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McDonald S, Blackie LER. A Theoretical Qualitative Investigation Exploring Illness Perceptions and Decision-Making About COVID-19 in an Ethnically Diverse UK-Based Sample. Patient Prefer Adherence 2023; 17:473-489. [PMID: 36844799 PMCID: PMC9948639 DOI: 10.2147/ppa.s389660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/09/2022] [Indexed: 02/20/2023] Open
Abstract
PURPOSE The primary aim of the present investigation was to explore perceptions, experiences, and decision-making relating to the COVID-19 illness as the UK entered into a phase of "living safely with COVID-19". A secondary aim was to explore how perceptions around the COVID-19 vaccine might vary by ethnicity. PARTICIPANTS AND METHODS We adopted a qualitative approach with a diverse sample of UK-based participants. One-hundred-and-ninety-three individuals completed an online survey measuring perceptions towards COVID-19 with questions conceptualized through the Common-Sense Model of Self-Regulation. RESULTS Through deductive thematic analysis we identified one overarching theme in our data, "The transition back to normal routines", with four themes illustrating individuals' perceptions and experiences with COVID-19: 1) "Living with the uncertainty", 2) "Concern for others", 3) "The multiple consequences of COVID-19", and 4) "Sense of control", with the sub-theme of "Should I vaccinate, should I not vaccinate?". CONCLUSION Findings from the present investigation provide key insights for understanding how people's perceptions of COVID-19 during this transition period might impact their decisions and behavior moving forward. Specifically, findings suggest some prevailing concerns around catching the virus, while no strong qualitative evidence for concerns over long COVID were identified in this sample, the responsibility felt by individuals towards taking their own precautionary measures in light of the easing of all national restrictions, and some potential differences in perceptions towards the vaccine between individuals from different ethnic backgrounds.
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Affiliation(s)
- Stephanie McDonald
- School of Psychology, University of Nottingham, Nottingham, UK
- Correspondence: Stephanie McDonald, School of Psychology, University of Nottingham, Nottingham, UK, Email
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Amenta E, Grigoryan L, Dillon L, Hines-Munson C, Van J, Trautner B. A survey on self-medication for the prevention or treatment of COVID-19 and distrust in healthcare of veterans in a primary care setting in the United States. Ther Adv Drug Saf 2022; 13:20420986221143265. [PMID: 36540619 PMCID: PMC9760501 DOI: 10.1177/20420986221143265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The SARS-CoV-2 (COVID-19) pandemic brought the public overwhelming and conflicting information. Rates of trust in healthcare professionals have been declining among laypersons over the past five decades. In this setting, we sought to evaluate the use of medications, both with or without a prescription, to prevent and treat SARS-CoV-2 as well as trust in healthcare among patients in a primary care clinic. DESIGN We surveyed 150 veterans in primary care clinic waiting rooms at a large southwestern tertiary care Veterans Affairs hospital. This survey was performed in March-November 2021. METHODS The survey asked about respondents' demographics, use of medications, nutritional supplements, and other remedies for the prevention and treatment of COVID-19, perceived access to care using Agency for Healthcare Research and Quality (AHRQ) Consumer Assessment of Healthcare Providers and System (CAHPS), overall health status, and barriers to medical appointments in the last 12 months. Distrust was measured using the Revised Health Care Distrust scale. We used univariate and multivariate linear regression analyses to study predictors of distrust to healthcare. RESULTS Forty-two (28%) of 150 respondents reported taking an agent for the prevention of COVID-19, while 4% reported storing antibiotics for the treatment of COVID-19, if diagnosed. Medications were obtained from medical providers, US stores or markets, the Internet, home stockpiles, and other countries. Medications with potentially harmful effects taken for the prevention and treatment of COVID-19 included hydroxychloroquine, pseudoephedrine, and antibiotics. Among those surveyed, the mean (SD) on the health system distrust score was 2.2 (0.6) on a scale of 1-5, with 5 indicating higher distrust. Younger age, self-reported poor health, lack of a regular physician, and self-reported poor access to care were independently associated with distrust in healthcare. CONCLUSION Self-medication to prevent COVID-19 infection with unproven therapies was common among respondents, as was some level of distrust in the healthcare system. Access to care was one of the modifiable factors associated with distrust. Future studies may explore whether improving trust may moderate self-treatment behavior and storage of potentially harmful medications. PLAIN LANGUAGE SUMMARY Self-Medication Habits and Trust in Healthcare Among Patients in a Primary Care Setting in the United States The public has received information from many different sources on COVID-19. Trust in healthcare leadership has also been impacted. We studied self-medication habits to prevent or treat COVID-19 among a group of primary care patients in a large hospital system in the Southwest United States. We also explored these patients' trust in their healthcare system.We asked people waiting in primary care clinic waiting rooms whether they had taken any medications, nutritional supplements, or other remedies to prevent or treat COVID-19. We also asked people whether they stored medications in the event that they were diagnosed with COVID. The survey explored patients' trust in the healthcare system through a validated trust survey tool. The survey also assessed basic demographic information, health literacy, access to care, and self-reported health status. These survey answers were analyzed to see whether there was an association between trust in healthcare and other factors including self-medication habits, access to care, demographics, or perceived health.This study found that over 25% of the 150 people surveyed had taken a medication, nutritional supplement, or remedy in an attempt to prevent COVID. We found that some people were taking potentially harmful medications, including hydroxychloroquine, pseudoephedrine, and antibiotics. We found that patients' distrust score was 2.2 on a scale of 1-5 (5 is associated with higher distrust). Self-medication for the prevention or treatment of COVID was not associated with distrust; however, younger age, self-perceived lack of access to healthcare, self-perceived poor overall health, and not having a regular doctor were predictors for lower trust. This information provides a basis to further study self-medication habits as well as ways to improve trust in the healthcare system.
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Affiliation(s)
- Eva Amenta
- Michael E. DeBakey Veteran Affairs Medical
Center, Center for Innovations in Quality, Effectiveness, and Safety
(IQuESt), Houston, TX, USA,Section of Infectious Diseases, Department of
Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Larissa Grigoryan
- Michael E. DeBakey Veteran Affairs Medical
Center, Center for Innovations in Quality, Effectiveness, and Safety
(IQuESt), Houston, TX, USA,Department of Family and Community Medicine,
Baylor College of Medicine, Houston, TX, USA
| | - Laura Dillon
- Michael E. DeBakey Veteran Affairs Medical
Center, Center for Innovations in Quality, Effectiveness, and Safety
(IQuESt), Houston, TX, USA
| | - Casey Hines-Munson
- Michael E. DeBakey Veteran Affairs Medical
Center, Center for Innovations in Quality, Effectiveness, and Safety
(IQuESt), Houston, TX, USA
| | - John Van
- Michael E. DeBakey Veteran Affairs Medical
Center, Center for Innovations in Quality, Effectiveness, and Safety
(IQuESt), Houston, TX, USA
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Chalasani R, Krishnamurthy S, Suda KJ, Newman TV, Delaney SW, Essien UR. Pursuing Pharmacoequity: Determinants, Drivers, and Pathways to Progress. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2022; 47:709-729. [PMID: 35867522 DOI: 10.1215/03616878-10041135] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The United States pays more for medical care than any other nation in the world, including for prescription drugs. These costs are inequitably distributed, as individuals from underrepresented racial and ethnic groups in the United States experience the highest costs of care and unequal access to high-quality, evidence-based medication therapy. Pharmacoequity refers to equity in access to pharmacotherapies or ensuring that all patients, regardless of race and ethnicity, socioeconomic status, or availability of resources, have access to the highest quality of pharmacotherapy required to manage their health conditions. Herein the authors describe the urgent need to prioritize pharmacoequity. This goal will require a bold and innovative examination of social policy, research infrastructure, patient and prescriber characteristics, as well as health policy determinants of inequitable medication access. In this article, the authors describe these determinants, identify drivers of ongoing inequities in prescription drug access, and provide a framework for the path toward achieving pharmacoequity.
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Janus SE, Makhlouf M, Chahine N, Motairek I, Al-Kindi SG. Examining Disparities and Excess Cardiovascular Mortality Before and During the COVID-19 Pandemic. Mayo Clin Proc 2022; 97:2206-2214. [PMID: 36336516 PMCID: PMC9300586 DOI: 10.1016/j.mayocp.2022.07.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/25/2022] [Accepted: 07/15/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the patterns and demographic features of cardiovascular disease (CVD) death and subtypes myocardial infarction (MI), stroke, and heart failure in the pre-COVID-19 era (2018-2019) vs during the COVID-19 pandemic (2020-2021) in the United States. METHODS In this cross-sectional study, we used the US Multiple Cause of Death files for 2018 to 2021 to examine the trend of excess cause-specific deaths using International Classification of Diseases, Tenth Revision codes for CVD (I00 to I99), MI (I21 and I22), stroke (I60 to I69), and heart failure (I42 and I50). Our primary outcome was excess mortality from CVD and its 3 subtypes (MI, stroke, and heart failure) between prepandemic (2018-2019) and pandemic (2020-2021) years. We performed a subgroup analysis on race and month-to-month and year-to-year variation using χ2 analysis to test statistical significance. RESULTS Overall, 3,598,352 CVD deaths were analyzed during the study period. There was a 6.7% excess CVD mortality, 2.5% MI mortality, and 8.5% stroke mortality during the COVID-19 pandemic (2020-2021) compared with the prepandemic era (2018-2019). Black individuals had higher excess CVD mortality (13.8%) than White individuals (5.1%; P<.001). This remained consistent across subtypes of CVD, including MI (9.6% vs 1.0%; P<.001), stroke (14.5% vs 6.9%; P<.001), and heart failure (5.1% vs -1.2%; P<.001). CONCLUSION There has been a significant rise in CVD and subtype-specific mortality during the COVID-19 pandemic that has been persistent despite 2 years since the onset of the pandemic. Excess CVD mortality has disproportionately affected Black compared with White individuals. Further studies targeting and eliminating health care disparities are necessary.
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Affiliation(s)
- Scott E Janus
- Department of Medicine, University Hospitals, Cleveland, OH; Harrington Heart and Vascular Institute, University Hospitals and School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Mohamed Makhlouf
- Department of Medicine, University Hospitals, Cleveland, OH; Harrington Heart and Vascular Institute, University Hospitals and School of Medicine, Case Western Reserve University, Cleveland, OH
| | | | - Issam Motairek
- Department of Medicine, University Hospitals, Cleveland, OH; Harrington Heart and Vascular Institute, University Hospitals and School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Sadeer G Al-Kindi
- Department of Medicine, University Hospitals, Cleveland, OH; Harrington Heart and Vascular Institute, University Hospitals and School of Medicine, Case Western Reserve University, Cleveland, OH.
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Rimmler S, Golin C, Coleman J, Welgus H, Shaughnessy S, Taraskiewicz L, Lightfoot AF, Randolph SD, Riggins L. Structural Barriers to HIV Prevention and Services: Perspectives of African American Women in Low-Income Communities. HEALTH EDUCATION & BEHAVIOR 2022; 49:1022-1032. [PMID: 35856333 PMCID: PMC9574897 DOI: 10.1177/10901981221109138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND African American women are at a disproportionate HIV risk compared with other U.S. women. Studies show that complex structural and social determinants, rather than individual behaviors, place African American women at greater risk of HIV infection; however, little is known about women's views of what puts them at risk. AIMS This study sought to comprehend the perceptions of African American women living in low-income housing regarding the factors that influence both their personal sexual health behaviors and use of HIV prevention services. METHODS We conducted seven focus groups with 48 African American women from 10 public housing communities in a small city in the southeastern United States. We analyzed the focus group transcripts using thematic data analysis to identify salient themes and points of interest related to the study aim. RESULTS Women identified factors related to the health care system (trustworthiness of the health care system), the external environment (racism, classism, patriarchal structures, and violence/crime), as well as predisposing (health beliefs, stigma, and gender norms), enabling (agency to negotiate gendered power), and need (perceived HIV risk and perceptions of partner characteristics) features of individuals in the population. CONCLUSION African American women living in public housing are especially vulnerable to HIV infection due to intersectional discrimination based on racism, classism, gender power dynamics, and community conditions. Our findings confirm the need to develop HIV intervention programming addressing intersectional identities of those making up the communities they plan to address, and being informed by those living in the communities they plan to act on.
