Health Risk Appraisals are tools that identify and quantify an individual’s risk of morbidity or mortality using demographic, medical and lifestyle information. “Health Risk Appraisals and Medicare”, an evaluation report completed by RAND for CMS, reached the following conclusions.

• Effective Health Risk Assessment (HRA) programs have demonstrated beneficial effects on behavior, physiological variables and general health status
• Interventions that combine Health Risk Assessment (HRA) feedback with the provision of Wellness Plans are most likely to show beneficial effects
• To be effective, Health Risk Assessment (HRA) questionnaires ought to be accompanied by follow-up interventions (e.g., information, support and referrals)

High quality Health Risk Appraisals offer, a computation for individual risk from the following most common diseases and health risk factors.

• Chronic Asthma
• COPD
• Diabetes
• High Blood Pressure
• Ischemic heart disease
• Major depression
• Stroke
• Overweight and obesity
• Use of Tobaccos Products
• Mental health
• Immunizations

The Health Risk Assessment (HRA) collects and analyzes data to predict a individual’s likelihood of experiencing the most common diseases.

Health Risk Appraisals: Demographic characteristics

An individual’s age, sex and ethnicity are indicators of increased risk for certain diseases or conditions. At minimum, the Health Risk Assessment (HRA) ought to collect information, to the extent allowed by law, information on the individual’s age, sex and ethnicity.

The Health Risk Assessment (HRA) ought to include questions addressing the individual’s personal and family history of diseases or risk factors for common diseases or conditions. The Health Risk Assessment (HRA) must include questions to assess health risks related to the personal health characteristics and behaviors listed below.

• Weight
• Diet and Nutrition
• Use of Tobaccos Products
• High Blood Pressure
• Cholesterol
• Physical Fitness
• Alcohol Use
• Traveling by motor vehicle
• Stress Management
• Mental health

Perceived Health Status

The Health Risk Assessment (HRA) ought to include questions that assess An individual’s self-perceived health status. The questions ought to allow an individual to rate their own health status on a relative scale.

Disclosure of use of Health Risk Assessment (HRA) information

The business ought to disclose how the information obtained from the Health Risk Assessment (HRA) will be used and to whom it’ll be disclosed. The business may offer the disclosure and use information within the Health Risk Assessment (HRA) tool or reports or through written communications.

Ability to save/print Health Risk Assessment (HRA) results

Internet-based Health Risk Assessment (HRA) ought to give the individual the ability to save/print his/her Health Risk Assessment (HRA) results. For paper-based Health Risk Appraisals, the business ought to have a mechanism in place for the individual to receive a written copy of the results.

Health Risk Assessment (HRA) Results

Companies ought to offer a printed/printer-friendly web-based report for each individual participant. The report may emphasis on either individual risks for specified diseases or on Wellness.

Health Risk Assessment (HRA) computations may emphasis on either individual risks based on personal risk factors or on overall risk or health. The report ought to offer an explanatory information to assist them understand the outcome. Reports ought to clearly identify specific behaviors that can lower risk for each risk factor, and recommend targets for improvement. Reports ought to include resources (e.g., community programs, web-based resources and materials) that can assist individuals change to a healthier lifestyle. At minimum, the business ought to offer computation for individual risk from the following most common diseases and health risk factors.

• Chronic Asthma
• COPD
• Diabetes
• High Blood Pressure
• Ischemic heart disease
• Major depression
• Stroke
• Overweight and obesity
• Use of Tobaccos Products
• Mental health
• Immunizations

Health Risk Assessment (HRA) report

The Health Risk Assessment (HRA) ought to offer web-based print-friendly results and the ability for the user to print the results. The Health Risk Assessment (HRA) report ought to include a profile of individual risk level for personal diseases or conditions according to age, sex, ethnicity and health risk factors that were identified in the questionnaire. The report ought to clearly identify specific behaviors that can lower the risk for each risk factor and recommend targets for improvements.

Resource Avaiability

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There really is nothing that is more unpleasant for many people than having to spend time in a hospital. Hospitals today are over crowded, but aside from that issue, being away from home while dealing with an illness or while recuperating is thought to have adverse effects on the recovery process.

One way in which the burden upon hospitals is being alleviated and which also offers a pleasant alternative is home healthcare. Previously home healthcare delivery was restricted to a few individuals and only in very specific circumstances, but as hospital administrators and governments began to recognize the many benefits both to patients and taxpayers, the options started increasing. Let’s take a look at some of the delivery options available from a home healthcare service.

Nursing Services

Perhaps the most developed area in home healthcare options is nursing services that run the gamut of medical needs, from maternity through to mental health.

While some of the services a home health care nurse can provide are straightforward, others may require a range of specialized equipment. For example, patients on an intravenous treatment will need to have their own machine, which usually includes a walking stand. A nurse would make regular trips to the home to check the function of the machine and the amount of the prescribed dosage within the drip bag. Specialized provisions such as this may have some fees accrued on behalf of the patient for equipment.

Personal and Home Support Services

The needs of the patient who opts for home healthcare will go beyond just health concerns. Often a patient or his caregiver will require assistance in the running of his home. Home healthcare delivery options include allowances for those running or taking care of a household throughout an illness.

These services include relief workers for a personal caregiver. This respite comes in very handy when you are the person in charge of a household in which a patient resides. In this case, you have become the primary caregiver, and even the most dedicated individual will find himself or herself needing a break from time to time. Home healthcare services can provide this relief by scheduling individuals to come into the home and assume the responsibilities of the primary caregiver, allowing that individual to take some time away from the task.

Each of the areas discussed, as well as those which have not been mentioned, include a range of more specific niches within the home healthcare industry. If you do opt for treatment or recuperation from the comfort of home, make sure that you are aware of all the options that a home healthcare service could provide.

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The last decade has been witness to the giant strides taken by the Indian healthcare scenario, towards modernization and development- gone are the days when those who could afford it had to travel abroad to get highly specialized services such as cardiac surgery, while others had to do without it.

Today, patients from the developed Western nations are coming to India to receive specialized medical treatment. Not only is India meeting international standards, but at prices that compare very favorably with developed countries.

In India, healthcare is delivered through both the public healthcare system and the private sector. The public healthcare system consists of healthcare facilities run by the central and state governments, which provide services free of cost or at subsidized rates to low-income families in rural and urban areas.

In the private sector, healthcare facilities are owned and run by for-profit companies and non-profit or charitable organizations.

In the earlier era, the high custom duties imposed by the government on imported medical equipment was a big deterrent to set up private hospitals offering specialised medical care using state of the art equipment, usually imported from abroad. As a result, there were very few privately run large hospitals but there were many small private practitioners who provided primary and secondary care.

The low level of medical insurance was another major problem faced by the private hospitals – not having insurance meant that the patients had to pay for the treatment from their own pockets and not everyone could afford the high costs of private healthcare.

The rise in the levels of awareness has led to a surge in the medically insured nos. and now the people want nothing but the best medical care.

The innovations whether in business models, in marketing & promotion or in the use of technology, have created unique experiences for patients.

