| Course | DNP 740 Clinical Prevention and Population Health (DNP/740) |
|---|---|
| Week | 3 |
| Paper type | Social determinants and disparities analysis |
| Length | about 1,154 words, 4 double-spaced pages plus title page and references |
| Format | APA 7 student paper |
| School | University of Phoenix |
| Program | DNP |
| Updated | September 2026 |
Free sample paper for DNP 740 Week 3
Steep Stairs, No Bus and Nobody Checking In: The Social Determinants Behind Falls Among Older Adults in the County's Remote Townships, and the Causes of the Causes
[Student Name]
University of Phoenix
DNP/740: Clinical Prevention and Population Health
Week 3 Assignment
[Instructor Name]
[Date]
The county and residents are composites written for a model paper.
Last week's data showed that falls concentrate in the county's two remote townships, where 24% of older residents live but 41% of fall-related ambulance calls originate. This paper asks why, moving from immediate risk factors to the social conditions behind them.
Causes of the Causes
Braveman and Gottlieb (2014) reviewed evidence on the social determinants of health and argued for considering the causes of the causes: the upstream social and economic conditions, such as income, wealth, education, neighborhood and housing, that shape proximate risk factors and behaviors. They emphasized that these conditions affect health through multiple pathways, including material resources, stress and the physical environment, and that addressing them requires action beyond health care.
Proximate Causes in the Townships
The immediate causes of falls are familiar: muscle weakness, poor balance, medications that cause dizziness, poor vision, foot problems and home hazards such as loose rugs, poor lighting and steep stairs without rails. In the townships, these risks are more common and less often addressed.
Housing
Most homes in the townships are older, built before 1960, often with steep stairs, outdoor steps without rails and bathrooms without grab bars. Many owners cannot afford repairs on fixed incomes. Housing, shaped by income and the area's economic history, directly produces the hazards that cause falls.
The loose step on Mrs. B.'s porch was a fall risk; the pension that could not pay a carpenter was the cause of that cause.
Income and Wealth
The townships' median household income for residents 65 and older is about 60% of the county's. Low income limits home repairs, gym or exercise class fees, new glasses and transportation, each linked to fall risk.
Transportation and Distance
There is no public transit to the townships. The nearest physical therapist is 35 minutes away. Residents who no longer drive depend on family or neighbors. Distance means fewer clinic visits, fewer screenings and less access to exercise programs, which cluster in town.
Social Isolation
A higher proportion of older adults in the townships live alone, often after children moved away for work. Living alone increases the risk that a fall goes unnoticed, leading to long lies on the floor, and reduces the encouragement that helps people exercise.
Education and Health Literacy
What people believe about falls shapes whether they try to prevent them.
Lower educational attainment in the townships is associated with less awareness that falls are preventable. Several residents told me that falling is "just what happens when you get old."
Medication Burden
Township residents see several prescribers in different towns and fill prescriptions at distant pharmacies, which makes medication review rare. Sedatives and blood pressure medications that cause dizziness are common in the clinic's records for these patients. Fragmented care, itself a product of distance and access, adds a medication pathway to fall risk.
Health Care Access
Fewer township residents have a regular clinician, and those who do are seen less often. Clinic screening for fall risk is lowest among patients without a recent visit, who are disproportionately township residents.
What the Evidence Offers
Keall et al. (2015) conducted a cluster-randomized trial in New Zealand in which households received low-cost home modifications, including handrails for steps, grab rails for bathrooms, outdoor lighting, edging for steps and slip-resistant surfaces, delivered by builders. The rate of injuries caused by falls at home was estimated to fall by 26% per year of exposure in the treatment group compared with controls after adjustment. The modifications were inexpensive, which makes this an intervention that directly addresses a housing determinant.
Climate and Season
Winter ice on unpaved driveways and steps adds seasonal risk. Ambulance data show a rise in fall calls from December through February in the townships, where roads and paths are cleared last. Seasonal hazards are shaped by the same determinants of income and infrastructure.
Structural Roots
The townships' economic history, the closing of the mill in the 1990s and the out-migration of younger workers, produced the low incomes, aging housing and isolation seen today. Understanding this history helps explain why the disparity persists and why short-term programs alone will not close it.
Which Determinants a Local Program Can Change
A county program cannot raise pensions or build bus lines. It can reduce the effects of low income and poor housing through free home modifications; reduce distance by bringing exercise and screening to the townships through the churches and community centers; and reduce isolation through daily check-in calls and volunteer visits. Advocacy with the area agency on aging for rural transit is a longer-term goal.
Equity Lens
A population view that attends to distribution (Kindig & Stoddart, 2003) makes equity part of the definition, not an add-on.
Braveman and Gottlieb (2014) emphasize that social determinants produce unjust differences. An equity lens means directing resources first where the burden is greatest and access is lowest, not distributing equally across the county.
Interacting Determinants
Determinants rarely act alone. A widow in a remote township with a low pension and no car faces a home she cannot repair, a class she cannot reach and nobody nearby to help if she falls. Each determinant magnifies the others, which is why single-factor programs often disappoint.
Strengths in the Townships
The townships also have strengths: dense church networks, neighbors who check on one another and a volunteer fire department with strong community ties. Programs built on these assets are more likely to be trusted and sustained than programs imported from town.