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Affiliation(s)
- Shelby Rimmler
- The University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
| | - Carol Golin
- The University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
- Gillings School of Global Public
Health, Chapel Hill, NC, USA
| | - James Coleman
- North Carolina Institute of Medicine,
Chapel Hill, NC, USA
| | - Hayley Welgus
- Gender and Development Consultant,
Chiang Mai, Thailand
| | | | - Leah Taraskiewicz
- The University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Linda Riggins
- The University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
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Silver D, Kim Y, McNeill E, Piltch-Loeb R, Wang V, Abramson D. Association between COVID-19 vaccine hesitancy and trust in the medical profession and public health officials. Prev Med 2022; 164:107311. [PMID: 36272515 PMCID: PMC9580241 DOI: 10.1016/j.ypmed.2022.107311] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 09/16/2022] [Accepted: 10/15/2022] [Indexed: 11/05/2022]
Abstract
One's personal physician, national and state or local public health officials, and the broader medical profession play important roles in encouraging vaccine uptake for COVID-19. However, the relationship between trust in these experts and vaccine hesitancy has been underexplored, particularly among racial/minority groups where historic medical mistrust may reduce uptake. Using an April 2021 online sample of US adults (n = 3041) that explored vaccine hesitancy, regression models estimate levels of trust in each of these types of experts and between trust in each of these experts and the odds of being COVID-19 vaccine takers vs refusers or hesitaters. Interaction terms assess how levels of trust in the medical profession by race/ethnicity are associated with vaccine hesitancy. Trust in each expert is positively associated with trust in other experts, except for trust in the medical profession. Only trust in one's own doctor was associated with trust in the medical profession, as measured by factor scores derived from a validated scale. Lower levels of trust in experts were significantly associated with being either a hesitater or a refuser compared to being a taker. Black respondents had higher odds of being either a hesitater or a refuser compared to white respondents but the interaction with trust was insignificant. For Hispanic respondents only, the odds of being a hesitater declined significantly when trust in the medical profession rose. Mistrust in the medical profession, one's doctor and national experts contributes to vaccine hesitancy. Mobilizing personal physicians to speak to their own patients may help.
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Affiliation(s)
- Diana Silver
- Department of Public Health Policy and Management, NYU School of Global Public Health, 708 Broadway, New York, NY 10003, USA.
| | - Yeerae Kim
- Department of Social and Behavioral Sciences, NYU School of Global Public Health, 708 Broadway, New York, NY 10003, USA.
| | - Elizabeth McNeill
- Department of Public Health Policy and Management, NYU School of Global Public Health, 708 Broadway, New York, NY 10003, USA.
| | - Rachael Piltch-Loeb
- Department of Social and Behavioral Sciences, NYU School of Global Public Health, 708 Broadway, New York, NY 10003, USA.
| | - Vivian Wang
- Department of Public Health Policy and Management, NYU School of Global Public Health, 708 Broadway, New York, NY 10003, USA.
| | - David Abramson
- Department of Social and Behavioral Sciences, NYU School of Global Public Health, 708 Broadway, New York, NY 10003, USA.
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Wang MJ, Lo YT. Strategies for Improving the Utilization of Preventive Care Services: Application of Importance-Performance Gap Analysis Method. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13195. [PMID: 36293776 PMCID: PMC9603724 DOI: 10.3390/ijerph192013195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/08/2022] [Accepted: 10/08/2022] [Indexed: 06/16/2023]
Abstract
The utilization of preventive care services is limited. Previous studies based on communities have looked at many types of barriers to preventive care (i.e., why not do). This study aimed to gain an insight into the key factors and performance gaps (i.e., why do and how to do) of people who attended a regional teaching hospital to undergo health check-ups using a purposive sampling method to recruit people to complete a self-administered questionnaire. Paired sample t-tests and importance-performance gap and regression analyses were performed. The results indicated that the participants' wish to understand their health status, the quality of medical devices and the completeness of items, and process layout planning were the key factors that affect people's health check-up behavior. Promoting the effectiveness of hospital performance may improve the positive cycle of people's health check-up behavior from the community to the hospital. Continuing to promote the knowledge of preventive care services is necessary, and it is very important for people to have a good experience of undergoing health check-ups in the hospital. Important strategies for improving the utilization of preventive care services may include: meeting the person's personalization needs, improving the quality of medical devices and the completeness of items, and having appropriate process layout planning, a detailed interpretation of the results, and further follow-ups in the hospital.
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Affiliation(s)
- Ming-Jye Wang
- Department of Secretariat, National Taiwan University Hospital Hsin-Chu Branch, No. 25, Lane 442, Sec. 1, Jingguo Rd., Hsinchu City 300, Taiwan
| | - Yi-Ting Lo
- Department of Development and Planning, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City 300, Taiwan
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Ibrahim BB, Vedam S, Illuzzi J, Cheyney M, Kennedy HP. Inequities in quality perinatal care in the United States during pregnancy and birth after cesarean. PLoS One 2022; 17:e0274790. [PMID: 36137150 PMCID: PMC9499210 DOI: 10.1371/journal.pone.0274790] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 09/05/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE High-quality, respectful maternity care has been identified as an important birth process and outcome. However, there are very few studies about experiences of care during a pregnancy and birth after a prior cesarean in the U.S. We describe quantitative findings related to quality of maternity care from a mixed methods study examining the experience of considering or seeking a vaginal birth after cesarean (VBAC) in the U.S. METHODS Individuals with a history of cesarean and recent (≤ 5 years) subsequent birth were recruited through social media groups to complete an online questionnaire that included sociodemographic information, birth history, and validated measures of respectful maternity care (Mothers on Respect Index; MORi) and autonomy in maternity care (Mother's Autonomy in Decision Making Scale; MADM). RESULTS Participants (N = 1711) representing all 50 states completed the questionnaire; 87% planned a vaginal birth after cesarean. The most socially-disadvantaged participants (those less educated, living in a low-income household, with Medicaid insurance, and those participants who identified as a racial or ethnic minority) and participants who had an obstetrician as their primary provider, a male provider, and those who did not have a doula were significantly overrepresented in the group who reported lower quality maternity care. In regression analyses, individuals identified as Black, Indigenous, and People of Color (BIPOC) were less likely to experience autonomy and respect compared to white participants. Participants with a midwife provider were more than 3.5 times more likely to experience high quality maternity care compared to those with an obstetrician. CONCLUSION Findings highlight inequities in the quality of maternal and newborn care received by birthing people with marginalized identities in the U.S. They also indicate the importance of increasing access to midwifery care as a strategy for reducing inequalities in care and associated poor outcomes.
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Affiliation(s)
| | - Saraswathi Vedam
- Department of Family Practice, Birth Place Lab, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jessica Illuzzi
- Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States of America
| | - Melissa Cheyney
- Anthropology Department, School of Language, Culture and Society, College of Liberal Arts, Oregon State University, Corvallis, OR, United States of America
| | - Holly Powell Kennedy
- Department of Midwifery, Yale University School of Nursing, Orange, CT, United States of America
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Coleman P, Barber TM, van Rens T, Hanson P, Coffey A, Oyebode O. COVID-19 Outcomes in Minority Ethnic Groups: Do Obesity and Metabolic Risk Play a Role? Curr Obes Rep 2022; 11:107-115. [PMID: 34655051 PMCID: PMC8518892 DOI: 10.1007/s13679-021-00459-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE OF REVIEW Globally, minority ethnic groups have been at higher risk of COVID-19 mortality and morbidity than majority populations. This review outlines factors that may interact to create these inequalities and explores the hypothesis that differing levels of cardio-metabolic risk, according to ethnic group, play a role. RECENT FINDINGS Two UK Biobank studies have reported that the body mass index is more strongly associated with an increased risk of COVID-19 infection and mortality in minority ethnic populations than in White populations. A study of UK patients found that the strongest association between obesity and adverse COVID-19 outcomes was in people of Black ethnicity. Differences in the prevalence of obesity and its metabolic sequelae have been shown to partly mediate ethnic inequalities in COVID-19 outcomes, although not always consistently. It is possible that ethnic differences in the consequences of obesity may explain some of the remaining disparity in COVID-19 risk.
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Affiliation(s)
- Paul Coleman
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Thijs van Rens
- Department of Economics, University of Warwick, Coventry, UK
| | - Petra Hanson
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Alice Coffey
- Warwick Medical School, University of Warwick, Coventry, UK
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Tabler J, Snyder JA, White C, Freng A, Thunström L. COVID-19 health practices and attitudes in the United States: the role of trust in healthcare. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2022; 31:1-14. [PMID: 35968051 PMCID: PMC9361898 DOI: 10.1007/s10389-022-01737-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/17/2022] [Indexed: 11/29/2022]
Abstract
Aim Individual-level COVID-19 vaccination and related preventive health behaviors is politically polarized in the United States. We examined whether the current polarization in COVID-19 health behavior may be explained by differences in trust in healthcare, locus of control, or insurance status. Subject and methods Our sample includes 553 US adults recruited on Amazon MTurk. We assessed odds ratios of currently vaccinated, or willing to be vaccinated if unvaccinated using logistic regression. We assessed count of routine changes and positive attitudes toward facemasks using negative binomial regression. Results Trust in healthcare was found to be an important determinant of all COVID-19 related health behavior measured in our study. Further, the effects on COVID-related attitudes/behavior from trust in healthcare are large in magnitude. For instance, our results suggest that individuals at or above the upper quartile of trust in healthcare are around 20 percentage points more likely to be vaccinated than those at or below the lower quartile. Further, we find that the effect of trust in healthcare on adherence or endorsement of COVID-19 mitigation strategies is distinct from political affiliation, i.e., the effect on COVID-19 related health behavior is independent of the polarization across political party lines. Locus of control was not associated with adherence/attitude toward COVID-19 mitigation strategies. Insurance status was only found to be positively associated with odds of being vaccinated. Conclusion Our study highlights the importance of increasing trust in healthcare as a means to protect public health in the wake of major public health crises. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-022-01737-9.
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Affiliation(s)
- Jennifer Tabler
- Department of Criminal Justice and Sociology, University of Wyoming, 1000 E University Ave, Laramie, WY USA
| | - Jamie A. Snyder
- Department of Criminal Justice and Sociology, University of Wyoming, 1000 E University Ave, Laramie, WY USA
| | - Clair White
- Department of Criminal Justice and Sociology, University of Wyoming, 1000 E University Ave, Laramie, WY USA
| | - Adrienne Freng
- Department of Criminal Justice and Sociology, University of Wyoming, 1000 E University Ave, Laramie, WY USA
| | - Linda Thunström
- Department of Economics, University of Wyoming, Laramie, WY USA
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Nguyen TC, Gathecha E, Kauffman R, Wright S, Harris CM. Healthcare distrust among hospitalised black patients during the COVID-19 pandemic. Postgrad Med J 2022; 98:539-543. [PMID: 34588293 PMCID: PMC8483918 DOI: 10.1136/postgradmedj-2021-140824] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/18/2021] [Indexed: 01/01/2023]
Abstract
STUDY PURPOSE Distrust of the healthcare system is longstanding in the black community. This may especially threaten the health of the population when a highly contagious infection strikes. This study aims to compare COVID-19-related perspectives and behaviours between hospitalised black patients who trust versus distrust doctors and healthcare systems. STUDY DESIGN Cross-sectional study at a tertiary care academic hospital in Baltimore, Maryland. Hospitalised adult black patients without a history of COVID-19 infection were surveyed between November 2020 and March 2021 using an instrument that assessed COVID-19-related matters. Analyses compared those who trusted versus mistrusted doctors and healthcare systems. RESULTS 37 distrusting hospitalised black patients were compared with 103 black patients who trusted doctors and healthcare systems. Groups had similar sociodemographics (all p>0.05). Distrustful patients were less likely to think that they were at high risk of contracting COVID-19 (54.0% vs 75.7%; p=0.05), less likely to believe that people with underlying medical conditions were at higher risk of dying from the virus (86.4% vs 98.0%; p=0.01) and less likely to be willing to accept COVID-19 vaccination (when available) (51.3% vs 77.6%; p<0.01) compared with those who were trusting. CONCLUSION Healthcare distrustful hospitalised black patients were doubtful of COVID-19 risk and hesitant about vaccination. Hospitalisations are concentrated exposures to the people and processes within healthcare systems; at these times, seizing the opportunity to establish meaningful relationships with patients may serve to gain their trust.