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Why Pursue Mental Health Integration?

It is the right thing to do: The NCCBH vision statement provides the foundation for our work: We are committed to creating and sustaining healthy and secure communities, achieved through a system that holds the needs of consumers paramount, regardless of their ability to pay.

Vital to this commitment is a network of organizations and advocates promoting services of unparalleled value.

NCCBH members primarily serve public sector consumers, those with severe and persistent mental illness or serious emotional disturbance-the needs of this population are often overlooked in primary care and integration planning. We must assure that their needs as well as the needs of the broader community are appropriately addressed.

Many people in the broader community now receive their behavioral healthcare in a primary care setting, and the gap between the medical and behavioral healthcare systems must be bridged: As noted by Robin Dea and many other commentators, there is:

“evidence that many, if not most, people coming into primary care are being treated for psychosocial problems, not organically based medical disease . . . evidence of medical cost offsets from treating behavioral health problems presenting as physical health problems in the primary care setting . . . the assumption that if adequate detection of early stage psychiatric illness took place in primary care, there would be some prevention of patients going to more severe episodes of major psychiatric illnesses . . . and primary care is where most people who have behavioral health problems are in fact seen.”

Some of the important findings from the research field include:

-The Epidemiologic Catchment Area (ECA) Study and articles based on this survey data, reported the finding that about 50% of care for common mental disorders was delivered in general medical settings. However, many subsequent studies have shown that these disorders may be undiagnosed or under-treated.
-Screening systems, treatment guidelines and provider education in primary care are necessary but not sufficient steps to ensure a difference in outcomes.
-Collaborative and stepped care has been shown to achieve outcomes that are better than “usual care”.

There is the opportunity for quality improvement of care within the primary care and specialty behavioral healthcare settings: Studies have shown that many people with depression stop taking their medications before the minimal time required to effectively treat an episode of depression. Patients at Group Health Cooperative who initiated medications for depression with their primary care physician and received targeted stepped up care and relapse prevention support were significantly more likely to adhere to adequate dosages of medication and to demonstrate a greater decrease in depressive symptoms.

Application of research findings such as these through adoption of evidence-based practices in both primary care and specialty behavioral health (BH) settings will result in better outcomes for consumers.

With the publication of Priority Areas for National Action: Transforming Health Care Quality, the Institute of Medicine’s 2003 follow up to Crossing the Quality Chasm: A New Health System for the 21st Century, a major opportunity and challenge has appeared for the public mental health system.

The Quality Chasm recommended the systematic identification of priority areas for national quality improvement; Priority Areas proposes twenty areas for transforming health care nationally. Included in this list are major depression (screening and treatment) and severe and persistent mental illness (focus on treatment in the public sector).

Their inclusion as priority areas, as well as the findings in the Interim Report from the President’s New Freedom Commission on Mental Health, with its observation that the system is “fragmented and in disarray-not from lack of commitment and skill of those who deliver care, but from underlying structural, financing and organizational problems” suggests that the time for new strategies is at hand.

Many people being served by public behavioral health services need better access to primary care: A rationale less frequently articulated for integration is that the specialty BH system, especially the public sector focusing on the severe and persistent mentally ill adult population (SPMI) and seriously emotionally disturbed (SED) children, serves a disabled consumer population with healthcare needs that are frequently under-addressed due to difficulties in obtaining medical services.

Most state Medicaid waivers related to coverage for physical healthcare have focused on enrollment of the TANF population into Medicaid managed care plans, leaving the disabled Medicaid population unable to adequately access care, or in better situations, reliant on “safety net” providers-community health centers (CHCs) or county delivered health services.

Community health centers serve people who need better access to behavioral healthcare. These “safety net” providers serve a broader scope of patients than just the Medicaid population. But many states have implemented mental health Medicaid waivers that focus the public mental health system on the SPMI/SED and Medicaid populations, with minimal levels of support for non-SPMI/SED or uninsured populations. Often there is not a good match of target populations between the two systems. If the Medicaid mental health program also has a highly managed service authorization and payment methodology, there may be additional barriers to reimbursement for mental health services.

This has led to frustration for “safety net” healthcare providers because they have difficulty obtaining behavioral health services for their non-SPMI/SED or uninsured patients. In a recent survey of CHC medical directors, 80% indicated that cost is the main barrier to behavioral health care for their uninsured populations. The recent financing and development of behavioral health services in CHCs addresses this frustration and is just the latest in a series of efforts to acknowledge that a large proportion of the population gets their behavioral health services in primary care.

Because behavioral health clinicians are a resource for assisting people with all types of chronic health conditions: Yet another reason for integration is the potential contribution of BH clinicians regarding behavioral and lifestyle change: providing interventions targeted at better management of chronic disease, supporting and “leveraging” the time of primary care providers through disease management programs.

Disease management activities focus on several areas: early identification of populations at-risk for costly chronic disease (e.g., asthma, diabetes), care interventions that utilize evidence-based practices, education-intensive orientations that focus on both patient and provider, care management and a coordinated approach across multidisciplinary treatment teams, and a method for systematic data collection that measures clinical and cost-effectiveness. Large organized healthcare systems, such as Northern California Kaiser-Permanente, implement their major disease management programs with specifically assigned nurses as care managers and educators.

However, many physicians in individual or group practices do not have access to this level of support unless they are in the network of a health plan with active disease management programs. In markets where primary care and multi-specialty groups have accepted accelerated risk, disease management approaches will be especially value-added.

We are in a time of significant public policy activity regarding financing of the national healthcare system and the uninsured population. As we approach the 40th anniversary of the founding of the community mental health center movement, the dialogue has returned us to our public health beginnings-serving the needs of a population.

The Health Resources and Services Administration (HRSA) Primary Care Integration Initiative is currently being implemented across the country. The HRSA initiative includes: identification of system issues related to integration and the development of related strategies; development of a service manual for CHC behavioral health services; development of BH intervention models for CHCs; and grants for establishing BH services in existing CHCs.

Newly funded CHC sites will be expected to provide dental, mental health and substance abuse services, either directly or by subcontract arrangements. CHCs are in the process of decision making about building their own BH services or contracting for BH services, as they prepare their grant applications. (The NCCBH website, www.nccbh.org, has a Primary Care Integration Resource Center with more details about the HRSA process.)

At the same time that HRSA is putting new BH resources into CHCs, reports are emerging from many states indicating that the public mental health system is funded at somewhere around half the level that is needed. In the private sector, the relentless downward pressure on behavioral health PMPMs has also reduced overall system resources, shifting cost from the private sector to the public sector.

Reports such as these were released prior to the current fiscal crisis in state Medicaid programs; rather than addressing the shortfalls, there are significant new reductions in BH services in many states. And, the implementation of managed care methods for Medicaid have made it difficult for some community based BH providers to continue to enact their mission of serving the needs of the population, regardless of ability to pay.

The implications for system-wide duplication and competition for the scarce resources of BH staff and funding, as well as the opportunity to improve consumer access to both health and behavioral healthcare services, suggests that collaboration is a priority at the national, state and local levels. Good public policy will work at sustaining, supporting and requiring collaboration between the two “safety net” systems of community mental health centers and community health centers.

