1) State health outcome of interest and pick two key behaviors that are important factors leading to your health outcome. Explain importance of these behaviors for etiology, prevention or intervention.
My outcome of interest is prenatal diagnosis of congenital heart disease. One key behavior that can impact this outcome is lack of use of medical care, particularly if access is difficult. I can hypothesize that various stressors (i.e. financial, family stressors) can lead to a lack of motivation to obtain medical care leading to poor health behaviors. If the patient never makes it to the obstetrician for routine screening, there is no opportunity to refer the patient for more advanced imaging at specialty medical centers leading to a lower rate of prenatal diagnosis of CHD. Another possible behavior that can be invoked is obesity. Obtaining adequate images of the fetal heart to make a diagnosis of congenital heart disease is challenging in obese women. During a screening ultrasound in the second trimester, the obstetrician may not have adequate images of the fetal heart with an inability to diagnose congenital heart disease. In fact, more recently fetal cardiac centers are receiving more referrals for “inadequate view of the fetal heart” in obese women.
For the first example, improving ones behavior to utilize medical care would be an intervention to lead to improved prenatal detection of fetal CHD.
2) Describe how you would study the role of one of the behaviors described in Q1 and your health outcome if interest. Incorporate a social factor in the study approach (race/ethnicity, stress, social exclusion).
To assess the role of health care utilization at it relates to this outcome, we would create a questionnaire-based project that would be administered to mothers with a postnatal diagnosis of congenital heart disease in their baby. The questionnaire would ascertain the patient’s general attitude towards health care and what type of health care they received for that pregnancy. The questionnaire responses can be compared to mothers with a prenatal diagnosis of CHD. Many social factors can be incorporated in the study such as race/ethnicity. I can imagine that attitudes towards health care would vary by race/ethnicity.
3) If key health behaviors are strongly influence by neighborhood, income, and/or education, do we need to continue to study how these behaviors influence health outcomes?
Yes, it seems that all of these factors are on the same pathway towards health outcomes. The question is if you intervene at the front end and improve one’s neighborhood, income, education would it lead to a big enough change in one’s behavior to improve the outcome? It would seem likely that intervening on the front end may not change behavior patterns. Social structure, beliefs, family support, mental health and likely genetic factors will influence health behaviors. Many of these factors would still be relevant even if we improved ones income or educational level. Thus, health behaviors should be assessed in addition to other social factors.