Chapter 14. New Chapter Title

14.1 Section Title

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Critical Thinking Exercise
Applying a Developmental Perspective and Appreciating Diversity

After reading Chapter 14 and the other chapters in this text, you learned that different health issues become salient at different points in the lifespan and that coping resources expand with advanced cognitive development. Furthermore, you have come to appreciate the influence of demographic differences such as gender, socioeconomic status, and culture when it comes to understanding health attitudes and behaviors. Apply what you have learned to the following three case studies.

Imani is a 36-month-old African American female whose family lives in a middle-class neighborhood in New Jersey. Both her parents work in professional jobs; her mother is an attorney and her father is a stockbroker. Her two older brothers are in full-day primary school. Imani has been lethargic for the last week and was rushed to the doctor after having a seizure. She was diagnosed with a tumor in her brain and has been admitted to the hospital for observation and treatment.

Valencia is a 12-year-old girl from the Dominican Republic. She moved to the United States 3 years ago with her parents and two siblings in search of a better life. She lives in an apartment in New York City’s Bronx borough, in a low-income neighborhood that is known for gang violence. She has learned English, but speaks only Spanish at home because her parents are not fluent in English. She has been having dizzy spells for a few weeks, but never told her parents. Finally, after experiencing a loss of vision during her seventh-grade math class, she went to the school nurse, who contacted her parents; they took her to the doctor, who diagnosed her with a tumor in her brain. Valencia has been admitted to the hospital for observation and treatment.

Guadalupe is a 46-year-old mother of four from Mexico. She and her mother, a widow, came to the United States 20 years ago as migrant workers and settled in California, where she met her husband. All three generations of her family live in a small, run-down home in a rural community. For the past several years, both Guadalupe and her husband have commuted over an hour each way to work at a factory. They would best be described as working poor. Guadalupe has been having dizzy spells for several weeks, but did not discuss her health issues with her husband as she did not want him to worry. Her husband was concerned that something was wrong because she has begun showing signs of severe depression and anxiety. She was rushed to the hospital after having a seizure and passing out at work, and was later diagnosed with a brain tumor. She has been in the hospital for observation and treatment.

Question

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As a toddler, Imani will not understand what is happening to her and is likely to be afraid of the unfamiliar hospital setting. She does not have the cognitive sophistication to understand that her condition could be fatal and will take cues from her parents. If they act calm and reassuring, Imani will be less distressed. Imani’s parents are her attachment figures, so she is likely to be concerned about them leaving her (when she goes in for surgery or when one of them leaves to tend to her siblings).

Question

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Imani’s parents are both employed in professional jobs and the health insurance they likely have gives their daughter access to lifesaving health care. Their financial resources make it possible to travel for the best care and their high level of health literacy means that they feel comfortable navigating the health care system. Valencia’s family, on the other hand, does not have the same financial capital and will likely accept whatever treatment is available in the area. Neither Valencia nor her parents are likely to be comfortable questioning the doctors, so they do not understand much of what the medical professionals are telling them. To make matters worse, Valencia has to serve as her parents’ interpreter because of the language barriers, so even more details get lost in translation. Guadalupe does not have insurance so she, too, will be offered treatment at the local hospital. In her culture, elders are the ones who heal the sick, so she has not had much contact with the medical system. Consequently, her health literacy is low. She may decide to wait to see whether natural remedies can help to cure her cancer or at least make the symptoms go away.

Question

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Health researchers have found that telehealth interventions have been successful in helping patients manage a variety of conditions. Chemotherapy supervision at a distance has proven safe and effective (Sabesan, 2015). Telehealth would be useful in all three scenarios. Imani’s parents, Valencia, and Guadalupe could use it to check in with doctors when they have questions about treatment. It would be particularly helpful for Valencia and Guadalupe because it would give them access to more doctors and health services than are available in their communities. They could communicate with their doctors without having to go to their offices for appointments. They would save money on co-pays and Guadalupe would not have the additional cost of taking off work to go to her appointments. Telehealth would also help resolve the language barrier between Valencia’s parents and doctors. Telehealth would provide her parents with access to Spanish-speaking doctors so her parents would not need her to translate. They could ask more questions and be more involved in her treatment.
Sabesan, S. (2015). Specialist cancer care through telehealth models. Australian Journal of Rural Health, 23(1), 19–23.