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Affiliation(s)
- Thang Cong Nguyen
- Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Evelyn Gathecha
- Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Regina Kauffman
- Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Scott Wright
- Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Ché Matthew Harris
- Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
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Delivering Value Through Equitable Care for Low Back Pain: A Renewed Call to Action. J Orthop Sports Phys Ther 2022; 52:414-418. [PMID: 35580022 DOI: 10.2519/jospt.2022.10815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Equitable care for low back pain (LBP) is key to ensuring the value and sustainability of services delivered by physical therapists. In this Viewpoint, we discuss how social determinants of health, implicit provider biases, structural characteristics of the health care system, and health care policies contribute to disparate care for many individuals with LBP. We aim to increase awareness of equity as a key component of value in physical therapy and highlight steps physical therapists can take to improve equitable LBP care. This "call to action" underscores the need to study, demonstrate, and advance equitable care for LBP by physical therapists to improve outcomes for patients and ensure the growth and sustainability of the physical therapy profession. J Orthop Sports Phys Ther 2022;52(7):414-418. Epub: 17 May 2022. doi:10.2519/jospt.2022.10815.
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Police killings and suicide among Black Americans. Soc Sci Med 2022; 305:114964. [PMID: 35660700 DOI: 10.1016/j.socscimed.2022.114964] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 03/02/2022] [Accepted: 04/04/2022] [Indexed: 11/23/2022]
Abstract
Black Americans are killed at higher rates by police than whites. Previous studies have shown that discrimination can lead to suicidal ideation, and that mental health of Black Americans deteriorates after police killings. The objective of this study is to examine whether police killings are associated with an increase in suicide rates amongst Black Americans. Controlling for a number of factors, we found that on months with at least one killing of a Black person by police, there were, on average, 0.0472 additional suicides per 100,000 Black Americans in the U.S. Census Division where the killing occurred. We did not find any spillover effects on other divisions. This association persisted when controlling for gun ownership, and did not seem to be a result of variance in deaths by assault. There was no association between killings of Black Americans and white suicides; white killings and Black suicides; or white killings and white suicides. This study highlights another reason for urgent action on reducing police killings.
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Zhang R, Qiao S, McKeever BW, Olatosi B, Li X. Listening to Voices from African American Communities in the Southern States about COVID-19 Vaccine Information and Communication: A Qualitative Study. Vaccines (Basel) 2022; 10:vaccines10071046. [PMID: 35891210 PMCID: PMC9319640 DOI: 10.3390/vaccines10071046] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/21/2022] [Accepted: 06/26/2022] [Indexed: 11/23/2022] Open
Abstract
The high uptake of COVID-19 vaccines is one of the most promising measures to control the pandemic. However, some African American (AA) communities exhibit vaccination hesitancy due to mis- or disinformation. It is important to understand the challenges in accessing reliable COVID-19 vaccine information and to develop feasible health communication interventions based on voices from AA communities. We conducted 2 focus group discussions (FGDs) among 18 community stakeholders recruited from 3 counties in South Carolina on 8 October and 29 October 2021. The FGDs were conducted online via Zoom meetings. The FGD data were managed and thematically analyzed using NVivo 12. Participants worked primarily in colleges, churches, and health agencies. We found that the challenges of accessing reliable vaccine information in AA communities primarily included structural barriers, information barriers, and a lack of trust. Community stakeholders recommended recruiting trusted messengers, using social events to reach target populations, and conducting health communication campaigns through open dialogue among stakeholders. Health communication interventions directed at COVID-19 vaccine uptake should be grounded in ongoing community engagement, trust-building activities, and transparent communication about vaccine development. Tailoring health communication interventions to different groups may help reduce misinformation spread and thus promote vaccination in AA communities in the southern states.
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Affiliation(s)
- Ran Zhang
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC 29208, USA; (R.Z.); (X.L.)
| | - Shan Qiao
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC 29208, USA; (R.Z.); (X.L.)
- Correspondence: ; Tel.: +1-803-777-6844
| | - Brooke W. McKeever
- School of Journalism and Mass Communications, College of Information and Communications, Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
| | - Bankole Olatosi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
| | - Xiaoming Li
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC 29208, USA; (R.Z.); (X.L.)
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Bharmal N. Social Determinants and Health Equity in Functional Medicine. Phys Med Rehabil Clin N Am 2022; 33:665-678. [DOI: 10.1016/j.pmr.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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The racial and cultural ecology of home and community-based services for diverse older adults. J Aging Stud 2022; 61:101023. [DOI: 10.1016/j.jaging.2022.101023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 11/19/2022]
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Brown A, Auguste E, Omobhude F, Bakana N, Sukhera J. Symbolic Solidarity or Virtue Signaling? A Critical Discourse Analysis of the Public Statements Released by Academic Medical Organizations in the Wake of the Killing of George Floyd. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:867-875. [PMID: 35044980 DOI: 10.1097/acm.0000000000004597] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Many academic medical organizations issued statements in response to demand for collective action against racial injustices and police brutality following the murder of George Floyd in May 2020. These statements may offer insight into how medical schools and national organizations were reflecting on and responding to these incidents. The authors sought to empirically examine the initial statements published by academic medical organizations in response to societal concerns about systemic, anti-Black racism. METHOD The authors searched for initial public statements released by a sample of academic medical organizations in Canada and the United States between May 25 and August 31, 2020. They assembled an archive with a purposive sample of 45 statements, including those issued by 35 medical schools and 10 national organizations. They analyzed the statements using Fairclough's 3-dimensional framework for critical discourse analysis (descriptive, interpretive, explanatory), which is a qualitative approach to systematically analyzing language and how it reflects and shapes social practice. RESULTS Many statements used formal and analytical language and reflected hierarchical thinking and power differentials between statement producers and consumers. The authors identified several tensions in the statements between explicit messaging and implied ideologies (e.g., self-education vs action to address racism), and they found a lack of critical reflection and commitment to institutional accountability to address anti-Black racism in academic medicine. The authors also found that many statements minimized discussions of racism and de-emphasized anti-Black racism as well as portrayed anti-Black racism as outside the institution and institutional accountability. CONCLUSIONS This research offers insight into how 45 academic medical organizations initially responded following the murder of George Floyd. Many of these statements included self-exculpatory and nonracist discursive strategies. While these statements may have been well intentioned, organizations must move beyond words to transformative action to abolish institutional racism in academic medicine.
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Affiliation(s)
- Allison Brown
- A. Brown is assistant professor, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; ORCID: https://orcid.org/0000-0002-4552-8146
| | - Emmanuelle Auguste
- E. Auguste is an undergraduate student, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Favour Omobhude
- F. Omobhude is an undergraduate student, Faculty of Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Naomie Bakana
- N. Bakana is an undergraduate student, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada
| | - Javeed Sukhera
- J. Sukhera is chair/chief, Psychiatry Institute of Living and Hartford Hospital, Hartford, Connecticut; ORCID: https://orcid.org/0000-0001-8146-4947
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Govier DJ, Cohen-Cline H, Marsi K, Roth SE. Differences in access to virtual and in-person primary care by race/ethnicity and community social vulnerability among adults diagnosed with COVID-19 in a large, multi-state health system. BMC Health Serv Res 2022; 22:511. [PMID: 35428257 PMCID: PMC9012053 DOI: 10.1186/s12913-022-07858-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/29/2022] [Indexed: 02/08/2023] Open
Abstract
Background Research exploring telehealth expansion during the COVID-19 pandemic has demonstrated that groups disproportionately impacted by COVID-19 also experience worse access to telehealth. However, this research has been cross-sectional or short in duration; geographically limited; has not accounted for pre-existing access disparities; and has not examined COVID-19 patients. We examined virtual primary care use by race/ethnicity and community social vulnerability among adults diagnosed with COVID-19 in a large, multi-state health system. We also assessed use of in-person primary care to understand whether disparities in virtual access may have been offset by improved in-person access. Methods Using a cohort design, electronic health records, and Centers for Disease Control and Prevention Social Vulnerability Index, we compared changes in virtual and in-person primary care use by race/ethnicity and community social vulnerability in the year before and after COVID-19 diagnosis. Our study population included 11,326 adult patients diagnosed with COVID-19 between March and July 2020. We estimated logistic regression models to examine likelihood of primary care use. In all regression models we computed robust standard errors; in adjusted models we controlled for demographic and health characteristics of patients. Results In a patient population of primarily Hispanic/Latino and non-Hispanic White individuals, and in which over half lived in socially vulnerable areas, likelihood of virtual primary care use increased from the year before to the year after COVID-19 diagnosis (3.6 to 10.3%); while in-person use remained stable (21.0 to 20.7%). In unadjusted and adjusted regression models, compared with White patients, Hispanic/Latino and other race/ethnicity patients were significantly less likely to use virtual care before and after COVID-19 diagnosis; Hispanic/Latino, Native Hawaiian/Pacific Islander, and other race/ethnicity patients, and patients living in socially vulnerable areas were also significantly less likely to use in-person care during these time periods. Conclusions Newly expanded virtual primary care has not equitably benefited individuals from racialized groups diagnosed with COVID-19, and virtual access disparities have not been offset by improved in-person access. Health systems should employ evidence-based strategies to equitably provide care, including representative provider networks; targeted, empowering outreach; co-developed culturally and linguistically appropriate tools and technologies; and provision of enabling resources and services.
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Shibli H, Palkin D, Aharonson-Daniel L, Davidovitch N, Daoud N. Inequalities in Trust Levels and Compliance With Physical Distancing During COVID-19 Outbreaks: Comparing the Arab Minority and Jewish Populations in Israel. Int J Public Health 2022; 67:1604533. [PMID: 35450127 PMCID: PMC9017601 DOI: 10.3389/ijph.2022.1604533] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: This study explores associations between trust in directives and compliance with physical distancing by comparing two populations in Israel. Methods: Following two lockdowns, we conducted two cross-sectional surveys among the Arab minority and Jewish citizens of Israel (first survey, N = 613; second survey, N = 542). We conducted multivariable logistic regression analyses for the association between trust and compliance with physical distancing separately for each group in each survey. Results: In both surveys trust levels were significantly lower among Arabs than Jews (p < 0.001). Compared to Jews, Arabs were less likely to report compliance with physical distancing in the first and second surveys (OR = 0.52, 95% CI 0.32-0.84 and OR = 0.62, 95% CI 0.39-0.98, respectively). In both surveys trusting the directives was an important determinant of compliance with physical distancing among Jews only. Conclusion: Our findings indicate that momentum is important in building and maintaining public trust and compliance during pandemics. Policymakers should note the lack of trust among Arabs, which warrants further research and interventions.
