Tuberculosis Screening That Stops at the Second Appointment: A Community Health Assessment of a Composite Service Area in Maricopa County, Arizona
[Student Name]
Edson College of Nursing and Health Innovation, Arizona State University
NUR 440: Community and Public Health Nursing in the United States
Dr. [Course Faculty]
March 17, 2025
Model document. The service area and its figures are composite and illustrative.
The Community and Its Boundaries
This community health assessment covers a composite service area of three adjacent ZIP codes in western Maricopa County, Arizona, assembled for teaching and describing no real employer, clinic or resident. The area holds an estimated 92,400 people, of whom 29 percent are under 18 and 9 percent are 65 or older. Maricopa County itself held roughly 4.5 million residents, and about 1 in 7 was born outside the United States (U.S. Census Bureau, 2024). Inside the composite area that share runs higher: close to 1 in 4 residents was born abroad, and 38 of every 100 households report speaking a language other than English at home, with Spanish, Dari, Swahili and Kinyarwanda the most common of those languages.
The area is not short of assets. One federally qualified health center anchors primary care, two elementary schools employ full time nurses, a food bank distributes on two mornings, a resettlement agency keeps a field office in the same plaza as the clinic, and a bus line connects that plaza to the county hospital in about 40 minutes. Access still breaks in predictable places. About 12 percent of county residents under 65 carried no health coverage in the most recent reporting year, and adult diabetes prevalence sat near 11 percent (County Health Rankings & Roadmaps, 2024). The clinic books scheduled interpretation in three languages while its patients speak nine, and its doors close at 5 p.m.
Data came from three sources over one period. A windshield survey on three separate days recorded housing density, food retail, sidewalk and lighting conditions, and the placement of bus stops relative to the clinic door. Six key informants were interviewed: the clinic manager, a school nurse, a resettlement caseworker, a faith community health volunteer, the food bank coordinator and the county tuberculosis program nurse. Secondary data came from the county and federal sources named in the references. Every local figure reported below covers the 12 months ending June 30, 2024, and the county and national figures name their own reporting years, because a rate without its window invites the wrong comparison.
Health Status, Denominators and the Global Picture
The health center served 11,860 patients during the 12 months ending June 30, 2024. Of those, 2,140 (18 percent) had arrived in the United States within the previous three years, most through resettlement or family reunification. New arrivals are offered a domestic medical examination soon after they land, and 486 of these patients left that visit with a referral for interferon gamma release assay testing for latent tuberculosis infection. Of the 486 referred, 291 returned a result, a testing completion rate of 60 percent across that 12 month period. Of the 291 tested, 122 were positive, or 42 percent. Of the 122 with infection, 71 started treatment, or 58 percent, and 42 of those 71 finished the course, or 59 percent. End to end, 42 of 122 identified infections were treated to completion, which is 34 percent.
Those losses matter because of where tuberculosis actually sits in this population. The United States reported 9,615 tuberculosis cases in 2023, an incidence of 2.9 per 100,000 people, and the burden was concentrated rather than spread: incidence among people born outside the country ran near 15 per 100,000, against well under 1 per 100,000 among people born here (Centers for Disease Control and Prevention, 2024). Most of those cases are not new local transmission but reactivation of infection acquired years earlier and elsewhere, which is why treating latent infection is the lever that changes the count. The global figures explain the arithmetic, since the World Health Organization estimated 10.8 million new tuberculosis illnesses and 1.25 million deaths worldwide in 2023 (World Health Organization, 2024).
Set beside those figures, the local numbers point at a hand off rather than at refusal. Two of every five referrals never became a test result, and more than four in every ten identified infections never reached a first dose, yet the informant interviews described no pattern of patients declining care. What they described was a second appointment on a different day, at a different door, in a language the front desk could not schedule in. Healthy People 2030 carries objectives to reduce tuberculosis and to raise the share of people who complete treatment for latent infection (Office of Disease Prevention and Health Promotion, n.d.). The figures above are composite and illustrative, but the shape they describe is an ordinary one.