The conceptual model proposed in this paper can become the basis for HRSA grantees to work with their partners in the public mental health system to fully define working relationships and collaboration on behalf of consumers of care.

In summary, the reasons for integration are grounded in the desire to improve access to both primary care and behavioral health services; ensure that there are evidence-based practices as well as consistent communication and coordination of clinical activities (especially medication management-a key concern of consumers) among the providers serving any single individual; wed the skill sets of primary care physicians and BH clinicians in order to better manage chronic health issues; and, participate in and shape the public policy debate regarding how services should be organized, delivered and financed in ways that ensure that needs of public sector SPMI/SED consumers and the broader community alike are met.

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I would like to pay monthly to a health insurance company so my mom could get health check up when she needs it.

Do you know any health insurance companies that can accept low monthly payments since I don't get paid that much?
We live in northern california.

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Personally, our healthcare costs are so far up over $2,000 from 2007 and $3,100 from 2006. How can that be? In 2006 my husband fought cancer and our spending is more than doubled this year?!?!

It is absolutely insane. I wonder about the families that don’t have healthcare coverage or are on limited income. What do they do? How do they make it? How do they get through a health crisis?

It has been estimated that a half-million people file for bankruptcy each year due to medical costs/bills.

What can we do? According to AARP in their July-August 2008 magazine we need to stand up and let our legislature know that we need healthcare reform. They also said that we consumers need to be wiser shoppers when it comes to our doctors and healthcare providers. But the biggest culprit to increase cost in healthcare expenses is the vast number of dollars wasted on paper pushing. The articled noted that we pay twice as much than Canada in administrative costs and that by changing the way we are billed, insurance companies are billed, etc. we could save $360 billion dollars each year.  Now let’s account that saving to families, it would be a start.

But what other practical approaches can we take to save money on healthcare costs. No matter what our income level there are services out that that we can all utilize at little if any costs. Health Fairs many types of organization offer these, social service organizations, towns, libraries, park districts, etc. At a health fair you can typically expect to get free screenings, complementary vitamins and supplements, immunizations and more. These are not generally for just low income. But those of us going through financial challenges should look into Mobile Health Clinics and our local health departments for free or greatly discounted health services.

Some colleges and universities offer free or greatly discounted services such as dental care exams, minor dental work, check ups, x-rays, etc. provided by their students, whom are supervised and check by a licensed dental professional. Same is true for other medical services.

Some cost cutters will tell you to shop around and do comparison shopping for doctors as you do for other products and services. The only thing, here is that I like my doctor, I’ve been going to the same one for almost 20 years. Maybe I can talk to him about prevailing local average charges for his services.  Look into a Healthcare Savings Program in your community, these programs negotiate better prices on behalf of their members which equates to savings for you.

Ask for samples of medication to help with prescription costs also make sure to ask your doctor for generic or other substitutes for needed medication. Shop at a drug store that offers discounts such as those touted in the media from Costco. Shop on line and utilize mail in prescription programs through your insurance company.

A colleague has shared that she has spent less than $100 a year on healthcare costs for almost ten years. She uses natural remedies, watches her diet, drinks alcohol in moderation, walks three miles 4 days a week. When she does start to feel under the weather she reaches for her “Nutritional Healing” book. She claims that by just following the suggestion for those ailments you may have can greatly reduce the onset of them and in some cases prevent them all together.

Recently I read a story about a mother who did not take her child in for annual preventive dental care, which by the way was covered 100% by insurance, for 3-4 years, now she has a bill of over $1,000 for root canal’s. Preventive medicine does work to keep you healthy and protect your pocket book. Keep up on annual check ups for physical, dental, eyes, etc.

Many hospitals and some bigger medical practices offer programs that help to cover your out of pocket in some cases they will just take the covered amount and waive the difference you would have had to pay. If you don’t have insurance ask your doctor if he will take the negotiated amount that he/she agrees to with insurance companies. I have heard of many practices doing this. We are all hurting, gas prices are at all time highs, food is on the rise, pay raises are down if given at all, talk to your healthcare professional let them know you could use some help or the very least some guidance on how you can cut down on health care costs.

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Also, I heard that universal healthcare would result in everyone getting healthcare, but it would involve long lines. Everyone would get treated for cancer and not worry about the bill but they would have to wait 6 months for treatment.

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If you’ve always wanted to work in a hospital or doctor’s office, becoming a healthcare support staffer might be just the shot in the arm your career needs. With training from a top-notch career college, in about 8 to 12 months, depending on the program, you can be a valued team member in a hospital, lab, pharmacy, physician’s office or dental practice.

According to the Department of Labor, healthcare will generate three million new jobs between 2006 and 2016, more than any other industry, employing over 12 million workers*. California, in particular, has a shortage of healthcare professionals, with vacancies across the state, raising salaries and increasing employment opportunities for high school graduates, career changers and other job seekers.

Although the media has focused on the critical need for registered nurses (RNs), well-trained and competent clinical support staff, such as Medical Assistants and Surgical Technologists, as well administrative support staff, including Health Claims Examiner/Medical Billers, are also an essential component in providing quality healthcare services.

In the past, on-the-job training might have been sufficient to become a member of a medical/dental office or lab support staff. But today, the bar has been raised: workers need to hit the ground running, with a complete understanding of the advances in medical technology, as well as the knowledge and practical skills necessary to be competent in different environments, whether private, public, governmental or university-based. As a Medical Assistant, for example, you might expect to help out with basic insurance billing, medical records and other office skills, but you might also check vital signs or help set up for physical exams. Medical Assistants have found work in hospitals, clinics, HMOs, and home health organizations.

Other hands-on, patient-oriented careers that have been increasing along with a growing and aging population are Massage Therapist, Pharmacy Technician, and Dental Assistant.

Vocational Nursing is a respected, rewarding career that allows you to help people each and every day. It’s a career that offers high demand opportunities for qualified nurses in hospitals, doctors’ offices, clinics, colleges, home health agencies, and convalescent homes. It’s also a great first step for those considering further advancement in nursing or other healthcare careers.

Optical Dispensing is another field with great potential. An optical dispensing specialist who passes the National Opticianry Exam and Contact Lens Registry Exam can be qualified to work as an ophthalmic lab technician, contact lens fitter, eye doctor’s assistant, manufacturer’s representative or optical office manager. You can even open your own store someday — an exciting and challenging opportunity to realize your financial and personal independence.

No matter what healthcare support staff position is right for you, look for an accredited college with qualified faculty, modern facilities, and placement assistance. An admissions representative can help you figure out where your aptitude and talents lie. And when the time comes, you can receive help with interviewing skills, resume preparation, and job leads.

“I felt like I was in a dead end in my career, and now a whole new world has opened up for me,” said one recent healthcare graduate.

For more information about becoming an American Career College student, call 877-809-8686 or complete the form below.

*”U.S. Department of Labor, Occupational Outlook Handbook,” 2007-2008 edition.