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Affiliation(s)
- Haneen Shibli
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Negev, Israel
- PREPARED Center for Emergency Response Research, Negev, Israel
| | - Daiana Palkin
- Department of Public Health, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Negev, Israel
| | - Limor Aharonson-Daniel
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Negev, Israel
- PREPARED Center for Emergency Response Research, Negev, Israel
| | - Nadav Davidovitch
- Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Negev, Israel
| | - Nihaya Daoud
- Department of Public Health, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Negev, Israel
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Jain B, Khatri E, Stanford FC. Racial disparities in senior healthcare: System-level interventions. J Am Geriatr Soc 2022; 70:1292-1296. [PMID: 35006606 PMCID: PMC8986603 DOI: 10.1111/jgs.17658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 12/23/2021] [Accepted: 12/25/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Bhav Jain
- Massachusetts Institute of Technology, Cambridge, MA
| | | | - Fatima C. Stanford
- Departments of Medicine and Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Richmond J, Boynton MH, Ozawa S, Muessig KE, Cykert S, Ribisl KM. Development and Validation of the Trust in My Doctor, Trust in Doctors in General, and Trust in the Health Care Team Scales. Soc Sci Med 2022; 298:114827. [PMID: 35255277 PMCID: PMC9014823 DOI: 10.1016/j.socscimed.2022.114827] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/29/2022] [Accepted: 02/15/2022] [Indexed: 11/18/2022]
Abstract
RATIONALE Historic and present-day racism and inequity in the United States (U.S.) have resulted in diminished trust in health care among many populations. A key barrier to improving trust in health care is a dearth of well-validated measures appropriate for diverse populations. Indeed, systematic reviews indicate a need to develop and test updated trust measures that are multidimensional and inclusive of relevant domains (e.g., fairness). OBJECTIVE We developed three trust measures: the Trust in My Doctor (T-MD), Trust in Doctors in General (T-DiG), and Trust in the Health Care Team (T-HCT) scales. METHODS After developing an initial item pool, expert reviewers (n = 6) provided feedback on the face validity of each scale. We conducted cognitive interviews (n = 21) with a convenience sample of adults to ensure items were interpreted as intended. In 2020, we administered an online survey to a convenience sample of U.S. adults recruited through the Qualtrics Panel (n = 801) to assess scale reliability and validity. RESULTS Exploratory and confirmatory factor analyses indicated acceptable model fit for second order latent factor models for each scale (root mean square error of approximation: <0.07, comparative fit index: ≥0.98, and standardized root mean square residual: ≤0.03). The T-MD contained 25 items and six subscales: communication competency, fidelity, systems trust, confidentiality, fairness, and global trust. The T-DiG and T-HCT each contained 29 items and seven subscales (the same subscales in the T-MD plus an additional subscale related to stigma-based discrimination). Each scale was strongly correlated with existing trust measures and perceived racism in health care and was significantly associated with delayed health care seeking and receipt of a routine health exam. CONCLUSIONS The multidimensional T-MD, T-DiG, and T-HCT scales have sound psychometric properties and may be useful for researchers evaluating trust-related interventions or conducting studies where trust is an important construct or main outcome.
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Affiliation(s)
- Jennifer Richmond
- Vanderbilt University Medical Center, Department of Medicine, Division of Genetic Medicine, 2525 West End Ave, 7th Floor Suite, Nashville, TN, 37203, USA; University of North Carolina at Chapel Hill Gillings School of Global Public Health, Department of Health Behavior, 135 Dauer Drive, 302 Rosenau Hall, CB #7440, Chapel Hill, NC, 27599, USA.
| | - Marcella H Boynton
- University of North Carolina School of Medicine, North Carolina Translational & Clinical Sciences Institute (NC TraCS), 160 N. Medical Drive, Chapel Hill, NC, 27599, USA; University of North Carolina School of Medicine, Division of General Medicine and Clinical Epidemiology, 5034 Old Clinic Building, CB#7110, Chapel Hill, NC, 27599, USA; Lineberger Comprehensive Cancer Center, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | - Sachiko Ozawa
- University of North Carolina, Eshelman School of Pharmacy, Division of Practice Advancement and Clinical Education, CB #7574, Beard Hall 115G, Chapel Hill, NC, 27599, USA
| | - Kathryn E Muessig
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Department of Health Behavior, 135 Dauer Drive, 302 Rosenau Hall, CB #7440, Chapel Hill, NC, 27599, USA
| | - Samuel Cykert
- University of North Carolina School of Medicine, Division of General Medicine and Clinical Epidemiology, 5034 Old Clinic Building, CB#7110, Chapel Hill, NC, 27599, USA
| | - Kurt M Ribisl
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Department of Health Behavior, 135 Dauer Drive, 302 Rosenau Hall, CB #7440, Chapel Hill, NC, 27599, USA; Lineberger Comprehensive Cancer Center, 101 Manning Drive, Chapel Hill, NC, 27514, USA
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Powell L, Walsh M, Reinhard CL, Jankowski K, Watson B. One Health clinic promotes veterinarian-client trust among underserved pet owners and provides learning opportunities for veterinary students. J Am Vet Med Assoc 2022; 260:931-939. [PMID: 35298404 DOI: 10.2460/javma.21.06.0274] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the impact of a free One Health clinic with human and veterinary services on the veterinary-client relationship for underserved pet owners. A secondary aim was to understand the experience of veterinary students and volunteers who participated in the clinic. SAMPLE 78 pet owners, 55 students and 32 volunteers who attended the Delaware Humane Association One Health Clinic between December 2018 and November 2019. PROCEDURES Pet owners completed an anonymous questionnaire prior to and following their veterinary appointment regarding their trust in the veterinary profession, feelings of enablement and veterinarian-client concordance. Students and volunteers completed a questionnaire within 72 hours of clinic participation about their perceptions of the educational value of the clinic. RESULTS Following the One Health clinic, client trust in the veterinary profession increased significantly (t = -5.50, P < 0.001). Clients also reported high levels of enablement and veterinarian-client concordance. Students and volunteers agreed the clinic was a valuable educational experience (97.7%) and reported increased compassion, enhanced leadership, communication and teamwork skills, and an improved ability to identify social issues and think critically. CLINICAL RELEVANCE The results support the utilization of One Health clinics to improve access to veterinary care for underserved pet owners. Clients reported high levels of trust, enablement and concordance following the clinic which could have long-lasting effects on their willingness to seek veterinary care and comply with veterinarians' recommendations. The positive experiences of students and volunteers also highlights the potential of low-cost veterinary clinics as unique educational experiences.
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Affiliation(s)
- Lauren Powell
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Meriel Walsh
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Chelsea L Reinhard
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kristin Jankowski
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California Davis, Davis CA
| | - Brittany Watson
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
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Shukla N, Agarwal M, Khanna A, Shukla AC, Varghese A. Acceptance of COVID-19 Vaccination in India, after First Phase-Out: A Cross-Sectional Community-Based Study. ANNALS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES (INDIA) 2022. [DOI: 10.1055/s-0042-1743136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Background India rolled out the world's largest vaccination program on January 16, 2021, marking the beginning of an effort to vaccinate a population of 1.3 billion against coronavirus disease 2019 (COVID-19) infection. However, the hesitancy toward safe and effective vaccine against severe infection is a major global health threat. Hence, public acceptance of COVID-19 vaccine would be an essential deterrent to the pandemic control.
Materials and Methods A cross-sectional online study was conducted among the Indians from January 1 to January 31, 2021. The online questionnaire addressed several variables, including the sociodemographic parameters, COVID-19 vaccine acceptance, and concerns regarding COVID-19 vaccine.
Results Out of total 450 participants, majority of them (97.1) were aware about the COVID-19 vaccination drive. Only 66.2% showed their willingness to accept vaccination, 26.0% were still indecisive, and 7.8% did not want to accept it.
Conclusion Despite numerous efforts by various scientific organizations, public health experts, and media outlets, to educate the general population about the COVID-19 vaccine, significant portion of the Indian population may experience vaccine hesitancy, which poses dangers to both the individual and their community. Therefore, we must target these potential candidates, who are indecisive, for intervention to increase vaccine acceptance across the country. In this regard, large-scale study is required to understand the knowledge, expectation, and apprehension covering various economic and occupational strata of the society.
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Affiliation(s)
- Neetu Shukla
- Department of Community Medicine and Public Health, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Monika Agarwal
- Department of Community Medicine and Public Health, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Anish Khanna
- Department of Community Medicine and Public Health, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Amritesh Chandra Shukla
- Department of Botany, Faculty of Science, University of Lucknow, Lucknow, Uttar Pradesh, India
| | - Anila Varghese
- Department of Community Medicine and Public Health, King George's Medical University, Lucknow, Uttar Pradesh, India
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Granade CJ, Lindley MC, Jatlaoui T, Asif AF, Jones-Jack N. Racial and Ethnic Disparities in Adult Vaccination: A Review of the State of Evidence. Health Equity 2022; 6:206-223. [PMID: 35402775 PMCID: PMC8985539 DOI: 10.1089/heq.2021.0177] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Adult vaccination coverage remains low in the United States, particularly among racial and ethnic minority populations. Objective To conduct a comprehensive literature review of research studies assessing racial and ethnic disparities in adult vaccination. Search Methods We conducted a search of PubMed, Cochrane Library, ClinicalTrials.gov, and reference lists of relevant articles. Selection Criteria Research studies were eligible for inclusion if they met the following criteria: (1) study based in the United States, (2) evaluated receipt of routine immunizations in adult populations, (3) used within-study comparison of race/ethnic groups, and (4) eligible for at least one author-defined PICO (patient, intervention, comparison, and outcome) question. Data Collection and Analysis Preliminary abstract review was conducted by two authors. Following complete abstraction of articles using a standardized template, abstraction notes and determinations were reviewed by all authors; disagreements regarding article inclusion/exclusion were resolved by majority rule. The Social Ecological Model framework was used to complete a narrative review of observational studies to summarize factors associated with disparities; a systematic review was used to evaluate eligible intervention studies. Results Ninety-five studies were included in the final analysis and summarized qualitatively within two main topic areas: (1) factors associated with documented racial-ethnic disparities in adult vaccination and (2) interventions aimed to reduce disparities or to improve vaccination coverage among racial-ethnic minority groups. Of the 12 included intervention studies, only 3 studies provided direct evidence and were of Level II, fair quality; the remaining 9 studies met the criteria for indirect evidence (Level I or II, fair or poor quality). Conclusions A considerable amount of observational research evaluating factors associated with racial and ethnic disparities in adult vaccination is available. However, intervention studies aimed at reducing these disparities are limited, are of poor quality, and insufficiently address known reasons for low vaccination uptake among racial and ethnic minority adults.
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Affiliation(s)
- Charleigh J. Granade
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Megan C. Lindley
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tara Jatlaoui
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amimah F. Asif
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education, U.S. Department of Energy, Atlanta, Georgia, USA
| | - Nkenge Jones-Jack
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Xu J, Goodman M, Janisse J, Cher ML, Bock CH. Five-year follow-up study of a population-based prospective cohort of men with low-risk prostate cancer: the treatment options in prostate cancer study (TOPCS): study protocol. BMJ Open 2022; 12:e056675. [PMID: 35190441 PMCID: PMC8860062 DOI: 10.1136/bmjopen-2021-056675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Active surveillance (AS) is recommended for men with low-risk prostate cancer (LRPC) to reduce overtreatment and to maintain patients' quality of life (QOL). However, whether African American (AA) men can safely undergo AS is controversial due to concerns of more aggressive disease and lack of empirical data on the safety and effectiveness of AS in this population. Withholding of AS may lead to a lost opportunity for improving survivorship in AA men. In this study, peer-reviewed and funded by the US Department of Defense, we will assess whether AS is an equally effective and safe management option for AA as it is for White men with LRPC. METHODS AND ANALYSIS The project extends follow-up of a large contemporary population-based cohort of LRPC patients (n=1688) with a high proportion of AA men (~20%) and well-characterised baseline and 2-year follow-up data. The objectives are to (1) determine any racial differences in AS adherence, switch rate from AS to curative treatment and time to treatment over 5 years after diagnosis, (2) compare QOL among AS group and curative treatment group over time, overall and by race and (3) evaluate whether reasons for switching from AS to curative treatment differ by race. Validation of survey responses related to AS follow-up procedures is being conducted through medical record review. We expect to obtain 5-year survey from ~900 (~20% AA) men by the end of this study to have sufficient power. Descriptive and inferential statistical techniques will be used to examine racial differences in AS adherence, effectiveness and QOL. ETHICS AND DISSEMINATION The parent and current studies were approved by the Institutional Review Boards at Wayne State University and Emory University. Since it is an observational study, ethical or safety risks are low. We will disseminate our findings to relevant conferences and peer-reviewed journals.
