A nurse is reviewing the record of a client who has a new diagnosis of diabetes mellitus and an A1C of 9. The client has attended multiple workshops about diabetes management but reports not using the meal plan to assist with nutrition and feels unmotivated to start an exercise regimen. According to the Theory of Reasoned Action/Planned Behavior, which of the following explains the likelihood of this client having good outcomes in follow-up clinic visits?

Choice A: Impaired Transferability
Impaired transferability typically refers to an individual's difficulty in moving from one place to another, often due to physical limitations. This is a personal health diagnosis rather than a community diagnosis. Community diagnoses focus on broader issues that affect the health of the entire community rather than individual health problems.

Choice B: Disturbed Sleep Pattern
A disturbed sleep pattern is an individual health issue that affects a person's sleep quality and duration. While sleep issues can be prevalent in a community, this term is more commonly used in individual health assessments. Community diagnoses address collective health concerns that impact the community as a whole.

Choice C: Risk for Infection
Risk for infection is a term used to describe the potential for an individual to develop an infection. Although infection control can be a community health concern, this term is generally used in the context of individual health assessments. Community diagnoses would focus on factors contributing to the spread of infections within the community.

Choice D: Alteration in Family Health Management
This is the correct choice. Alteration in family health management refers to changes or challenges in how families manage their health and well-being. This can include issues such as access to healthcare, health education, and support systems. As a community diagnosis, it addresses the collective health management practices of families within the community, making it a broader public health concern.

Choice A Reason:
Assurance of services refers to the guarantee that health services are available and accessible to the population. While this is crucial for public health, it primarily affects the structural level of society rather than multiple levels. The Ecological Model emphasizes the interaction between individual, interpersonal, community, and societal factors. Assurance of services is more of a systemic factor and does not directly influence individual behavior across multiple levels.

Choice B Reason:
Health beliefs are a significant factor in the Ecological Model as they influence individual behaviors and decisions regarding health. These beliefs are shaped by personal experiences, cultural norms, and societal influences. Health beliefs operate at multiple levels, including the individual level (personal beliefs), interpersonal level (influence of family and friends), and community level (cultural and societal norms). They play a critical role in determining how individuals perceive health risks and engage in health-promoting behaviors.

Choice C Reason:
Medical funding is essential for the provision of healthcare services and the functioning of health systems. However, it primarily affects the structural and policy levels rather than multiple levels of society. While adequate funding is necessary for ensuring access to healthcare, it does not directly influence individual health behaviors across different levels of the Ecological Model.

Choice D Reason:
Laws and local ordinances that relate to health are crucial in shaping the environment in which individuals live. These regulations can influence health behaviors by creating supportive environments, such as smoke-free zones, safe drinking water standards, and regulations on food safety. These laws operate at the community and societal levels, impacting individual and collective behaviors by establishing norms and standards that promote health.

Choice E Reason:
Interaction with others is a key component of the Ecological Model, affecting health behavior at multiple levels. Social interactions influence individual behaviors through peer pressure, social support, and the sharing of information. At the interpersonal level, family and friends can encourage or discourage healthy behaviors. At the community level, social networks and community organizations play a role in shaping health norms and behaviors. These interactions are integral to understanding how health behaviors are adopted and maintained.