Determinants of Health, Interventions & Mobile Hep C Outreach

Session Overview & Learning Objectives

• Acknowledgement of the traditional owners/custodians of the land and respect for Elders past, present, and emerging.

• By the end of the session students should be able to:

  • Discuss how the determinants of health shape lifestyle choices.

  • Explain preventive, therapeutic, and nursing interventions and their impact on consumer health outcomes.

  • Analyse how socio-cultural factors influence individual decision-making.

Determinants of Health & Their Interaction

• Determinants = multifaceted, mutually interacting biological, behavioural, social, economic, and environmental factors.

• Behavioural determinants

  • Self-efficacy: strong predictor of health-promoting behaviour.

  • Lifestyle behaviours: physical activity, alcohol, smoking, diet.

  • Direct links to mental health and life satisfaction.

• Social determinants

  • Social support & networks → emotional + practical help → encourage positive choices.

• Socio-economic determinants

  • Income, education, employment status → resource access (nutritious food, safe environments).

  • Education ↔ health literacy → informed decisions.

• Environmental determinants

  • Access to parks/recreation, healthy-food outlets, safe neighbourhoods.

• Key idea: determinants inter-connect; none act in isolation ("spaghetti diagram" shown in slides).

Health as a Social Construct

• Health is shaped by social context, not solely biology.

• Student examples in chat:

  • Access to services, food, environment, peer pressure.

  • Health literacy & education.

  • "It’s not just the choices people make but what is available to them."

Types of Interventions

1. Preventive

• Aim: stop disease before it occurs.

• Examples: vaccination, health education campaigns.

2. Therapeutic

• Treat/manage existing disease.

• Examples: medications, surgeries, disease-specific programmes.

3. Nursing Interventions

• Independent (nurse-initiated within scope)

  • Vital signs, patient teaching, wound care, encouraging smartwatch self-monitoring, patient self-checks (BP, BGL).

• Dependent (require medical order)

  • Administering prescribed diuretics, antibiotics, transfusions.

• Collaborative (multidisciplinary)

  • Referrals to physio, dietitian, mental-health clinicians; GP teamwork; community agencies.

• Chat examples:

  • Collaborative: GP clinic coordinating MH support + physiotherapy.

  • Dependent: nurse gives medication per doctor’s chart.

Biopsychosocial–Cultural (BPSC) Approach

• Holistic framework: biology + psychology + social context + culture.

• Cultural factors include beliefs, values, traditions, identity.

• Practical implications:

  • Patients may distrust Western medicine or decline blood products.

  • Gender preferences in care (female client requests female GP).

• Ethical reflections

  • Respect for autonomy vs. “fixing” mindset.

  • Informed consent vs. coercion (blood-transfusion anecdote: refusal ignored → rapid death → ethical breach).

• Goal: support person-centred care by aligning interventions with patient goals, communication, and trust.

Case Study – The Combi Clinic (Mobile Hepatitis C Service)

Background on Hepatitis C (HCV)

• Viral liver disease; prevalence ≈ $\approx 1\%$ of Australians.

• If untreated → liver cirrhosis (scarring) in \approx 30\% + risk of hepatocellular carcinoma.

• Modern therapy: Direct-Acting Antivirals (DAAs); standard course 8{-}12\ \text{weeks}; cure rates >95\%.

Clinic Origin & Philosophy

• Founded 2017 by two GPs ("Dr Joss & Martin") + Nurse Mim.

• Motto: “Making livers great again.”

• Uses retro Combi-style van (actually Toyota with VW badge) + Hawaiian shirts & rock-and-roll to create approachable, fun atmosphere.

• Mission: HCV elimination in QLD; target hard-to-reach populations (homeless, parole/probation, prisons).

On-Site Workflow

1. Finger-stick point-of-care test.

   • Turn-around \approx 58\ \text{min}.