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Making real change seems a formidable challenge, but the only limitation is in the way we think. That’s right…the answers to positive change lie within each of us and center on the way we think about behaviors, attitudes and the corporate roles we play.

We can all point to poor communication (from others), lack of candor (in others), dishonesty (in others), and turf battles (fought by others) as the root causes of most problems faced by hospitals today. But what if we turn the tables and start to look within ourselves for the forces that will produce positive change?

Chances are you want to make a difference but don’t believe you have the resources to create real results. As a hospital administrator, department chairman, clinical director, or physician leader, you may believe there is something “out there” that will help you make the right choices and have a significant impact. I’m here to tell you, you already have what it takes––if you’re willing to make some personal changes.

These five actions, taken on a personal level, are guaranteed to create radical positive change in your healthcare setting. But remember––to change your healthcare center, you must first change yourself.

Action 1: Learn on the Run

Effective medical care comes from taking in signs, symptoms, lab results and diagnostic studies, then combining them to arrive at an accurate diagnosis and treatment plan. Unfortunately, many of us do not apply these same skills to the rest of our jobs.We stay attached to our patterns in spite of indisputable evidence that what we’re doing isn’t working. We even defend what doesn’t work, because it’s comfortable.

Learning on the Run is based on “taking in” all available data, then “diagnosing” the problem before acting. Become willing to drop your defenses, take in all the feedback you can gather and then assess the situation. Don’t allow yourself to become defensive, respond from habit or act based on stale relationship patterns. Open yourself up to learning––looking at the situation with fresh eyes, from new viewpoints.

Action 2: Drop the Roles That Bind You

Most stress and upset in healthcare settings result from our tendency to get stuck in the drama of the moment and inauthentic patterns of behavior. Authenticity––congruence between your inner state of being and your outer behaviors and actions––makes you a high-integrity player, regardless of title, position or identity.

Ask yourself: Do our roles guide our behavior, or do issues drive our behavior? These role-driven behaviors may sound familiar:

The Chief of Medicine has a predictable “intellectualizing” and “astute diagnostician” style of communicating, and is very defensive.

The Chairman of Family Practice has a long-suffering and martyr-like identity.

And Surgeons––well, they act like surgeons!

One of my favorite moments of authenticity occurred a few years ago during a highly charged Medical Executive Committee meeting at a major medical center. A very dominating, charismatic and extremely influential Chief of Cardiac Surgery known to be “surgical” even when outside the operating room, jumped to his feet still dressed in surgical garb. He bellowed, “Dr. High and Mighty Heart Surgeon is about to show up and I can’t stop him!”

The entire group took a collective breath and broke out in relieved laughter. Needless to say, the drama that had previously played many times was averted and energy was freed to deal with other issues and problems.

Now, how is your authenticity? Does your role bind you? If so, let it go.

Action 3: Take Responsibility (Be Accountable)

Too many people seem to feel more responsible for explaining their results, or lack of results, than for achieving them.

Accountable individuals, on the other hand, make solid agreements and take 100% responsibility for their experiences and commitments. They look inside themselves, wondering about their contribution to problems, rather than lashing out and making them somebody else’s fault. They communicate frequently with updates, they’re reliable on tight deadlines, and they rarely drop the ball or manipulate reality to stand solo in the spotlight. If they must change an agreement, they promptly alert those who will be affected and renegotiate the agreement.

You must be willing to ask yourself what part your attitude, words or behaviors play in interactions. When I was asked to help the Board of a major healthcare organization improve the quality and effectiveness of their meetings and planning sessions, I observed Board members’ discussions, breakout groups and activities during recesses and social activities. I later reported on my observations, calling these physicians on their hallway conversations, gossiping, politicizing, and criticizing of people who weren’t around. You know the general themes: “Ain’t it awful?” “There’s nothing we can do.” “It’s not our fault.”

Although I enjoyed a close relationship with the group, their response to my observations was one of deafening silence. I waited, with “tar and feather” fantasies of humiliation parading through my mind.

Finally, a doctor known both as a firebrand and as a respected Board member stood. “I’m choking on these words, but I have to say I’m a gossip.” He then proceeded to confess to their faces what he had said about these people behind their backs. As he owned his behavior and committed to speaking up more in meetings, he created the opening for many other people to do likewise. It became a radically responsible meeting with unforgettable breakthroughs.

You can encourage personal accountability by asking yourself these questions:

• What is it about my attitude or behavior that keeps this going?

• Is there anything I’d like to communicate, but haven’t?

• Have I broken or missed any agreements?

• What can I learn from this situation?

Action 4: Tell the Truth

Just as in today’s corporate world, hospital workers suffer from epidemic levels of lying. About 95% of the time, we lie or manipulate the truth because we want to control the uncontrollable: others’ reactions or emotions.We actually believe that the truth is not good for people and that we are protecting them by withholding or shading what’s real.

This is wrong and it slows your facility down! Truth instantly gets all the information on the table so everyone involved can quickly make informed decisions with the benefit of all details and opinions. True power and enormous speed are the results when people deal directly with the truth, and with one another.

Much of the exhaustion and burnout of our medical lives comes from the energy expenditure of not telling the truth. The host of reasons generally falls into one of three categories: not facing a feeling, not communicating an experience, or not keeping an agreement. As soon as you face these energy-eaters, you’ll fast-forward your healthcare interactions into far greater ease and speed.

Perhaps you’ve done something you feel guilty about and you haven’t come clean with the other person. You may feel angry with someone or hurt about something someone has said, and you haven’t told the person directly. If you don’tcommunicate the truth directly, your inner self will keep reminding you with random flashes and thoughts, eating valuable time and energy from your day.

Perhaps you didn’t follow through on a commitment.  Such “integrity slips” tend to drag our energy down. All we have to do to get back to a highly productive state is to handle the broken agreement through some kind of direct communication. Tell the truth.

Is there someone with whom you need to communicate? Is there something you’ve left undone? What will actually heal and resolve this particular issue? Each time we’re willing to tell a hard truth, we become lighter, faster, a positive force for change.

Action 5: Awaken Your Sleeping Giant

Does your organization focus time and energy on improving staff weaknesses, or capitalizing on staff members’ talents and strengths?

Truly successful people get “good enough” at basic skills, but optimize their natural gifts, their areas of genius. They also recognize where they don’t need to be a genius and delegate those areas to others. When your staff members are allowed to align their purpose and genius with their jobs, your health center’s efficiency, productivity, satisfaction and joy will skyrocket.

In healthcare, we constantly ask ourselves to set aside gifts and passions to do “what needs to be done.” Instead, let’s bring our gifts to the challenges at hand and thrive and expand as a result.

Our combined “healthcare voices” scream that the problems we face today are bigger and more complex than these five actions suggest. Because we doubt the effectiveness of simple solutions and strategies, we continue old, unproductive patterns of indirectness, defensiveness, blame and inadequate communication. But these don’t work.

