Marginalized groups

Introduction
Marginalized groups such as racial minorities, old people, the disabled, mentally challenged persons, commercial sex workers, the extremely poor, gay, lesbian, bisexual and transgendered (GLBT), and those who live in very remote areas bear a great burden of disease. They get affected by chronic health conditions such as diabetes, cancer, hypertension, stroke, and cancer (O’Donnel et al., 2016; Lopez III et al., 2021). These people also suffer from various mental health conditions, including depression, schizophrenia, and bipolar disorder (Schimitz et al., 2019). These health problems explain why most marginalized populations experience high rates of hospitalization and mortality.

Since most of the marginalized persons are poor, they do not have health insurance (Braveman et al., 2018). As a result, they cannot access quality healthcare services for their conditions. Many people in the marginalized communities are also illiterate. This makes it difficult for them to read and understand important health information (Lopez III et al., 2021). It is as well important to note that most marginalized groups live in communities that are underserved by healthcare facilities and healthcare providers (Braveman et al., 2018; Lopez III et al., 2021). This also prevents their access to care services of high quality.

The situation of the marginalized populations clearly demonstrates the importance of prioritizing their health. There is need to put important measures in place that can help to address their health problems. This can lead to the improvement of their health outcomes. The purpose of the current evidence-based practice (EBP) project is to implement appropriate initiatives that can help to promote effective disease control and prevention among the marginalized groups.

Review of Evidence-Based Literature
Various scholars and researchers have given important ideas and views concerning the health of marginalized populations. Robards et al (2018) examined how marginalized young populations in high-income countries access various healthcare services. The results of this study showed that these groups encounter several challenges in the way they engage with the care services. These include lack of knowledge about certain health problems, poor health seeking behaviors, and poor healthcare environments. Schimitz et al (2019) looked at how perceived sigma leads to mental health inequalities experienced by marginalized populations. From the findings of the study, it was shown that young lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations experience structural racism due to the status of their mental health.

O’Donnel et al (2016) examined various factors that hinder and facilitate marginalized groups’ access to primary healthcare services. From the findings of the study, it was established that both personal and structural barriers prevent these populations from accessing primary care. Lopez III et al (2021) studied the disproportionate harm of coronavirus disease on various marginalized communities in the United States. The study’s findings helped to reveal that the disease outcome disparities experienced in the country are as a result of ethnic, racial, and socio-economic status of the affected populations.
Baah et al (2019) reviewed various types of literature pertaining to marginalization with an aim to determine social determinants of health. It was found that associating the social determinants of health with the concept of marginalization is important in understanding healthier delivery inequities and chronic disease disparities among marginalization populations. Pega et al (2017) sought to study the role of intersectoral actions in addressing the social determinants of health. The researchers found that such actions are necessary in helping the health care sector to attain sustainable development goals of promoting the health of all people irrespective of their age.

Braveman et al (2018) sought to define the concept of health equity. From the results of the study, it was concluded that health equity involves reduction of health barriers though initiatives that help to promote the health of groups that are socially disadvantaged. On their part, Ward et al (2018) sought to come up with an appropriate synergetic framework that integrated community-based participatory research (CBPR) with Health Impact Assessments (HIAs) in combating various health inequalities. The study showed that integrating health equity dimension from both CBPR and HIA plays a significant role in improving health equity outcomes.

Project Objectives
The current EBP project aims at achieving the following objectives:
• To improve marginalized groups’ access to quality healthcare services.
• To enhance marginalized populations’ access to health information.
• To promote improved health outcomes of the marginalized groups.

Intervention
To promote effective disease prevention and control among the marginalized populations, there are three main strategies that can be used. Firstly, there is need to construct more health facilities, and recruit more health workers. As noted earlier on, many marginalized people reside in regions that are underserved by both facilities and healthcare providers (Schimitz et al., 2019; Lopez III et al., 2021). Addressing this disparity can help to improve these people’s access to quality care.
Secondly, it is important for the government to ensure that health cover is affordable to every person. Many of the marginalized groups live in extreme poverty. This makes it difficult for them to afford health insurance (Braveman et al., 2018; Lopez III et al., 2021). What this means is that they cannot afford to get care services of high quality. Ensuring that this people have health cover can enable them to benefit from quality services of care for their conditions.

Thirdly and lastly, it is necessary to provide health education to the marginalized populations. The level of illiteracy is high among these groups. Language barrier is also an issue. These problems make it difficult for the marginalized groups to benefit from important health information (Braveman et al., 2018). Providing health education can enable the populations to access the information.

Required Resources
Different types of resources are required in order for the proposed project to be effectively implemented. To begin with, financial resources are necessary. Financial resources basically refer to the required capital or money for implementation of a project (Wheatley et al., 2017; Shirley, 2018). Money is needed for the purchase of materials for construction of healthcare facilities. Money is also required for the payment of project workers.

Human resources are required for successful implementation of any project. Such resources include people who play a role in the performance of different project tasks (Shirley, 2018). Examples are project managers, administrators, and employees. All these people need to collaborate well in order to ensure the success of the project.
Another type of resources required for the current project is materials. These are tangible material supplies needed in a project (Schwalbe & Furlong, 2017). Examples include construction materials, equipment, machinery, and land. There must be enough budgetary allocations for the purchase of these materials.
Additionally, time is another important resource required in the project. Any effective project is one that is implemented within a certain time limit (Schwalbe & Furlong, 2017; Wheatley et al., 2017). To achieve this, there is need to have enough financial resources for the recruitment of project employees, and purchase of materials for the construction of facilities. This can help to ensure that the project is implemented within a short period of time.
Anticipated Measurable Outcomes
The proposed change project has various anticipated measurable outcomes. To start with, one of the expected outcomes is improvement of marginalized groups’ access to quality healthcare services. This can be achieved through the establishment of more facilities, and recruitment of more health workers (Galea & Vaughan, 2019). The project is also expected to improve the targeted groups’ access to health information. To achieve this, provision of health education is necessary (Western Institute of Nursing, 2016; Pratt, 2019).
Another anticipated outcome is to promote improved health outcomes among marginalized groups. This initiative can be effected through control of various diseases affecting the marginalized people (Western Institute of Nursing, 2016; Baah et al., 2019). Moreover, the project is expected to promote equity in the distribution of healthcare services. There is need to ensure that every person access quality care services regardless of his or her age, sex, gender or socio-economic background (Pratt, 2019).