Community Diagnosis, Plan and Evaluation
The community diagnosis follows the standard three part form. Risk of preventable tuberculosis disease among recently arrived residents of this service area, related to a referral pathway that requires a second visit on a separate day, limited interpretation capacity and clinic hours ending at 5 p.m., as evidenced by a 60 percent testing completion rate (291 of 486 referrals), a 58 percent treatment initiation rate (71 of 122 infections) and a 59 percent treatment completion rate (42 of 71 starts) across the 12 months ending June 30, 2024. The plan behind that statement belongs to four partners: the health center, the county tuberculosis program, two resettlement agencies, and the faith community volunteers who already carry health messages into the same households.
Three changes work at three levels of prevention. At the primary level, the blood draw moves into the first primary care visit itself, so testing no longer costs a second trip, and interpretation is booked at scheduling rather than requested at the front desk. At the secondary level, results are returned by a bilingual outreach worker who calls within three days and books the treatment start visit during that same call, with two evening clinic sessions added each month for households whose adults work daytime shifts. At the tertiary level, patients who start treatment are offered the 12 dose rifapentine and isoniazid short course rather than nine months of isoniazid alone, because a shorter course is finished more often (Sterling et al., 2020).
Evaluation reuses the denominators the assessment already built, so movement is visible without a new data system. The primary outcome is the share of identified infections carried through to completion, moving from 71 starts out of 122 infections and 42 completions out of 71 starts toward a goal of 70 percent started and 70 percent completed within 12 months, reported every three months. The process measure is the share of referrals tested during the same visit, audited monthly against that month's referral count. The balancing measure is the third next available primary care appointment, because same visit testing lengthens visits and could push routine care further out. Interpretation and outreach time is the main cost, roughly 380 paid hours a year.
References
Centers for Disease Control and Prevention. (2024). Reported tuberculosis in the United States, 2023. U.S. Department of Health and Human Services. https://www.cdc.gov/tb/statistics/
County Health Rankings & Roadmaps. (2024). Maricopa County, Arizona. University of Wisconsin Population Health Institute. https://www.countyhealthrankings.org/health-data/arizona/maricopa
Office of Disease Prevention and Health Promotion. (n.d.). Infectious disease. Healthy People 2030. U.S. Department of Health and Human Services. https://health.gov/healthypeople/objectives-and-data/browse-objectives/infectious-disease
Sterling, T. R., Njie, G., Zenner, D., Cohn, D. L., Reves, R., Ahmed, A., Menzies, D., Horsburgh, C. R., Crane, C. M., Burgos, M., LoBue, P., Winston, C. A., & Belknap, R. (2020). Guidelines for the treatment of latent tuberculosis infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020. MMWR Recommendations and Reports, 69(1), 1-11. https://doi.org/10.15585/mmwr.rr6901a1
U.S. Census Bureau. (2024). QuickFacts: Maricopa County, Arizona. https://www.census.gov/quickfacts/fact/table/maricopacountyarizona
World Health Organization. (2024). Global tuberculosis report 2024. https://www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/tb-reports
How this NUR 440 Module 5 example is structured
Arizona State University does not publish module by module deliverable names for this course, so this NUR 440 Module 5 example is written as the genre the module almost certainly wants: in many sections this module asks for a community health assessment that ends in a community diagnosis and a plan, and your course instructions and rubric decide the exact form. The first sheet draws the boundary and describes the people inside it, because a rate means nothing until the population it belongs to is named. The second sheet reports health status, and every number arrives with its denominator and the 12 month window it covers, then sets the local picture beside national and global tuberculosis data. The third sheet states the community diagnosis in standard form and attaches interventions, partners and the measures that would show movement.
NUR 440 Module 5 questions, answered
What does NUR 440 Module 5 usually ask for?
ASU does not publish module by module deliverable names for this course, so write to the genre. In many sections this module asks for a community health assessment of a defined population that ends in a community diagnosis and a plan with measures. Your course instructions and rubric decide the exact sections, the number of sources and the length your section expects.
How should I report a rate so it holds up?
Give three parts every time: the numerator, the denominator it came from and the period it covers. Write 291 of 486 referrals over 12 months rather than a 60 percent screening rate. Keep local, county and national figures visibly separate, and name the reporting year for each, since comparing a 2024 local count with a 2019 national rate quietly breaks the argument.
How do I add a global dimension without guessing?
Anchor it in published data about the population actually in front of you. World Health Organization burden estimates and national incidence broken out by place of birth do more work than a sentence about interconnected health. Use the global figure to explain why a local pattern exists, then return to your own denominators, because the paper is still an assessment of one community.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Arizona State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.