Today in medical therapeutics we are able to abandon old therapies and technologies in favor of those that work. To gain true power for positive change in our organizations, we must be willing to abandon personal behaviors and attitudes in favor of new ones that work.

Adopting these five actions has completely transformed my life and the lives of thousands of clients. They’re yours, now. Your choice is a personal one. Take action and realize your dreams. Your next decision determines your healthcare facility’s future.

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In which John sweats through his shirt while discussing the American health care system and various proposals for reform, including the public option, nonprofit health insurance cooperatives, and continuing to feed the pig.

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The field of medicine has made impressive advancements both in the diagnosis and treatment of most diseases. But, the soaring prices of health insurance plans make it difficult for low-income wage earners. They claim that getting a health insurance policy is out of their reach.

However, health insurance has been made mandatory by law in California. The need for health insurance both for families and individuals is critical as health insurance provides timely financial security to the insured during sudden medical emergencies. The state of California has a plethora of health insurance companies engaged in fierce competition to provide quality service to its customers. As a result the consumers are the beneficiaries as they can obtain the best plans at the most affordable prices.

Every state in the U.S. has its own health insurance regulatory board to oversee and regulate the practices of insurance providers within their jurisdiction. In the state of California, they aim to provide affordable health insurance outreach programs particularly to medium and low income wage earners. Health insurance laws in California are rigidly enforced.

The Medicaid program was created specifically for low wage earners in California to provide affordable health insurance coverage to the maximum number of uninsured individuals. This insurance outreach program is funded by both the federal and the state governments. There is yet another advantage as some employers do not include the families of employees in their insurance coverage. Such employees can avail of the Medicaid program if they want to include their families in their insurance coverage. Applicants are required to furnish some documents that may include proofs of their employment and income. They will also be subjected to a credit check to qualify.

For those residing in California, there are various health insurance providers with a variety of health plans to choose from. But you will have to do some research to find the health coverage that will be best suited for you and your family. Individual health insurance plans in California that are directly purchased by the individuals are certainly more expensive than group insurance. Family health insurance plans, as the name implies, includes the applicant and all the family members in its coverage. There is a California health insurance coverage that is best suited for you and your family in the event of unforeseen medical expenses. You have to exercise discretion and do proper research to find the best affordable health insurance you need.

Owing to the growing number of immigrants coming into the state of California, the number of uninsured individuals is steeply rising. It was due to this factor that the California Health Insurance Act was passed in 2003 to provide the largest possible number of workers and their families with affordable health insurance coverage.

There are health insurance policies galore in California and most of them are regulated by the California Department of Insurance and you have to select the one from many different kinds, depending upon your needs, budget and health care requirements. Some of the policies are: Indemnity Policies (Traditional Fee-for-Service Insurance), Preferred Provider Organizations (PPOs), Health Maintenance Organizations (HMOs or Managed Care), Self-Insured Health Plans (Single Employer Self-Insured Plans) and Multiple Employer Welfare Arrangements (MEWAs). There are also special policies like: Major Risk Medical Insurance Program (MRMIP), Healthy Families Program (HFP), Access for Infants and Mothers Program (AIM), Pacific Health Advantage (PacAdvantage), and other Supplemental Health Insurance Policies.

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UnitedHealthcare, a UnitedHealth Group company, and Health Net, Inc. today announced that UnitedHealthcare has completed the previously announced acquisition of Health Net of the Northeast’s licensed subsidiaries and has obtained rights to renew Health Net’s membership in Connecticut, New York and New Jersey. The transaction has received all regulatory approvals required for completion     “UnitedHealthcare has a long, successful history of providing people in the Northeast with affordable, quality health care options, and we look forward to serving the health and well-being needs of Health Net’s Northeast members as they renew with UnitedHealthcare,” said Jeff Alter, UnitedHealthcare chief executive officer, Northeast Region. “With UnitedHealthcare, Health Net’s members in the Northeast will gain access to one of the largest local and national care provider networks, robust clinical programs, proactive care management and wellness tools, and technology that simplifies and enhances the health care experience.”

“We believe UnitedHealthcare is the best option for our customers in the Northeast,” said Paul Lambdin, president of Health Net of the Northeast. “We look forward to working with UnitedHealthcare on a seamless renewal process that we believe our customers will appreciate. We will continue to maintain the high quality of service our customers have come to expect from us.”

As Health Net’s commercial customers in the Northeast reach renewal dates, UnitedHealthcare will work to enroll them in a comparable Oxford or UnitedHealthcare plan. Until members are enrolled in a replacement plan, their current Health Net benefits remain in effect under their existing Health Net contracts. There will be no interruption to coverage or payments during this transition period.

Health Net will continue to administer all of the Health Net plans—commercial, Medicare and Medicaid— in the Northeast under administrative services agreements with UnitedHealthcare until members transition to UnitedHealthcare plans. For Health Net’s Medicare Advantage members in Connecticut and its Prescription Drug Plan members in New York, there will be no changes to the 2010 plans. UnitedHealthcare expects to file 2011 Medicare plan benefits with the Centers for Medicare and Medicaid Services  during 2010 that will be made public after receiving CMS approval, beginning October 1, 2010. Subject to approval by CMS, UnitedHealthcare will begin operating these Medicare plans on January 1, 2011.   Approval has also been requested from the New Jersey Department of Human Services to transition Health Net’s New Jersey Medicaid business. Upon receiving approval, Medicaid members currently enrolled in Health Net of New Jersey’s Healthy Options plan will be transitioned to UnitedHealthcare’s AmeriChoice plan, unless they choose another participating health care plan. For Health Net’s Medicaid members in New Jersey, there are no expected changes until the middle of 2010.

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Beliefs and Practices in Women Health

• Ramaiah Bheenaveni *

Rural women’s health is an infinitely broad topic. Many Indian women have come from circumstances in which women have limited access to healthcare. Traditionally, there has been discrimination towards women in decision-making; access to resources such as food, education and health care; job opportunities; and in child-rearing and parenting. However, women’s health in rural areas affects everything in their environment from their families to their economies and vice versa. A woman’s health, especially among the poor and illiterate, is often neglected not just by her family but by the woman herself. She is taught not to complain and if she does then she is directed either to use condiments in the kitchen or try faith healing.

Man is unique in that he has a distinct cultural environment of his own. This includes all the conditions in which men are born, brought up, live, work, procreate and perish. Culture as an environment is deeply related to the health of humans. It includes patterns of social organizations designed to regulate a particular society; one can understand the behaviour of people belonging to various sections and predict how an individual of a particular section will react in a given situation. With our knowledge of health, the treatment of diseases among ignorant peoples appears to be strange since they frequently follow practices of praying, wearing of amulets or consulting an exorcist who recites certain verbal formula. Hence, we can say that beliefs and cultural practices are predominately playing significant roles in the human health more peculiarly in the health of women.

Many rural people did not know about the services set up for them at sub-centres and PHC by the government because they did not see any evidence of these services being provided for them. As a part of the awareness programmes, the health workers (ANM) have been organizing to several exposure trips at the villages. It was there that the women were informed about the specifics of various services supposed to be made available to them. This encouraged some of them to ask questions and report on the situation in their PHC. They explained that though a nurse did visit their village it was not a daily visit, nor did she go beyond a certain point in the village, and certainly did not take a round of the village. They made a show of doing their duty by providing nominal services.