How the Intervention would be evaluated
Any EBP project needs evaluation in order to determine whether it meets its objectives and anticipated outcomes. The current project will be evaluated by an evaluation team that comprises healthcare administrators, managers, staff members, and other stakeholders. For the interest of time, the project will employ summative evaluation. This is a technique that enables the project team to collect and analyze vital data pertaining to the outcome of an intervention (Kaczmarek & Romaniuk, 2020). Summative evaluation is normally carried out after the completion of a project. This means that the current project will be evaluated at the end of its implementation.

Conclusion

Most marginalized populations experience poor health outcomes due to economic and social disadvantaging. They live in places that are underserved by both healthcare workers and health facilities. Many are also poor that they cannot afford health insurance. These barriers prevent them from accessing quality healthcare services. It is as well important to note that some marginalized persons are illiterate. This prevents them from accessing useful health information. To change this situation, there is need to establish more facilities and employ more healthcare providers. It is also important to provide affordable insurance, and health education. These initiatives can lead to effective prevention and control of various diseases affecting the marginalized groups.

References:
Baah, F. O., Teitelman, A. M., & Riegel, B. (2019). Marginalization: Conceptualizing patient vulnerabilities in the framework of social determinants of health – An integrative review. Nurs Inq., 26 (1): e12268. doi: 10.1111/nin.12268.
Braveman, P., Arkin, E., Orleans, T., Proctor, D., Acker, J., & Plough, A. (2018). What is health equity? Behavioral Science & Policy, 4 (1): 1-14. doi:10.1353/bsp.2018.0000.
Galea, S., & Vaughan, R. D. (2019). Public Health and Marginalized Populations: A Public Health of Consequence, October 2019. American Journal of Public Health, 109 (10), 1327–1328. https://doi.org/10.2105/AJPH.2019.305293
Kaczmarek, K., & Romaniuk, P. (2020). The use of evaluation methods for the overall assessment of health policy: potential and limitations. Cost Eff Resour Alloc, 18: 43.doi: 10.1186/s12962-020-00238-4
Lopez III, L., Hart, L. H., & Katz, M. H. (2021). Racial and Ethnic Health Disparities Related to COVID-19. JAMA, 325 (8):719-720. doi:10.1001/jama.2020.26443
O’Donnell, P., Tierney, E., O’Carroll, A., Nurse, D., & MacFarlane, A. (2016).Exploring levers and barriers to accessing primary care for marginalised groups and identifying their priorities for primary care provision: a participatory learning and action research study. Int J Equity Health, 15 (197). https://doi.org/10.1186/s12939-016-0487-5
Pega, F., Valentine, N. B., Rasanathan, K., Hosseinpoor, A. R., Torgersen, T. P., Ramanathan, V., Posayanonda, T., Röbbel, N., Kalboussi, Y., Rehkopf, D. H., Dora, C., Montesinos, E., &Neira, M. P. (2017). The need to monitor actions on the social determinants of health.Bulletin of the World Health Organization, 95 (11), 784–787. https://doi.org/10.2471/BLT.16.184622
Pratt, B. (2019). Inclusion of Marginalized Groups and Communities in Global Health Research Priority-Setting. Journal of Empirical Research on Human Research Ethics, 14 (2) 169-181. https://doi.org/10.1177/1556264619833858
Robards, F., Kang, M., Usherwood, T., &Sanci, L. (2018). How Marginalized Young People Access, Engage With, and Navigate Health-Care Systems in the Digital Age: Systematic Review. Journal of Adolescent Health, 62 (4): 365-381. https://doi.org/10.1016/j.jadohealth.2017.10.018
Schimitz, R. M., Robinson, B. A., Tabler, J., Welch, B., &Rafaqut, S. (2019). LGBTQ+ Latino/a Young People’s Interpretations of Stigma and Mental Health: An Intersectional Minority Stress Perspective. Society and Mental Health. https://doi.org/10.1177/2156869319847248
Schwalbe, K., & Furlong, D. (2017). Healthcare Project Management. Minneapolis, Minnesota : Schwalbe Publishing.
Shirley, D. (2018). Project Management for Healthcare. London: CRC Press.
Ward, M., Schulz, A. J., Israel, B. A., Rice, K., Martenies, S. E., &Markarian, E. (2018). A conceptual framework for evaluating health equity promotion within community-based participatory research partnerships.Evaluation and Program Planning, 70: 25-34. https://doi.org/10.1016/j.evalprogplan.2018.04.014
Western Institute of Nursing. (2016). Creating a Nursing Force for Change. Retrieved from https://www.winursing.org/
Wheatley, L., Doyle, W., Evans, C., Gosse, C., & Smith, K. (2017). Integrated Comprehensive Care – A Case Study in Nursing Leadership and System Transformation . Nurs Leadersh, 30 (1): 33-42. doi: 10.12927/cjnl.2017.25107.