following exercise.
[insert the drag and drop exercise here]

Reflect on the five hierarchical levels of influence associated with the model
(intrapersonal, interpersonal, organizational, community, and society).

Consider the upstream (primary and secondary prevention) and downstream (tertiary
prevention) approaches to the Model with your assigned Health People focus area.
(See the In the News assignment for more information about the assignment of focus
areas.)
[insert Stationary graphic: Upstream vs. Downstream health perspectives]
By Day 4, post a comprehensive response to the following about your assigned focus
area.

How might you react to being diagnosed with the disease / condition associated with
your focus area? What are some of the cultural biases to being diagnosed with this
disease?

Describe one primary and one secondary method of preventing the health problem (i.e.,
upstream methods). Which would you most likely choose?

Describe two biomedical methods (tertiary prevention) of dealing with the health
problem (i.e., downstream methods).

What are the advantages and challenges of applying the Social Ecology Health Model
to a health problem?
Respond by Day 6 in one or more of the following ways:



Ask a probing question.
Expand on the colleague's posting with additional insight and resources.
Offer polite disagreement or critique, supported with evidence.
ANDREA MACALUSO
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In addition, you may also respond as follows:



Offer and support an opinion.
Validate an idea with your own experience.
Make a suggestion or comment that guides or facilitates the discussion.
Return to this Discussion in a few days to read the responses to your initial posting. Note
what you have learned and/or any insights you have gained as a result of your colleagues'
comments. You are not required to post these final insights.
After you have completed the Discussion, please proceed to the Application.
ANDREA MACALUSO
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Application
There is no Application Assignment this week.
You have completed Week 1. Please proceed to Week 2.
ANDREA MACALUSO
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