A variety of factors, including an older population, a limited supply of health care providers, and further distances from health care resources may contribute to special health concerns for people in non-metropolitan areas. Access to health care and social services are critical issues for rural women.

Belief is the psychological state in which an individual is convinced of the truth of a proposition. Like the related concepts truth, knowledge, and wisdom, there is no precise definition of belief on which scholars agree, but rather numerous theories and continued debate about the nature of belief 1.

The cultural phenomenon of social organization, according to Giger and Davidhizar (2004), includes groups in the social environment that influence cultural development and identification. The family, an important aspect of the social organization phenomenon, strongly influences cultural behavior through a process of socialization or enculturation of children and group members (Giger & Davidhizar; Niska, 1999). These learned cultural behaviors guide individuals through life situations, events and health practices. Understanding family from a cultural perspective is a significant element in providing nursing care to Mexican-Americans since Giger and Davidhizar identify the family as being most values in this culture.

Environmental control is defined by Giger and Davidhizar (2004) as the ability of persons within a particular cultural heritage to plan activities that control their environment as well as their perception of one’s ability to direct factors in the environment. Kuipers’ (1999) discussion of this model, in relation to Mexican-American culture, emphasized the construct of environmental control with a focus on locus-of-control, health beliefs, and folk medicine. Locus-of-control explains the way in which individuals, within their cultural environment, perceive their ability to control what happens to them and to their health. Health may be viewed as being dependent on outside forces or their own actions (Bundek et al., 1993). Beliefs about health and illness, which are components of environmental control, affect health practices, use of health resources, and a person’s response to experiences of both health and illness (Giger & Davidhizer, 2004; Northam, 1996). A third component of environmental control, folk medicine, includes alternative therapies such as using herbs and teas or visiting a cultural folk healer.

Objectives:

1. Exploration of women beliefs on health, risk and their relationship to lifestyles;

2. Elicitation of their views across a range of health-related behaviours and practices, especially puberty, menstruation, pregnancy and child rearing, and assessment of the potential for the positive promotion of women health in these and other areas of her sexual health.

3. Identification of the sources of information and influences on the development of health beliefs amongst women, particularly with respect to common elements in attitudes to risk-taking across a number of health beliefs and practices.

4. To focus on what women themselves know and want to know, including the salience of health, and the relevance of health-related knowledge in their lives

Hypothesis:

1. There is a positive relationship between social beliefs and cultural practices of a given society

2. Positive relationship may be observed among the social beliefs and cultural practices and various other factors such as caste, religion, social and traditional customs in society

3. The explanation for the persistence of belief systems is that people remain committed to them, but for this commitment to last long, the belief system must be validated

Research Design:

A quantitative and qualitative study, building on our previous work in this area, concerning the knowledge, attitudes, beliefs and practices of female children and young women to health, risk and lifestyles. A guiding methodological principle underpinning the study was the development of a sensitive research design for rather than on women: a study grounded not simply in what women know or need to know, but also in what they want to know and feel to be important in the context of their everyday lives. The methods enabling these principles to be taken forward are described below.

a) Area of the Study:

The Telangana region of Andhra Pradesh consists of ten districts namely Hyderabad, Ranagareddy, Mahabubnagar, Medak, Adilabad, Nizamabad, Karimnagar, Warangal, Nalgonda, and Khammam. From this region, the village Ramchandrapur in Koheda Mandal of Karimnagar district has been randomly selected as an area of the study.

b) Universe & Sampling:

According to 2001 census, the village Ramchandrapur has an approximate population of 1840 who from nearly 550 families. This village has a primary health centre (PHC), but lacks a major hospital within a range of 35 kms. And this village has been selected as universe for this study.

So for this study, the researcher adopted stratified-proportionate random method of sampling based on caste composition of the villagers and selected the respondents from the families mentioned in the habitation list of Ramchandrapur. This village population data was collected from Supraja Seva Samithi, a voluntary organization, which is working in the region for the last 10 years in the fields of health, education and environmental protection. The list consists of various caste grouping and from which proportionate stratified samples were selected. Then a list of about 181 respondents was prepared for data collection. Therefore, it is obvious that an attempt has been made to present a general picture of community data and on the basis of which, views and attitudes of the respondents were taken into consideration.

C) Tools of Data Collection:

As the research is qualitative and quantitative, non-participant observation and interview schedule was adopted for the collection of primary data. The aspects that will cover in the interview schedule were defined under two parts, one is for socio-economic and cultural status of respondents such as name, sex, age, social status, education, religion, income, nature and type of the house, etc. and the other for socio-cultural beliefs and practice patterns in health and the related treatment of the villagers.

D) Analysis and interpretation of data:

After arranging the collected data through tabulation and classification, they were analyzed and interpreted in the socio-cultural context so as to give a scientific basis to the study. Although statistical methods like frequencies, percentages, means, standard deviations, t-test, chi-squire and ANOVA have been used in the study, they were applied in a relevant way.

Findings:

Socio-Economic Profile:

During the field work, observed that 22 castes were appeared and most of the respondent belongs to the BC castes like Yadava, Gouda, Munnuru Kapu, Vishwa Brahmin, Mudiraj and a insignificant number of people belongs to services caste like Mangali, Chakali, Mera and so on. A considerable amount of people belongs to SC community i.e. Mala and Madigas. Only a few respondents belong to ST (Erukala) community. Out of the 181 respondents, 55 percent are male and 45 percent female,. This research is carried out with almost all the equal four fold age groups of respondents. Thus, it is noted that age group is scattered in this study. More number of respondents i.e. 91% belongs to Hindu religion and 5% are Muslim. Nearly 4% of the respondents belong to Christianity. It is also proved that common phenomena of religion composition in India.

In this village, a majority of the respondents i.e. 82 (45%) are illiterates. The next more number of respondents have studied up to primary and secondary level i.e. 24 (13%). There are 21 (12%) of the respondents can read and write. A significant number of respondents i.e. 18 (10%) claimed to have studied up to college level while the small number of people who have studied up to professional level, technical level and others stands at 7 (4%), 3 (2%) and 2 (1%) respectively. The findings reveal that more number of the respondents i.e. 55 (30.4%) are labourers and one-fourths of the respondents i.e. 45 (24.9%) are engaging in the farming. On the whole 38(21%) are continuing their caste occupation while 20 (11%) and 17 (9.4%) respondents are doing other occupation and brought up into the service sector respectively. Only a few of the respondents i.e. 6 (3.3%) are carrying out business.