Why Downstream Programs Fall Short
A program that only teaches exercise at the senior center will reach residents who can drive to town, leaving those most at risk untouched. Addressing determinants means bringing the program to the townships and removing the barriers of cost and distance.
Resident Voices
In conversations at a township church supper, residents described fear of falling and giving up activities. One man said he stopped going to his mailbox in winter. Their accounts confirm the data and suggest that fear of falling itself deserves attention, since giving up the walk to the mailbox is the start of the weakness that leads to the next fall.
Measuring Determinants
To track whether the program affects determinants, not only falls, I will measure the number of homes modified, the number of township residents attending exercise sessions within 10 miles of home and the number enrolled in check-in calls, alongside fall outcomes by township.
Conclusion
Falls concentrate in the county's remote townships because of upstream conditions: older housing, low incomes, distance without transit, isolation and limited health care access. The social determinants framework directs attention to these causes of the causes, and a randomized trial shows that low-cost home modifications, which address a housing determinant, reduce fall injuries. A local program can reduce the effects of these determinants even where it cannot change them directly.
References
Braveman, P., & Gottlieb, L. (2014). The social determinants of health: It's time to consider the causes of the causes. Public Health Reports, 129(Suppl. 2), 19-31. https://doi.org/10.1177/00333549141291S206
Keall, M. D., Pierse, N., Howden-Chapman, P., Cunningham, C., Cunningham, M., Guria, J., & Baker, M. G. (2015). Home modifications to reduce injuries from falls in the home injury prevention intervention (HIPI) study: A cluster-randomised controlled trial. The Lancet, 385(9964), 231-238. https://doi.org/10.1016/S0140-6736(14)61006-0
Kindig, D., & Stoddart, G. (2003). What is population health? American Journal of Public Health, 93(3), 380-383. https://doi.org/10.2105/AJPH.93.3.380
What the DNP 740 Week 3 instructions ask
In DNP 740 Week 3 the instructions usually ask students to identify a disparity in their population and analyze the social determinants that contribute to it. Most prompts name the determinant domains to cover, such as economic stability, education, health care access, neighborhood and built environment, and social context. Students are expected to support the analysis with scholarly literature and local evidence, explain how the determinants interact, and point to places where intervention is realistic. Some sections also ask for a short equity statement or for the voices of community members. The paper usually runs four to six pages in APA style. The disparity should come from the data profile built in Week 2, so the analysis continues the same project rather than starting a new one.
How this DNP 740 Week 3 example is built
The sample opens with the numbers from the previous week that define the disparity, then introduces the causes-of-the-causes framework before any local analysis. Each determinant gets its own short section: housing stock built before 1960, retirement income about 60% of the county level, no transit and a 35-minute drive to physical therapy, living alone, health literacy, medication burden and access to a regular clinician. The paper then turns to evidence that an upstream change can reduce injuries, citing the Keall home modification trial and its 26% lower rate of fall injuries at home among exposed households. Later sections name structural roots such as the mill closing, list community strengths like church networks, and propose measures that track the determinants themselves as well as falls.
DNP 740 Week 3 grading rubric: where the points go
Rubrics for this week tend to reward depth of analysis above all. Faculty want each determinant linked to the disparity through a clear mechanism rather than listed, supported by a source or by local evidence, and connected to other determinants where they interact. A second group of points covers the use of scholarly literature, with preference for sources that address upstream causes rather than only individual risk factors. Organization matters because the paper covers many domains; headings that follow the determinant categories make grading easier. APA mechanics, including matching citations and references, carry the remaining points. The analyses that score best show which determinants a local program can change and which need policy action, since that distinction sets up the intervention weeks.
DNP 740 Week 3 help: mistakes to avoid
A common Week 3 mistake is listing all five determinant domains with a sentence each, which reads like a checklist and never explains how any of them produces the disparity. Another is stopping at proximate causes such as weak muscles or loose rugs without asking why those conditions are more common in one group. Students also slip into blaming individuals, describing residents as unmotivated when the barrier is distance or cost. Avoid claims about a community that you cannot support with data or direct observation. Include strengths as well as deficits, because programs built on existing assets are more likely to last. Close by naming the determinants your later program will target, since the Week 5 and Week 6 papers in DNP 740 build on that choice.
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Other DNP 740 week samples
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- DNP 740 Week 6: Evidence-Based Interventions
- DNP 740 Week 7: Program Plan and Logic Model
- DNP 740 Week 8: Equity-Focused Evaluation Plan
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DNP 740 Week 3 questions, answered
What does DNP/740 Week 3 usually ask for?
Many sections ask students to analyze how social determinants shape a health disparity in their population and to identify points for intervention.
What are the causes of the causes?
The upstream social and economic conditions, such as income, education, housing and neighborhood, that shape the more immediate risk factors and behaviors linked to health outcomes.
Do home modifications prevent falls?
A cluster-randomized trial of low-cost home modifications, such as handrails, grab rails and improved lighting, found a 26% reduction in the rate of fall injuries at home among those exposed to the intervention.
Where can I find a free DNP 740 Week 3 sample paper?
A full DNP 740 Week 3 social determinants paper is on this page, with margin notes explaining each part; a custom sample built around your own population and disparity is free on request.
What is the difference between a proximate cause and a social determinant?
A proximate cause acts directly on the outcome, such as a slippery step, while a social determinant is the upstream condition, such as low income or old housing, that makes the proximate cause more likely in one group.
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