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Affiliation(s)
- Jinping Xu
- Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Michael Goodman
- Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - James Janisse
- Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Michael L Cher
- Urology, Wayne State University School of Medicine, Detroit, Michigan, USA
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Arellano Carmona K, Chittamuru D, Kravitz RL, Ramondt S, Ramírez AS. Beyond Dr. Google: Health information seeking from an intelligent online symptom checker: Cross-Sectional Questionnaire Study (Preprint). J Med Internet Res 2022; 24:e36322. [PMID: 35984690 PMCID: PMC9440406 DOI: 10.2196/36322] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/21/2022] [Accepted: 05/24/2022] [Indexed: 01/20/2023] Open
Abstract
Background The ever-growing amount of health information available on the web is increasing the demand for tools providing personalized and actionable health information. Such tools include symptom checkers that provide users with a potential diagnosis after responding to a set of probes about their symptoms. Although the potential for their utility is great, little is known about such tools’ actual use and effects. Objective We aimed to understand who uses a web-based artificial intelligence–powered symptom checker and its purposes, how they evaluate the experience of the web-based interview and quality of the information, what they intend to do with the recommendation, and predictors of future use. Methods Cross-sectional survey of web-based health information seekers following the completion of a symptom checker visit (N=2437). Measures of comprehensibility, confidence, usefulness, health-related anxiety, empowerment, and intention to use in the future were assessed. ANOVAs and the Wilcoxon rank sum test examined mean outcome differences in racial, ethnic, and sex groups. The relationship between perceptions of the symptom checker and intention to follow recommended actions was assessed using multilevel logistic regression. Results Buoy users were well-educated (1384/1704, 81.22% college or higher), primarily White (1227/1693, 72.47%), and female (2069/2437, 84.89%). Most had insurance (1449/1630, 88.89%), a regular health care provider (1307/1709, 76.48%), and reported good health (1000/1703, 58.72%). Three types of symptoms—pain (855/2437, 35.08%), gynecological issues (293/2437, 12.02%), and masses or lumps (204/2437, 8.37%)—accounted for almost half (1352/2437, 55.48%) of site visits. Buoy’s top three primary recommendations split across less-serious triage categories: primary care physician in 2 weeks (754/2141, 35.22%), self-treatment (452/2141, 21.11%), and primary care in 1 to 2 days (373/2141, 17.42%). Common diagnoses were musculoskeletal (303/2437, 12.43%), gynecological (304/2437, 12.47%) and skin conditions (297/2437, 12.19%), and infectious diseases (300/2437, 12.31%). Users generally reported high confidence in Buoy, found it useful and easy to understand, and said that Buoy made them feel less anxious and more empowered to seek medical help. Users for whom Buoy recommended “Waiting/Watching” or “Self-Treatment” had strongest intentions to comply, whereas those advised to seek primary care had weaker intentions. Compared with White users, Latino and Black users had significantly more confidence in Buoy (P<.05), and the former also found it significantly more useful (P<.05). Latino (odds ratio 1.96, 95% CI 1.22-3.25) and Black (odds ratio 2.37, 95% CI 1.57-3.66) users also had stronger intentions to discuss recommendations with a provider than White users. Conclusions Results demonstrate the potential utility of a web-based health information tool to empower people to seek care and reduce health-related anxiety. However, despite encouraging results suggesting the tool may fulfill unmet health information needs among women and Black and Latino adults, analyses of the user base illustrate persistent second-level digital divide effects.
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Affiliation(s)
| | - Deepti Chittamuru
- School of Social Sciences, Humanities and Arts, University of California, Merced, CA, United States
| | | | - Steven Ramondt
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, Netherlands
- Department of Communication Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - A Susana Ramírez
- School of Social Sciences, Humanities and Arts, University of California, Merced, CA, United States
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Yetman HE, Cox N, Adler SR, Hall KT, Stone VE. What Do Placebo and Nocebo Effects Have to Do With Health Equity? The Hidden Toll of Nocebo Effects on Racial and Ethnic Minority Patients in Clinical Care. Front Psychol 2022; 12:788230. [PMID: 35002881 PMCID: PMC8733207 DOI: 10.3389/fpsyg.2021.788230] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/30/2021] [Indexed: 12/21/2022] Open
Abstract
A placebo effect is a positive clinical response to non-specific elements of treatment with a sham or inert replica of a drug, device, or surgical intervention. There is considerable evidence that placebo effects are driven by expectation of benefit from the intervention. Expectation is shaped by a patient's past experience, observations of the experience of others, and written, verbal, or non-verbal information communicated during treatment. Not surprisingly, expectation in the clinical setting is strongly influenced by the attitude, affect, and communication style of the healthcare provider. While positive expectations can produce beneficial effects, negative information and experiences can lead to negative expectations, and consequently negative or nocebo effects. Key components identified and studied in the placebo and nocebo literature intersect with factors identified as barriers to quality care in the clinical setting for Black patients and other patients of color, including poor patient-clinician communication, medical mistrust, and perceived discrimination. Thus, in the context of discrimination and bias, the absence of placebo and presence of nocebo-generating influences in clinical settings could potentially reinforce racial and ethnic inequities in clinical outcomes and care. Healthcare inequities have consequences that ripple through the medical system, strengthening adverse short- and long-term outcomes. Here, we examine the potential for the presence of nocebo effects and absence of placebo effects to play a role in contributing to negative outcomes related to unequal treatment in the clinical encounter.
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Affiliation(s)
- Hailey E Yetman
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Nevada Cox
- Penn State College of Medicine, Hershey, PA, United States
| | - Shelley R Adler
- Osher Center for Integrative Health, University of California, San Francisco, San Francisco, CA, United States
| | - Kathryn T Hall
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Valerie E Stone
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
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78
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Okoro O, Kennedy J, Simmons G, Vosen EC, Allen K, Singer D, Scott D, Roberts R. Exploring the Scope and Dimensions of Vaccine Hesitancy and Resistance to Enhance COVID-19 Vaccination in Black Communities. J Racial Ethn Health Disparities 2022; 9:2117-2130. [PMID: 34553340 PMCID: PMC8457035 DOI: 10.1007/s40615-021-01150-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/25/2021] [Accepted: 09/03/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND The long history of distrust that characterizes the relationship between the Black/African-American population and the US Medical community makes COVID-19 vaccine hesitancy of great concern. A needs assessment of the Black/African-American community assessed willingness and explored the perceptions of community members regarding COVID-19 vaccination. METHODS The study used a mixed-methods approach. Respondents (n = 183) were surveyed with a web-based questionnaire. They were asked whether there would get vaccinated for COVID-19 barring any access or cost-related challenges. Perceptions of community members regarding vaccination were explored through one-on-one interviews (n = 30) and eight focus groups (n = 49), with participants drawn from across various demographic characteristics. Survey responses were summarized using frequencies and proportions. A thematic analysis was conducted on the qualitative data. RESULTS Thirty-four percent of respondents indicated "Yes" (willing to get vaccinated); 26.8% indicated "No", while 37.1% expressed hesitancy ("Maybe" or "I don't know"). Themes emerging from the qualitative data are grouped into three broad categories: vaccine accessibility (transportation, information, navigating healthcare system); vaccine hesitancy (with sub-categories of compliance, complacency and confidence); and vaccine "resistance" (conspiracy theories, conflicting beliefs, distrust of Government, trustworthiness of Health care). CONCLUSION Findings demonstrate a nuanced expansion of "vaccine hesitancy" to delineate groups with varying issues and perspectives. Interventions to enhance vaccination rates in Black/African-American communities should incorporate components that assure accessibility at the minimum, but also address non-access-related issues. Priority should be given to enhancing vaccine literacy, information-sharing as efficacy and safety data emerge, and addressing specific concerns identified through community-engaged outreach efforts.
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Affiliation(s)
- Olihe Okoro
- grid.17635.360000000419368657Department of Pharmacy Practice & Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, MN USA
| | - Janet Kennedy
- Healthy Alliances Matter for All LLC, Duluth, MN USA
| | - Glenn Simmons
- grid.17635.360000000419368657Department of Biomedical Sciences, University of Minnesota Medical School Duluth, Duluth, MN USA
| | - Elyse Carter Vosen
- grid.418807.20000 0004 0397 1478Department of Global, Cultural, and Language Studies, College of St. Scholastica, Duluth, MN USA
| | | | - Desiré Singer
- Healthy Alliances Matter for All LLC, Duluth, MN USA
| | - Desmond Scott
- Healthy Alliances Matter for All LLC, Duluth, MN USA
| | - Renee Roberts
- grid.17635.360000000419368657Department of Pharmacy Practice & Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, MN USA
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79
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Zhang Q, Metcalf SS, Palmer HD, Northridge ME. Developing an agent-based model of oral healthcare utilization by Chinese Americans in New York City. Health Place 2022; 73:102740. [DOI: 10.1016/j.healthplace.2022.102740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 11/04/2022]
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80
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Mallela DP, Canner JK, Zarkowsky DS, Haut ER, Abularrage CJ, Hicks CW. Association between Race and Perioperative Outcomes after Carotid Endarterectomy for Asymptomatic Carotid Artery Stenosis in NSQIP. J Am Coll Surg 2022; 234:65-73. [PMID: 35213462 PMCID: PMC9860456 DOI: 10.1097/xcs.0000000000000016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Previous studies have documented that Black patients have worse outcomes after lower extremity revascularization procedures compared with White patients. However, the association of race on carotid endarterectomy (CEA) outcomes is not well described. The aim of this study was to compare perioperative outcomes of CEA for Black vs White patients with asymptomatic carotid artery stenosis. STUDY DESIGN All patients who underwent CEA for asymptomatic carotid stenosis in the ACS-NSQIP targeted vascular database (2011-2019) were included. Perioperative (30-day) outcomes were compared for Black vs White patients using multivariable logistic regression adjusting for age/sex, comorbidities, and disease characteristics. RESULTS Of 16,764 asymptomatic CEA patients, 95.2% (N = 15,960) were White and 4.8% (N = 804) were Black. Black patients were slightly younger (mean age 71.4 ± 0.1 vs 69.9 ± 0.3 years, P < 0.001) and more frequently had high-grade carotid artery stenosis compared to White patients (79.5% vs 74.0%, p = 0.001). Comorbidities including hypertension, diabetes, kidney disease, congestive heart failure, and coronary artery disease were all more prevalent among Black patients (p ≤ 0.01). Crude perioperative stroke (2.4% vs 1.3%, p = 0.007) and stroke/death (2.6% vs 1.4%, p = 0.003) were higher for Black patients, but myocardial infarction (1.7% vs 1.5%, p = 0.67) and death (0.4% vs 0.2%, p = 0.12) were similar. After adjusting for baseline differences between groups, the risk of perioperative stroke (odds ratio 1.66, 95% CI 1.01 to 2.73) and stroke/death (odds ratio 1.75, 95% CI 1.10 to 2.81) remained significantly higher for Black patients compared with White patients. CONCLUSIONS Black patients undergoing CEA for asymptomatic carotid artery stenosis had more severe stenosis, more comorbidities, and worse perioperative outcomes compared to White patients. Overall, our data suggest substantial differences in the treatment and outcomes of asymptomatic carotid artery stenosis based on race.