It is also noted that a majority of the respondents i.e. 84.21% are living under the tiled houses and a significant number of the respondents i.e. 15.79% posses R.C.C houses. A substantial number of the BC community respondents i.e. 75% owned the tiled house and rest of them i.e. 14.29% have R.C.C. houses and 8.04% own asbestos roofed houses. Most of the SC respondents i.e. 91.49% are residing under the tiled houses while only 8.51% consist R.C.C. houses. Among the ST respondents, 33.33% have R.C.C., tiled house and thatched house equally. Regarding the income, less than 24% of the respondents earn Rs. 1501 – 2000 per month. Almost equal number i.e. 22.7 and 21.5 % of the respondents earn below Rs. 500 and between Rs. 1001 and 1500 respectively. A significant number of respondents i.e. 20 % obtaining monthly income is in the range of Rs. 501 – 1000 while only 12.7% claimed their income was over Rs. 2000.

This village consist very good fertile lands, There is just below half of the respondents i.e. 84 (46.4%) have not possess any land on their own. There are 35 (19.3%) of the respondents possess land between 1- 2.19 acres. A significant number of respondents i.e. 28 (15.5%) and 20 (11.04%) are having land between 2.20 – 4.39 acres and 5 – 9.39 acres respectively. A considerable number of respondents i.e. 14 (7.7%) are owned land 10 and above acres.

Social Dogmatism on Menstruation

Patriarchal societies have tended to control women by first announcing menarche (the onset of menstrual cycle in a young girl) to the world in an apparently celebratory fashion while thereafter attempting to control the implied fertility and sexual power by monthly rites of pollution, restriction and isolation of the menstruating woman.

The various names for menstruation or ‘periods’ point to its polluting quality. For instance in Telugu, it is called samurta or peddamanshi meaning attaining maturity. Menstrual blood is believed to be polluting. There are varying restrictions put on a girl due to this belief such as not touching people or hanging washed clothes out to dry; not touching certain flowering plants lest they die or not fruit; sleeping on a jute bag or woollen blanket away from others. A woman cannot touch her child during menstruation. If she has to, the child must first be unclothed completely or made to wear silken clothes. Visiting or touching images of gods, temples, religious scriptures is also prohibited. A fear is inculcated in the adolescent that she will sin if she breaks these taboos. Restrictions are also placed on diet. These pollution taboos result in many women getting an enforced rest for at least these three days of the month since they are barred from carrying out their normal activities.

Not only is menstrual blood supposed to be dirty, but evil too. A menstruating girl should not let her shadow fall on a child with measles lest the child turn blind. The used menstrual cloth also possesses an evil quality. If men see the cloth, dry or otherwise, they could go blind. If a cow were to swallow the cloth she would curse the girl with infertility. In villages in A.P., women do not throw their menstrual cloth-they either burn it or bury it.

There seem to be some similarities between Hindus and Muslims regarding the practice of some of these rituals. Among Muslims, the menstruating woman should not touch holy books lest they become impure. Converted Christians follow, although to a lesser degree, the rituals of their original castes. The taboos and rituals clearly devalue. Women’s reproductive powers. The notion of women being polluted and unclean can be ascribed to patriarchal control of women’s reproductive powers. While the woman fulfils a vital social role of giving birth to progeny through her biological reproductive capacity, she is, at the same time, isolated during menstruation.

Cultural Practices of Puberty

Most women do not know about the physiology of menstruation and therefore the first experience of menstruation is filled with fear, shame and disgust. In some areas such as in rural areas of A.P. the girl is sometimes told to dub three or four dots of menstrual blood or mustard oil on the wall and draw a line between the second and third or third and fourth; it is believed that she will finish her menstruation within two and a half or three and a half days in all subsequent periods.

Elaborate rituals are performed in south Indian states-as well as in many parts of north India-at the onset of menstruation. The onset of puberty is traditionally viewed in terms of the girl’s emergent sexuality and prospective motherhood. The pubescent girl is given an elaborate ritual bath, after a massage with turmeric and vermillion. The Mudiraj communities in A.P. isolate the pubescent girl for 21 days within the house, away from the male gaze. The room in which she is secluded is separated with an iron rod and a fire is kept constantly burning during this period. Fire signifies purity and also keeps away daiyyam or witches and evil spirits. The girl is polluted and hence prohibited from touching people and other people are not allowed to touch her. In case of default, a bath is essential for ritual purification.

The Impact of the Food Habits on Women Health:

Although women are more or less marginalized and neglected in relation to the quality and quantity of food, certain occasions in a woman’s life are celebrated with the offering of a variety of nutritious foods specially prepared for her. Almost every community has the practice of feeding a girl on her first menstruation with delicious and nutritive foods, with the time of seclusion for the period ranging between nine to 21 days. In parts of A.P., sweets made of jaggery, groundnuts, sesame, fenugreek, wheat flour and sorgum are given to the girl. Menstruation for the first time in the house of one’s in-laws is also considered very auspicious in all regions of A.P. and is celebrated with gaiety.. The idea seems to be to give the girl ‘rich’, that is, strength-giving foods as well as both ‘hot’ and ‘cold’ foods.

Certain ‘hot’ foods (like jaggery) and ‘cold’ foods (like tamarind and lemons) are taboo as it is believed that the girl will suffer from menstrual pain. ‘Hot’ foods may cause heavy bleeding and ‘cold’ foods may cause severe menstrual pain. Special foods are understood to compensate for the loss of blood, regularise the menstrual cycle and flow, strengthen her reproductive organs and generally contribute to her fertility.

Work Prohibition of Pregnant Women:

It is also observed during the fieldwork that almost all the respondents have revealed that prohibition of work is compulsory while a women pregnancy but this notion is varies to one community to another. The higher social status communities are not allowed to perform the works even domestic works also from the early months to after late months of maternity. Whereas weaker section women perform the daily domestic actives some of them perform field activates but it is only in the early months. They should also take rest in the late months of pregnancy and early months of maternity.

Encourage and Disencourage Food Items During the Pregnancy of Women:

During pregnancy and lactation, many traditional communities across the country restrict a woman’s food intake. It is believed that if a pregnant woman eats too much, the foetus will not have room to move. The abdomen is supposed to contain both the food and the foetus and the latter’s space needs should be given greater priority. Another reason for controlling a pregnant woman’s food consumption is perhaps that excess weight would reduce the productivity of her work in the fields and around the house. A widely prevalent practice all over India is shrimanta. In the seventh month of pregnancy special rituals are performed and different types of sweets are prepared and given to the parents-to-be. The purpose is to give moral support and encouragement to the pregnant woman and celebrate her achievement of having reached near full-term. The sweets are generally made of wheat flour, jaggery, ghee, fenugreek and dry fruits. In the final stages of pregnancy, the pregnant woman is supposed to cat these foods custom every day. This is a good custom because it provides the calories and protein needed for the rapidly growing foetus in the last trimester of pregnancy.