2. Immediate result discussion + prescription of DAAs.

3. Medication supplied free if patient cannot pay.

4. Education during wait time:

   • Harm-reduction: “If you can’t stop injecting, use a new Sharpie (needle) every time.”

   • Lifestyle, adherence, safe injecting equipment.

5. Reinforcement of follow-up: revisit van or linked services.

Determinants Addressed by Model

• Access/Location: clinic travels to homeless drop-in centres & prisons → removes transportation barrier.

• Financial: free meds/testing when needed.

• Stigma: informal setting, humour, relationship-building reduces shame.

• Health literacy: simplified, patient-centred dialogue in plain language.

Patient Narratives (Video Highlights)

• Client relieved: “Thought Hep C would halve my life; now life is beautiful.”

• Ex-prisoner left gate → straight to Combi Clinic; praises non-judgemental care.

• Emotional testimonials underscore psychological benefit of cure.

Nursing Roles within Combi Clinic

• Baseline observations (BP, HR, BGL) while awaiting results.

• Provide vaccine catch-ups, wound checks.

• Build rapport; assess wider needs (housing, MH, addictions).

• Arrange referrals:

  • Social work (housing, finance).

  • AOD services, needle-syringe programmes.

  • Mental-health, counselling.

  • Dental or dietitian if indicated.

Wider Connections & Real-World Relevance

• Illustrates primary, secondary, tertiary prevention in one mobile service.

• Demonstrates necessity of cultural safety & trauma-informed, non-stigmatizing practice.

• Showcases how innovative models can accelerate public-health targets (e.g., WHO HCV elimination).

Key Numbers & Timeframes

• HCV prevalence \approx 1\% of Australians.

• Point-of-care HCV RNA test time: 58\ \text{min}.

• DAA treatment course: 8{-}12\ \text{weeks}.

Ethical & Practical Takeaways for Nursing Students

• Always elicit and document patient goals/values; avoid coercion.

• Intervene at determinants level (environment, finance, literacy) not just individual behaviour.

• Use technology (smartwatches, point-of-care tests) to empower self-management.

• In collaborative care, know local policies, referral pathways, and community resources (food banks, culturally matched providers).

Quick-Reference Checklist

• [ ] Identify dominant determinants affecting patient.

• [ ] Choose correct intervention type (preventive/therapeutic/nursing).

• [ ] Apply BPSC lens; ask about cultural preferences.

• [ ] Ensure informed consent; respect refusal.

• [ ] Provide tailored education; reinforce self-efficacy.

• [ ] Coordinate MDT referrals; document clearly.

• [ ] Evaluate and reassess outcomes; solicit patient feedback.

The session focuses on understanding how determinants of health (biological, behavioural, social, socio-economic, environmental) interact to shape lifestyle choices. Health is viewed as a social construct, influenced by available resources and social context, not solely biology. Interventions are categorized as preventive (stopping disease), therapeutic (treating existing disease), and nursing, which can be independent (nurse-initiated, e.g., teaching), dependent (requiring medical orders), or collaborative (multidisciplinary referrals).

The Biopsychosocial–Cultural (BPSC) approach is a holistic framework that integrates biology, psychology, social context, and culture, emphasizing person-centred care, respect for patient beliefs, and informed consent.

The Combi Clinic, a mobile Hepatitis C (HCV) service, exemplifies these concepts. It provides on-site, rapid diagnostic testing (\approx 58\ \text{min}) and free Direct-Acting Antivirals (DAAs) with high cure rates (8{-}12\ \text{week} course). Targeting hard-to-reach populations (HCV prevalence \approx 1\% of Australians), the clinic addresses key determinants such as access, financial barriers, stigma, and health literacy through its informal setting and patient-centred approach. Nursing roles involve baseline observations, rapport building, and comprehensive referrals (e.g., social work, AOD, mental health). This model demonstrates how cultural safety, trauma-informed care, and innovative delivery can accelerate public health goals and provides key ethical and practical takeaways for nursing students, including respecting patient autonomy and intervening at the determinants level.