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Affiliation(s)
- Deepthi P Mallela
- From the Division of Vascular Surgery and Endovascular Therapy (Mallela, Abularrage, Hicks), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joseph K Canner
- the Department of Surgery, Yale University School of Medicine, New Haven, CT (Canner)
| | - Devin S Zarkowsky
- the Division of Vascular Surgery, University of Colorado School of Medicine, Aurora, CO (Zarkowsky)
| | - Elliott R Haut
- the Division of Acute Care Surgery (Haut), Johns Hopkins University School of Medicine, Baltimore, MD
- the Department of Anesthesiology and Critical Care Medicine (Haut), Johns Hopkins University School of Medicine, Baltimore, MD
- the Department of Emergency Medicine (Haut), Johns Hopkins University School of Medicine, Baltimore, MD
- The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD (Haut)
- the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Haut)
| | - Christopher J Abularrage
- From the Division of Vascular Surgery and Endovascular Therapy (Mallela, Abularrage, Hicks), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Caitlin W Hicks
- From the Division of Vascular Surgery and Endovascular Therapy (Mallela, Abularrage, Hicks), Johns Hopkins University School of Medicine, Baltimore, MD
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81
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Alqahtani YS. Acceptability of the COVID-19 Vaccine among Adults in Saudi Arabia: A Cross-Sectional Study of the General Population in the Southern Region of Saudi Arabia. Vaccines (Basel) 2021; 10:41. [PMID: 35062702 PMCID: PMC8777608 DOI: 10.3390/vaccines10010041] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 01/06/2023] Open
Abstract
Vaccines afford protection against infectious diseases. However, a sizeable part of the population refuse vaccinations and continue to dispute the evidence supporting vaccinations. The objective of this study was to determine the prevalence of COVID-19 vaccination uptake and its determinants among the Saudi population in the southern region of Saudi Arabia. A cross-sectional survey studied COVID-19 vaccine acceptance in adults in Saudi Arabia, targeting the general population in the southwestern region. Data were collected through an online survey questionnaire tool. All data were analysed using SPSS version 23.0. The majority (57.29%) of the participants were willing to receive the new COVID-19 vaccine, whereas almost 64% believed it is necessary to take the COVID-19 vaccine to protect oneself and that the vaccine is safe, efficient and effective. The data showed that perceived risk of COVID-19 (p = 0.015), history of previous vaccination against seasonal influenza (p = 0.000), and trust in the healthcare system (p = 0.025) were significant predictors for COVID-19 vaccine acceptance. We conclude that participants' trust in the healthcare system, perceived risk of contracting COVID-19, and history of previous vaccination against seasonal influenza were significant predictors for COVID-19 vaccine acceptance. Knowing the acceptance rates for the COVID-19 vaccination can aid state agencies, medical practitioners, and other entities in reducing the impact of vaccine avoidance.
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Affiliation(s)
- Yahya S Alqahtani
- Department of Pharmaceutical Chemistry, College of Pharmacy, Najran University, Najran 66462, Saudi Arabia
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82
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Ayalon L, Cohn-Schwartz E. The Relationship Between Perceived Age Discrimination in the Healthcare System and Health: An Examination of a Multi-Path Model in a National Sample of Israelis Over the Age of 50. J Aging Health 2021; 34:684-692. [PMID: 34866449 DOI: 10.1177/08982643211058025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The present study aims to examine possible pathways that potentially account for the relationship between perceived age discrimination in healthcare settings (as one form of ageism) and health outcomes. METHODS We relied on 1570 complete surveys, which constitute a representative national sample of adults aged 50 and above in Israel. RESULTS We found a direct link between perceived age discrimination and health outcomes. This link was partially mediated by self-perceptions of aging and subsequently by health behaviors (e.g., eating vegetables) and preventive health behaviors (e.g., medical check-ups). The link between perceived age discrimination and health behaviors was moderated by age, thus, particularly detrimental for older people over the age of 65 as compared with those between the ages of 50 and 65. DISCUSSION This study adds to the literature as it examines comprehensive mechanisms to account for the path between perceived age discrimination and health status. Our findings point to the unique aspects associated with perceived age discrimination, which potentially make older people more susceptible to its negative effects.
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Affiliation(s)
- Liat Ayalon
- Louis and Gabi Weisfild School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Ella Cohn-Schwartz
- Gerontology Program, Department of Public Health, 26732Ben-Gurion University, Beer-Sheva, Israel
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83
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Smith TK. Racial and Social Impacts of Diabetes Mellitus: An Autobiographical Case Report. Cureus 2021; 13:e20211. [PMID: 35004031 PMCID: PMC8729318 DOI: 10.7759/cureus.20211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 11/05/2022] Open
Abstract
Type two diabetes mellitus is a chronic medical condition encountered by physicians providing medical care to adult and pediatric patients. This autobiographical case report discusses type two diabetes from the perspective of positive and negative interactions with the healthcare system in managing diabetes mellitus, especially for a physician of color and underrepresented in medicine. Bias and assumptions occur for some people diagnosed with diabetes mellitus or presumed to have the disease based on age, body habitus, comorbidities, lived environment, race, and ethnicity. I specifically address the social implications of bias experienced by persons of color strictly based on race and ethnicity. Intensified awareness about systemic and institutional racism in healthcare warrants eliminating the inequities and disparities in the medical management and treatment of diabetes mellitus.
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84
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Alijanzadeh M, Ahorsu DK, Alimoradi Z, Mahmoudi N, Griffiths MD, Lin CY, Liu HK, Pakpour AH. Fear of COVID-19 and Trust in the Healthcare System Mediates the Association between Individual's Risk Perception and Preventive COVID-19 Behaviours among Iranians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212146. [PMID: 34831900 PMCID: PMC8621944 DOI: 10.3390/ijerph182212146] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/01/2021] [Accepted: 11/12/2021] [Indexed: 12/26/2022]
Abstract
Problems caused by the novel coronavirus disease-2019 (COVID-19) and its mutations have brought challenges in pandemic control for all countries worldwide. The present study examines the mediating roles of fear of COVID-19 and trust in the healthcare system in the association between individual’s risk perception and performing preventive COVID-19 behaviours among Iranians. A cross-sectional study design was used to collect data from 3652 residents of Qazvin province in Iran from 3 February to 15 April 2021 using a multistage stratified cluster sampling method. Participants responded to an online questionnaire concerning their fear of COVID-19, risk perception, trust in the healthcare system, and preventive COVID-19 behaviours. Small to medium positive interrelationships were observed between the variables of the study. Fear of COVID-19, trust in the healthcare system or both (fear of COVID-19 and trust in the healthcare system) mediated the association between an individual’s risk perception and performing preventive COVID-19 behaviours. The study demonstrated there are at least four ways through which an individual’s risk perception can influence preventive COVID-19 behaviours. Therefore, clinicians, health communicators, and researchers may capitalize on these findings to enhance preventive COVID-19 behaviours to help mitigate the spread of COVID-19 infection.
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Affiliation(s)
- Mehran Alijanzadeh
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin 3419759811, Iran; (M.A.); (Z.A.); (N.M.)
| | - Daniel Kwasi Ahorsu
- Department of Rehabilitation Sciences, Faculty of Health & Social Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Rd Hung Hom, Hong Kong, China;
| | - Zainab Alimoradi
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin 3419759811, Iran; (M.A.); (Z.A.); (N.M.)
| | - Narges Mahmoudi
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin 3419759811, Iran; (M.A.); (Z.A.); (N.M.)
| | - Mark D. Griffiths
- Psychology Department, Nottingham Trent University, Nottingham NG3 5DS, UK;
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan;
| | - Hsien-Kuan Liu
- Department of Pediatrics, E-DA Hospital, Kaohsiung 82445, Taiwan
- School of Medicine, I-Shou University, Kaohsiung 840203, Taiwan
- Correspondence: (H.-K.L.); (A.H.P.)
| | - Amir H. Pakpour
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin 3419759811, Iran; (M.A.); (Z.A.); (N.M.)
- Department of Nursing, School of Health and Welfare, Jönköping University, 55111 Jönköping, Sweden
- Correspondence: (H.-K.L.); (A.H.P.)
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Torres MB, Dixon MEB, Gusani NJ. Undertreatment of Pancreatic Cancer: The Intersection of Bias, Biology, and Geography. Surg Oncol Clin N Am 2021; 31:43-54. [PMID: 34776063 DOI: 10.1016/j.soc.2021.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Pancreatic cancer is the third leading cause of cancer deaths in the United States. Black patients with pancreatic cancer experience higher incidence and increased mortality. Although racial biologic differences exist, socioeconomic status, insurance type, physician bias, and patient beliefs contribute to the disparities in outcomes observed among patients who are Black, indigenous, and people of color.
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Affiliation(s)
- Madeline B Torres
- General Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Avenue MC H149, Hershey, PA 17033, USA. https://twitter.com/MadelineBTorres
| | - Matthew E B Dixon
- Division of Surgical Oncology, Penn State Health Milton S. Hershey Medical Center, 500 University Avenue MC H070, Hershey, PA 17036, USA. https://twitter.com/mebdixon
| | - Niraj J Gusani
- Section of Surgical Oncology, Baptist MD Anderson Cancer Center, 1301 Palm Avenue, Jacksonville, FL 32207, USA.
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86
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Zhou X, Altice FL, Chandra D, Didomizio E, Copenhaver MM, Shrestha R. Use of Pre-exposure Prophylaxis Among People Who Inject Drugs: Exploratory Findings of the Interaction Between Race, Homelessness, and Trust. AIDS Behav 2021; 25:3743-3753. [PMID: 33751313 DOI: 10.1007/s10461-021-03227-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
Scale-up of pre-exposure prophylaxis (PrEP) in people who inject drugs (PWID) remains suboptimal. Patient-level factors are often complex and may contribute to scale-up. Using cross-sectional data from 234 opioid-dependent patients on methadone who met eligibility criteria for PrEP, we conducted logistic regression analyses to assess potential moderators associated with being on PrEP (n = 60). Mean provider trust was significantly higher among Blacks vs Whites (39.4 vs 34.9; p = 0.002) and non-homeless vs homeless participants (37.5 vs 34.8; p = 0.008). Though race/ethnicity was not a significant moderator on provider trust and PrEP use, increased provider trust was marginally associated with increased PrEP use among Blacks (p = 0.058). Additionally, homelessness significantly moderated provider trust and PrEP use (p = 0.024). Provider trust among non-homeless participants was positively correlated with PrEP use (p = 0.013) but not among homeless participants. Strategies that promote provider trust in Blacks and non-homeless PWID on methadone may improve PrEP scale-up.
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87
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Li J, Clouser JM, Brock J, Davis T, Jack B, Levine C, Mays GP, Mittman B, Nguyen H, Sorra J, Stromberg A, Du G, Dai C, Adu A, Vundi N, Williams MV. Effects of Different Transitional Care Strategies on Outcomes after Hospital Discharge-Trust Matters, Too. Jt Comm J Qual Patient Saf 2021; 48:40-52. [PMID: 34764025 DOI: 10.1016/j.jcjq.2021.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/08/2021] [Accepted: 09/21/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND As health systems shift toward value-based care, strategies to reduce readmissions and improve patient outcomes become increasingly important. Despite extensive research, the combinations of transitional care (TC) strategies associated with best patient-centered outcomes remain uncertain. METHODS Using an observational, prospective cohort study design, Project ACHIEVE sought to determine the association of different combinations of TC strategies with patient-reported and postdischarge health care utilization outcomes. Using purposive sampling, the research team recruited a diverse sample of short-term acute care and critical access hospitals in the United States (N = 42) and analyzed data on eligible Medicare beneficiaries (N = 7,939) discharged from their medical/surgical units. Using both hospital- and patient-reported TC strategy exposure data, the project compared patients "exposed" to each of five overlapping groups of TC strategies to their "control" counterparts. Primary outcomes included 30-day hospital readmissions, 7-day postdischarge emergency department (ED) visits and patient-reported physical and mental health, pain, and participation in daily activities. RESULTS Participants averaged 72.3 years old (standard deviation =10.1), 53.4% were female, and most were White (78.9%). Patients exposed to one TC group (Hospital-Based Trust, Plain Language, and Coordination) were less likely to have 30-day readmissions (risk ratio [RR], 0.72; 95% confidence interval [CI] = 0.57-0.92, p < 0.001) or 7-day ED visits (RR, 0.72; 95% CI, 0.55-0.93, p < 0.001) and more likely to report excellent physical and mental health, greater participation in daily activities, and less pain (RR ranged from 1.11 to 1.15, p < 0.01). CONCLUSION In concert with care coordination activities that bridge the transition from hospital to home, hospitals' clear communication and fostering of trust with patients were associated with better patient-reported outcomes and reduced health care utilization.
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88
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Njoku A, Joseph M, Felix R. Changing the Narrative: Structural Barriers and Racial and Ethnic Inequities in COVID-19 Vaccination. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9904. [PMID: 34574827 PMCID: PMC8470519 DOI: 10.3390/ijerph18189904] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/08/2021] [Accepted: 09/13/2021] [Indexed: 12/13/2022]
Abstract
The COVID-19 pandemic has disproportionately affected racial and ethnic minority groups in the United States. Although a promising solution of the COVID-19 vaccination offers hope, disparities in access again threaten the health of these communities. Various explanations have arisen for the cause of disparate vaccination rates among racial and ethnic minorities, including discussion of vaccine hesitancy. Conversely, the role of vaccine accessibility rooted in structural racism as a driver in these disparities should be further explored. This paper discusses the impact of structural barriers on racial and ethnic disparities in COVID-19 vaccine uptake. We also recommend public health, health system, and community-engaged approaches to reduce racial disparities in COVID-19 disease and mortality.