Food Items Encourage % Disencourage %

1.Milk 173 95.5 8 4.4

2.Green leafs 148 81.7 33 18.2

3.Toddy 80 44.1 101 55.8

4.Non-Veg 132 72.9 49 27

5.Papaya — — 181 100

6.Potato 49 27 132 72.9

7.Brinjal 50 27.6 131 72.3

The above table explains the villager’s perceptions on encourage and disencourage food items during the pregnancy of women. The data shows that there are 173 (95.5%) of the respondents have stated that they are encouraging milk and its related food items and only insignificant number of respondents i.e.8 (4.4%) are not encouraging the food items of milk. As many as 148 (81.7%) of them revealed that they are encouraging green leafs and rest of the significant number of respondents i.e. 33 (18.2%) are not interested to give the green leafs to the pregnants. Interestingly the data depicts that more than half of the respondents i.e. 101 (55.8%) have said that they are encouraging toddy and 80 (44.1%) of them are not giving taking toddy. A substantial number of the respondents i.e. 132 (72.9%) have expressed that they are encouraging the consummation of non-vegetarian foods like mutton, chicken and egg. The total number of respondents is practicing the prohibition of papaya consummation during the pregnancy. All most all equal number of respondents i.e. 49 (27%) and 50 (27.6%) have revealed that Potato and Brinjal are encouraged food items and as similar 132 (72.9%) and 131 (72.3%) of them are not encouraging the food items of Potato and Brinjal.

The data regarding Caring of Pregnant Women among the Villagers clarifies the pursuance of the opinion of several communities respondents such as Yadava 14 (7.7%), Gouda 3 (1.7%), Munurukapu 11 (6.1%), Oddera 6 (3.3%), Vishwa Brahmin 5 (2.8%), Mala 25 (13.8%), Madiga 21 (11.6%), Padmashali 7 (3.9%), each 3 (1.7%) of Mangali, Dudekula and Erukala, Kumari 2 (1.1%) and each 1 (0.6%) of Pusala, Mera, Chindi and Dakkali have stated that family and their kins are taking care of their pregnant women. In this category the total numbers of SC and ST communities are appeared because of less financial status and peer group pressure. A majority number of working caste like Yadava, Munnurukapu, Oddera, Padmashali, Dudekula and Kummari are appeared. However, these communities’ people are visiting either government or private hospital for check up their health conditions during early pregnant hood as well as before delivery. One more interesting thing that the caste Mangali itself is traditional birth attendant community in this village so we may consider them in response to this query that they are taking care about pregnant as a traditional birth attendant and as a family. On the whole 3 (1.7 %) of Yadava, 2 (1.1 %) Gouda, 1 (0.6 %) of Munnurukapu and Kummari, 8 (4.4 %) of Chakali, 5 (2.7%) of Dudekula and the total number of Mudiraj 7 (4%) community respondent have expressed that traditional birth attendant are taking care about pregnant of their communities. It is important to note that previous these caste people took care about pregnant but at presently they are seeking the help of traditional birth attendant by reason of saving of time. These kind of villagers always busy in their routine work if they involve in the caring process they should be lost more time in order to money also. The data also describes that all most all the respondents of Deshmukh 3 (1.6%), Vysya 4 (2.2%) and Vaisnava 5 (2.7%) communities have revealed that health workers or ANMs are looking after the pregnant women. It may due to the higher awareness regarding health and personal bias or prejudices of health workers or ANMs who are interested to associate with the higher social status communities.

On account of preferable birthplace; the responses of majority respondents i.e. 112 (62%) is that birth at the traditional birth attendant is more preferable. As many as number of respondent i.e. 36 (20%) have revealed that they prepared birthplace is Government Hospitals and the reaming respondents i.e. 32 (18%) have expressed their perception that Private Hospital are preferable to give the birth. The cluster analysis of data also provides the social status wise explanation that there are 7 (4%) of OC respondents, 19 (10.5%) of BCs and 10 (5.5%) of SCs are interested to go to the government hospitals. There are 10 (5.5%) of OCs and 23 (12.7%) of BCs were interested on Privates hospitals. Among the reaming of categories, the more number of BC respondents i.e. 70 (38.5%), 37 (20.5%) and the total number of ST community respondents i.e. 3 (1.7%) and only few {2(1.1%)} of OC respondent are still interested to give birth under the observation or treatment of traditional birth attendant.

Practices after Delivery:

Women underfed themselves during pregnancy and strove for a small baby to ensure easy delivery. Babies were not to be breast fed on first three days and baby-clothes were not used till a ceremony (purudu/Naming) on 9th day to 21st day. Mothers could not leave the delivery room till that day. To minimize the toilet needs, they severely restricted their intake of fluids and food during first week after delivery. Mothers did not wash hands properly; their clothes and linen were often dirty. Newborn babies, even if sick, were not moved out of home. The usual explanations for the sicknesses in neonates were ‘evil eye’, ‘witch craft’, or ill effects of foods eaten by mother.

The practice of breast-feeding female children for shorter periods of time reflects the strong desire for sons. If women are particularly anxious to have a male child, they may deliberately try to become pregnant again as soon as possible after a female is born. Conversely, women may consciously seek to avoid another pregnancy after the birth of a male child in order to give maximum attention to the new son

Summary and Conclusions:

Due to the orthodoxical and traditional dogma, majority numbers of respondent are not possess proper notion on Women’s health. In addition to supernatural beliefs about what brings on disease, women also have some beliefs about the non-physical causes of ill-health. The most commonly found syndrome was ‘weakness’ which consists of fatigue, body ache, ghabrahat (a generic term used for anxiety, fear, restlessness, trepidation, etc.), pallor, low backache and burning of palms and feet. Thus poverty, illiteracy and social backwardness complete the subordination of women. In reality, therefore, most women carry a tremendous degree of mental anguish and agony due to the improper beliefs and practices.

However, practices existed to over come or to tune with the problems, which may be physical, psychological, cultural and environmental. Subsequently practices are to be strengthen in order to persisting as the beliefs. Once, belief is to be got its own identity; the existence of practice should automatically come by the deeds of the victims or followers. Sometimes belief might be deteriorate due to the business, cost effective and the rationalism should also vanish the irrational beliefs so that we can eventually conclude beliefs exist by the practices which may takes place to over come the problems or to adjust with the nature.

References:

1. http://en.wikipedia.org/wiki/Belief

2. Giger, J.N., & Davidhizar, R. E. (2004): “Transcultural nursing: Assessment and intervention” (4th ed.). St. Louis: Mosby publication.

3. Spector, R. E. (2004): “Cultural diversity in health & illness” (5th ed.). Upper Saddle River, NJ: Pearson Prentice Hall Health publication..

4. Bundek, N. I., Marks, G., & Richardson, J. I. (1993): “Role of health locus of control beliefs in cancer screening of elderly Hispanic women”. Health Psychology, 12(3), 193-1999.

5. Pachter, L. M. (1994) “Culture and clinical care: Folk illness beliefs and behaviors and their implications for health care delivery”. Journal of the American Medical Association, 271(9), 690-694.

6. Roberson, M. H. (1987): “Folk health beliefs of health professional”. Western Journal of Nursing Research, 9(2), 257-263.

7. Treistman, J. (1988): “Health beliefs in socio-cultural perspective”. In G. Caliandro & B. L. Judkins (Ed.), Primary nursing practice (pp. 119-133). Glenview, IL: Scott, Foresman and Company.

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