A nurse is completing a summative evaluation of a condom distribution program at a local community college. Which of the following metrics should the nurse include?

Choice A Reason:
The lack of government-provided health insurance is a general issue that can affect both rural and urban populations. While it is a significant concern, it is not specific to rural communities. Government-provided health insurance programs, such as Medicaid and Medicare, are available to eligible individuals regardless of their location.

Choice B Reason:
The financial risk that is typical of underinsured clients is another broad issue affecting many individuals, both in rural and urban settings. Underinsurance can lead to significant out-of-pocket expenses and financial strain, but it is not unique to rural areas. This issue is more related to the overall health insurance market and coverage policies.

Choice C Reason:
Limited availability of managed care insurance can be a problem in rural areas due to fewer healthcare providers and facilities participating in managed care networks. However, this issue is not as critical as the direct access to primary care providers. Managed care insurance availability can vary widely, but the core issue in rural areas is often the physical presence of healthcare services.

Choice D Reason:
Limited access to primary care providers is a significant disadvantage specific to rural communities. Rural areas often face shortages of healthcare professionals, including primary care providers, which can lead to longer travel distances for medical care, longer wait times for appointments, and overall reduced access to essential health services. This lack of access can result in delayed diagnoses and treatment, poorer health outcomes, and increased reliance on emergency services for primary care needs.

Choice A: Implementing the Teach Back Method When Prescribing Medication
The Teach Back Method is an effective communication strategy where healthcare providers ask clients to repeat back the information given to ensure understanding. While this method can improve medication adherence and health literacy, it does not directly address the broader systemic issues related to poverty. It is a useful tool but not the most impactful intervention for breaking the cycle of poverty.

Choice B: Replacing Medicare Programs with Medigap Policies
Medigap policies are supplemental insurance plans that cover costs not included in traditional Medicare. However, replacing Medicare programs with Medigap policies would not necessarily improve outcomes for clients impacted by poverty. Medigap policies can be expensive and may not be affordable for low-income individuals. This intervention does not address the root causes of poverty or improve access to essential health services.

Choice C: Eliminating the Use of Client Portals or Virtual Visits
Eliminating client portals or virtual visits would likely have a negative impact on client outcomes, especially for those in poverty who may have limited access to transportation. Virtual visits and client portals provide convenient access to healthcare services, allowing clients to communicate with providers, access medical records, and receive care without the need for in-person visits. Removing these options would reduce access to care for many individuals.

Choice D: Opening a Community Health Center in an Underserved Area
This is the correct choice. Opening a community health center in an underserved area directly addresses the lack of access to healthcare services, which is a significant barrier for individuals living in poverty. Community health centers provide comprehensive primary care, preventive services, and support for managing chronic conditions. They often offer sliding scale fees based on income, making healthcare more affordable and accessible for low-income populations. By improving access to healthcare, community health centers can help break the cycle of poverty and improve overall health outcomes.