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Affiliation(s)
- Anuli Njoku
- Department of Public Health, College of Health and Human Services, Southern Connecticut State University, 144 Farnham Avenue, New Haven, CT 06515, USA; (M.J.); (R.F.)
| | - Marcelin Joseph
- Department of Public Health, College of Health and Human Services, Southern Connecticut State University, 144 Farnham Avenue, New Haven, CT 06515, USA; (M.J.); (R.F.)
- Greater Bridgeport Area Prevention Program, 1470 Barnum Avenue, Suite 301, Bridgeport, CT 06610, USA
| | - Rochelle Felix
- Department of Public Health, College of Health and Human Services, Southern Connecticut State University, 144 Farnham Avenue, New Haven, CT 06515, USA; (M.J.); (R.F.)
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Bertram M, Brandt US, Hansen RK, Svendsen GT. Does higher health literacy lead to higher trust in public hospitals? Int J Equity Health 2021; 20:209. [PMID: 34530812 PMCID: PMC8447678 DOI: 10.1186/s12939-021-01528-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/10/2021] [Indexed: 12/02/2022] Open
Abstract
Background Does higher health literacy lead to higher trust in public hospitals? Existing literature suggests that this is the case since a positive association between the level of health literacy and the level of trust in physicians and the health care system has been shown. This study aims to challenge this assumption. Methods Based on theoretical arguments from game theory and analysis of empirical data, we argue that the association is better described as an inversely u-shaped curve, suggesting that low and high levels of health literacy lead to a lower level of trust than a medium level of health literacy does. The empirical analysis is based on a study of the Danes’ relationship to the overall health care system. More than 6000 Danes have been asked about their overall expectations of the health service, their concrete experiences and their attitudes to a number of change initiatives. Results Game theory analysis show that the combined perceived cooperation and benefit effects can explain an inversely u-shaped relationship between social groups and trust in the health care system. Based on quantitative, binary regression analyses of empirical data, the lowest degree of trust is found among patients from the lowest and highest social groups, while the highest degree of trust is found in the middle group. The main driver for this result is that while patients having low health literacy perceive that the health care system is not cooperative, patients with a high level of health literacy have high expectations about the quality, which the health care system might not be able to provide. This reduces the perceived benefit from their encounter with the health care system. Conclusion It is important that health care professionals understand that some patient groups have a higher chance of cooperation (e.g., agreeing on the choice of treatment) or defection (e.g. passing a complaint) than others. In perspective, future research should undertake further qualitative examinations of possible patient types and their demands in relation to different health care sectors, focusing specifically on the opportunities to improve the handling of different patient types.
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Affiliation(s)
- Maja Bertram
- Department of Public Health, Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark.
| | - Urs Steiner Brandt
- Department of Sociology, Environmental and Business Economic, University of Southern Denmark, Esbjerg, Denmark
| | - Rikke Klitten Hansen
- Department for Planning and Finances, Odense University Hospital, Odense, Denmark
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90
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Nong P, Raj M, Trinidad MG, Rowe Z, Platt J. Understanding racial differences in attitudes about public health efforts during COVID-19 using an explanatory mixed methods design. Soc Sci Med 2021; 287:114379. [PMID: 34520940 PMCID: PMC8425672 DOI: 10.1016/j.socscimed.2021.114379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/29/2021] [Accepted: 09/04/2021] [Indexed: 10/28/2022]
Abstract
Efforts to mitigate the spread of COVID-19 rely on trust in public health organizations and practices. These practices include contact tracing, which requires people to share personal information with public health organizations. The central role of trust in these practices has gained more attention during the pandemic, resurfacing endemic questions about public trust and potential racial trust disparities, especially as they relate to participation in public health efforts. Using an explanatory mixed methods design, we conducted quantitative analysis of state-level survey data in the United States from a representative sample of Michigan residents (n = 1000) in May 2020. We used unadjusted and adjusted linear regressions to examine differences in trust in public health information and willingness to participate in public health efforts by race. From July to September 2020, we conducted qualitative interviews (n = 26) to further explain quantitative results. Using unadjusted linear regression, we observed higher willingness to participate in COVID-19 public health efforts among Black survey respondents compared to White respondents. In adjusted analysis, that difference disappeared, yielding no statistically significant difference between Black and White respondents in either trust in public health information sources or willingness to participate. Qualitative interviews were conducted to explain these findings, considering their contrast with assumptions that Black people would exhibit lower trust in public health organizations during COVID-19. Altruism, risk acknowledgement, trust in public health organizations during COVID-19, and belief in efficacy of public health efforts contributed to willingness to participate in public health efforts among interviewees. Our findings underscore the contextual nature of trust, and the importance of this context when analyzing protective health behaviors among communities disproportionately affected by COVID-19. Assumptions about mistrust among Black individuals and communities may be inaccurate because they overlook the specific context of the public health crisis. These findings are important because they indicate that Black respondents are exhibiting strategic trust during COVID-19 despite systemic, contemporary, and historic barriers to trust. Conceptual specificity rather than blanket generalizations is warranted, especially given the harms of stereotyping and discrimination.
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Affiliation(s)
- Paige Nong
- University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Minakshi Raj
- University of Illinois Department of Kinesiology and Community Health, USA.
| | - Marie Grace Trinidad
- University of Michigan Department of Learning Health Sciences, 300 N Ingalls St, Ann Arbor, MI, 48109, USA.
| | - Zachary Rowe
- Friends of Parkside, 5000 Connor St, Detroit, MI, 48213, USA
| | - Jodyn Platt
- University of Michigan Department of Learning Health Sciences, 300 N Ingalls St, Ann Arbor, MI, 48109, USA.
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91
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Smith NC. Black-White disparities in women's physical health: The role of socioeconomic status and racism-related stressors. SOCIAL SCIENCE RESEARCH 2021; 99:102593. [PMID: 34429206 DOI: 10.1016/j.ssresearch.2021.102593] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 05/18/2021] [Accepted: 05/23/2021] [Indexed: 05/18/2023]
Abstract
Black women have elevated rates of multiple physical illnesses and conditions when compared to White women - disparities that are only partially explained by socioeconomic status (SES). Consequently, scholars have called for renewed attention to the significance of racism-related stress in explaining Black-White disparities in women's physical health. Drawing on the biopsychosocial model of racism as a stressor and the intersectionality perspective, this study examines the extent to which SES and racism-related stressors - i.e., discrimination, criminalization, and adverse neighborhood conditions - account for disparities in self-rated physical health and chronic health conditions between Black and White women. Results indicate that Black women have lower SES and report greater exposure to racism-related stressors across all domains. Moreover, I find that SES and racism-related stressors jointly account for more than 90% of the Black-White disparity in women's self-rated physical health and almost 50% of the Black-White disparity in chronic health conditions. Theoretical and policy implications of these findings are discussed.
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Affiliation(s)
- Nicholas C Smith
- Indiana University - Bloomington, Department of Sociology Ballantine Hall 744, 1020 East Kirkwood Avenue Bloomington, IN, 47405, USA.
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92
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McClendon J, Chang K, J Boudreaux M, Oltmanns TF, Bogdan R. Black-White racial health disparities in inflammation and physical health: Cumulative stress, social isolation, and health behaviors. Psychoneuroendocrinology 2021; 131:105251. [PMID: 34153589 DOI: 10.1016/j.psyneuen.2021.105251] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/16/2021] [Accepted: 04/29/2021] [Indexed: 11/18/2022]
Abstract
Black Americans have vastly increased odds and earlier onsets of stress- and age-related disease compared to White Americans. However, what contributes to these racial health disparities remains poorly understood. Using a sample of 1577 older adults (32.7% Black; ages 55-65 at baseline), we examined whether stress, health behaviors, social isolation, and inflammation are associated with racial disparities in self-reported physical health. A latent cumulative stress factor and unique stress-domain specific factors were modeled by applying bifactor confirmatory analysis to assessments across the lifespan (i.e., childhood maltreatment, trauma exposure, discrimination, stressful life events, and indices of socioeconomic status). Physical health, health behavior, and social isolation were assessed using self-report. Interleukin-6 (IL-6) and C-reactive protein (CRP) were assayed from morning fasting serum samples; a z-scored inflammation index was formed across these 2 cytokines. A parallel serial mediational model tested whether race (i.e., Black/White) is indirectly associated with health through the following 3 independent pathways: (1) cumulative stress to preventative health behaviors (e.g., healthy eating) to inflammation, (2) cumulative stress to risky health behaviors (e.g., substance use) to inflammation; and (3) cumulative stress to social isolation to inflammation. There were significant indirect effects between race and self-reported physical health through cumulative stress, preventative health behaviors, and inflammation (B = -0.02, 95% CI: -0.05, -0.01). Specifically, Black Americans were exposed to greater cumulative stress, which was associated with reduced engagement in preventative health behaviors, which was, in turn, associated with greater inflammation and reduced physical health. A unique SES factor also indirectly linked race to physical health through preventative health behaviors. Cumulative stress exposure and unique aspects of socioeconomic status are indirectly associated with Black-White racial health disparities through behavioral (i.e., preventative health behavior) and biological (i.e., inflammation) factors. Culturally responsive evidence-based interventions that enhance engagement in preventative health behaviors are needed to directly confront health disparities. Ultimately, large scale anti-racist public policies that reduce cumulative stress burden (e.g., a living wage, universal healthcare) may best attenuate racial health disparities.
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Affiliation(s)
- Juliette McClendon
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA
| | | | | | | | - Ryan Bogdan
- Washington University in St. Louis, St. Louis, MO, USA.
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93
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Buikema AR, Buzinec P, Paudel ML, Andrade K, Johnson JC, Edmonds YM, Jhamb SK, Chastek B, Raja H, Cao F, Hulbert EM, Korrer S, Mazumder D, Seare J, Solow BK, Currie UM. Racial and ethnic disparity in clinical outcomes among patients with confirmed COVID-19 infection in a large US electronic health record database. EClinicalMedicine 2021; 39:101075. [PMID: 34493997 PMCID: PMC8413267 DOI: 10.1016/j.eclinm.2021.101075] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Racial and ethnic minority groups have been disproportionately affected by the US coronavirus disease 2019 (COVID-19) pandemic; however, nationwide data on COVID-19 outcomes stratified by race/ethnicity and adjusted for clinical characteristics are sparse. This study analyzed the impacts of race/ethnicity on outcomes among US patients with COVID-19. METHODS This was a retrospective observational study of patients with a confirmed COVID-19 diagnosis in the electronic health record from 01 February 2020 through 14 September 2020. Index encounter site, hospitalization, and mortality were assessed by race/ethnicity (Hispanic, non-Hispanic Black [Black], non-Hispanic White [White], non-Hispanic Asian [Asian], or Other/unknown). Associations between racial/ethnic categories and study outcomes adjusted for patient characteristics were evaluated using logistic regression. FINDINGS Among 202,908 patients with confirmed COVID-19, patients from racial/ethnic minority groups were more likely than White patients to be hospitalized on initial presentation (Hispanic: adjusted odds ratio 1·690, 95% CI 1·620-1·763; Black: 1·810, 1·743-1·880; Asian: 1·503, 1·381-1·636) and during follow-up (Hispanic: 1·700, 1·638-1·764; Black: 1·578, 1·526-1·633; Asian: 1·391, 1·288-1·501). Among hospitalized patients, adjusted mortality risk was lower for Black patients (0·881, 0·809-0·959) but higher for Asian patients (1·205, 1·000-1·452). INTERPRETATION Racial/ethnic minority patients with COVID-19 had more severe disease on initial presentation than White patients. Increased mortality risk was attenuated by hospitalization among Black patients but not Asian patients, indicating that outcome disparities may be mediated by distinct factors for different groups. In addition to enacting policies to facilitate equitable access to COVID-19-related care, further analyses of disaggregated population-level COVID-19 data are needed.
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Affiliation(s)
- Ami R. Buikema
- Optum, Eden Prairie, MN, USA
- Corresponding author at: 11000 Optum Circle, MN101-E300, Eden Prairie, MN 55344, USA.
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94
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Niznik JD, Harrison J, White EM, Syme M, Hanson LC, Kelley CJ, Porter L, Berry SD. Perceptions of COVID-19 vaccines among healthcare assistants: A national survey. J Am Geriatr Soc 2021; 70:8-18. [PMID: 34449885 PMCID: PMC8657352 DOI: 10.1111/jgs.17437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/30/2022]
Abstract
Background Limited COVID‐19 vaccination acceptance among healthcare assistants (HCAs) may adversely impact older adults, who are at increased risk for severe COVID‐19 infections. Our study objective was to evaluate the perceptions of COVID‐19 vaccine safety and efficacy in a sample of frontline HCAs, overall and by race and ethnicity. Methods An online survey was conducted from December 2020 to January 2021 through national e‐mail listserv and private Facebook page for the National Association of Health Care Assistants. Responses from 155 HCAs, including certified nursing assistants, home health aides, certified medical assistants, and certified medication technicians, were included. A 27‐item survey asked questions about experiences and perceptions of COVID‐19 vaccines, including how confident they were that COVID‐19 vaccines are safe, effective, and adequately tested in people of color. Multivariable regression was used to identify associations with confidence in COVID‐19 vaccines. Results We analyzed data from 155 completed responses. Among respondents, 23.9% were black and 8.4% Latino/a. Most respondents worked in the nursing home setting (53.5%), followed by hospitals (12.9%), assisted living (11.6%), and home care (10.3%). Respondents expressed low levels of confidence in COVID‐19 vaccines, with fewer than 40% expressing at least moderate confidence in safety (38.1%), effectiveness (31.0%), or adequate testing in people of color (27.1%). Non‐white respondents reported lower levels of confidence in adequate testing of vaccines compared to white respondents. In bivariate and adjusted models, respondents who gave more favorable scores of organizational leadership at their workplace expressed greater confidence in COVID‐19 vaccines. Conclusion Frontline HCAs reported low confidence in COVID‐19 vaccines. Stronger organizational leadership in the workplace appears to be an important factor in influencing HCA's willingness to be vaccinated. Action is needed to enhance COVID‐19 vaccine uptake in this important population with employers playing an important role to build vaccine confidence and trust among employees.
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Affiliation(s)
- Joshua D Niznik
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina, USA.,Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA.,Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Jill Harrison
- Department of Health Services, Policy, and Practice, Brown University, School of Public Health, Providence, Rhode Island, USA
| | - Elizabeth M White
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Maggie Syme
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Laura C Hanson
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina, USA
| | - Casey J Kelley
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina, USA
| | - Lori Porter
- National Association of Health Care Assistants (NAHCA), Carl Junction, Missouri, USA
| | - Sarah D Berry
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA.,Department of Medicine, and Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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95
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Qamar MA, Irfan O, Dhillon RA, Bhatti A, Sajid MI, Awan S, Rizwan W, Zubairi ABS, Sarfraz Z, Khan JA. Acceptance of COVID-19 Vaccine in Pakistan: A Nationwide Cross-Sectional Study. Cureus 2021; 13:e16603. [PMID: 34430184 PMCID: PMC8378420 DOI: 10.7759/cureus.16603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 01/06/2023] Open
Abstract
Introduction The coronavirus disease 2019 (COVID-19) vaccine is available across various countries worldwide, with public-private partnerships ensuring all individuals are vaccinated through a phased approach. Irrespective of the geographical spread, several myths pertaining to the COVID-19 vaccine have stemmed, ultimately limiting the national administration of vaccines and rollouts. This study assessed the acceptance of the COVID-19 vaccine among the general public in Pakistan. Methods A pre-validated questionnaire was administered from January 2021 to February 2021 to assess the public attitude and acceptance of the COVID-19 vaccine. Logistic regression analyses were run to identify factors associated with the acceptance among the population. Results A total of 936 responses were elicited, where 15% perceived their risk of being infected at 20-30% with an overall 70% agreeing to be vaccinated if recommended. Multivariate analysis identified higher acceptance in the male gender, healthcare workers, and students. Of all, 66% respondents chose healthcare workers and public officials, whereas 15.6% chose scientific literature, and 12.9% chose social media as the most reliable source of COVID-19 information. Conclusion Given the relatively greater trust in healthcare providers for information regarding COVID-19, healthcare workers ought to be on the frontline for vaccine campaigns and public outreach efforts, with governmental efforts in addition to the promotion of scientific materials for population-level understanding.
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Affiliation(s)
| | - Omar Irfan
- Pediatrics, Centre for Global Child Health, Hospital for Sick Children, Toronto, CAN
| | - Rubaid A Dhillon
- Internal Medicine, Riphah International University, Rawalpindi, PAK
| | | | | | - Safia Awan
- Internal Medicine, The Aga Khan University, Karachi, PAK
| | - Wajiha Rizwan
- Pediatrics, The Children Hospital and Institute of Child Health, Lahore, PAK
| | | | - Zouina Sarfraz
- Internal Medicine, Fatima Jinnah Medical University, Lahore, PAK
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96
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Reid HW, Lin OM, Fabbro RL, Johnson KS, Svetkey LP, Olsen MK, Matsouaka RA, Chung ST, Batch BC. Racial differences in patient perception of interactions with providers are associated with health outcomes in type II diabetes. PATIENT EDUCATION AND COUNSELING 2021; 104:1993-2003. [PMID: 33579569 PMCID: PMC8217118 DOI: 10.1016/j.pec.2021.01.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Examine the association of patient perceptions of care with hemoglobin A1c (HbA1c), medication adherence, and missed appointments in non-Hispanic Black (NHB) and White (NHW) patients with type 2 diabetes (T2DM). METHODS We used linear and logistic regression models to analyze the association of the Interpersonal Processes of Care survey (IPC) with HbA1c, medication adherence, and missed appointments. We then examined how these associations differed by race. RESULTS There was no overall association between IPC subdomains and HbA1c in our sample (N = 221). NHB patients perceiving their provider always explained results and medications had a HbA1c on average 0.59 (-1.13, -0.04; p = 0.04) points lower than those perceiving their provider sometimes explained results and medications. No effect was observed in NHWs. Never perceiving disrespect from office staff was associated with an average 0.67 (-1.1, -0.24; p = 0.002) point improvement in medication adherence for all patients. Never perceiving discrimination from providers was associated with a 0.44 (-0.63, -0.25; p < 0.0001) decrease in the probability of missing an appointment for NHB patients. CONCLUSIONS These results demonstrate that particular aspects of communication in the patient-provider interaction may contribute to racial disparities in T2DM. PRACTICE IMPLICATIONS Communication training for both providers and staff may reduce disparities in T2DM.
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Affiliation(s)
| | | | | | - Kimberly S Johnson
- Department of Medicine, Division of Geriatrics, Duke University School of Medicine, Center for Aging and Human Development, Duke University School of Medicine, Geriatrics Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, USA
| | - Laura P Svetkey
- Department of Medicine, Division of Nephrology, Duke University School of Medicine, Durham, USA
| | - Maren K Olsen
- Duke University Department of Biostatistics and Bioinformatics, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, USA
| | - Roland A Matsouaka
- Duke University Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Duke University, Durham, USA
| | | | - Bryan C Batch
- Department of Medicine, Division of Endocrinology, Duke University School of Medicine, Durham, USA
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97
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Said M, Boardman G, Kidd S. Barriers to accessing mental health services in Somali-Australian women: a qualitative study. Int J Ment Health Nurs 2021; 30:931-938. [PMID: 33715289 PMCID: PMC8359963 DOI: 10.1111/inm.12846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/17/2021] [Indexed: 11/29/2022]
Abstract
Despite the global prevalence of mental disorders being widely acknowledged, mental illness, complex trauma and the significant impact on individuals, families and communities continues to be poorly recognized, under-diagnosed and underreported. Based on the 2017 Australian census, one-in-five (20%) people have experienced some type of mental illness within the last 12 months (Australian Bureau of Statistics [ABS], 2019). The prevalence rate of mental illness in culturally and linguistically diverse (CALD) communities is difficult to estimate due to cultural and linguistic issues and underutilization of mental health services. In particular, little epidemiological data is available about the prevalence of mental illness in the Somali-Australian community. The aim of this study was to identify the perceived barriers to help-seeking for mental health for Somali-Australian women. A qualitative descriptive study incorporating focus group discussions with 31 Somali-Australian women was conducted in Melbourne, Australia. Braun & Clarke's (2006) thematic analysis was applied to the data. Four themes relating to help-seeking barriers were abstracted. Influence of faith explored how Islam can impact the person views on mental illness. Stigma focused on the relationship between public and self-stigma and help-seeking. Mistrust of Western healthcare system describes the participants concerns about the cultural disconnect between the community and the Western healthcare system. Finally, denial of mental illness reflected the community views on mental health. This study provides an insight into the factors that influence the Somali-Australian community help-seeking with mental health services. The findings have implications for mental health professionals and the Somali-Australian community.
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Affiliation(s)
- Mulki Said
- Victoria University, Footscray, Victoria, Australia
| | | | - Susan Kidd
- Victoria University, Footscray, Victoria, Australia
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98
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Kramer J, Yinusa-Nyahkoon L, Olafsson S, Penti B, Woodhams E, Bickmore T, Jack BW. Black Men's Experiences With Health care: Individuals' Accounts of Challenges, Suggestions for Change, and the Potential Utility of Virtual Agent Technology to Assist Black Men With Health Management. QUALITATIVE HEALTH RESEARCH 2021; 31:1772-1785. [PMID: 34092141 DOI: 10.1177/10497323211013323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Black men have the highest age-adjusted death rate of any major race-gender group in America. Understanding their perceived barriers to accessing health care may benefit future interventions working to increase Black men's health care engagement. Data collected from focus groups of Black men(N = 67), key informant interviews(N = 12), and interviews(N = 5) with participants who pilot tested an online health education system (called "Gabe") were analyzed to explore their health care experiences and how computer-based health programs might better assist Black men. Concerns pertaining to health care systems' failure to recognize the diversity among Black men, and physicians' lack of sociocultural awareness about the challenges they regularly face, were most salient. Building trust with providers was cited as being central to engagement, with Gabe users perceiving the system to be both trustworthy and accessible. Participants reported an openness to technology assisting with health management and provided suggestions of how online systems can meet the needs of Black men.
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Affiliation(s)
- Justin Kramer
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Leanne Yinusa-Nyahkoon
- Boston University School of Medicine, Boston, Massachusetts, USA
- Boston University, Boston, Massachusetts, USA
| | | | - Brian Penti
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | | | | | - Brian W Jack
- Boston University School of Medicine, Boston, Massachusetts, USA
- Boston University, Boston, Massachusetts, USA
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99
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Vandergrift LA, Christopher PP. Do prisoners trust the healthcare system? HEALTH & JUSTICE 2021; 9:15. [PMID: 34216311 PMCID: PMC8254986 DOI: 10.1186/s40352-021-00141-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 06/15/2021] [Indexed: 06/01/2023]
Abstract
BACKGROUND Individuals who are incarcerated have greater healthcare needs than non-justice-involved individuals, yet incarcerated individuals often report substandard care. There are disproportionate numbers of black, indigenous, and people of color (BIPOC) in prison, who, even in general society face greater obstacles to accessing healthcare and have worse health outcomes due to structural racism. Regardless of race, people with criminal justice involvement often report stigma from the non-carceral healthcare system. Providing sufficient healthcare in carceral settings themselves is complicated by lack of privacy and the inherent dialectic of prisons that restrict freedom and providers focusing on healing and health. Based on these adverse experiences, people who are incarcerated may have decreased distrust in the healthcare system, deterring individuals from getting adequate medical care. METHODS In this exploratory study, health care system distrust was evaluated among 200 people who were incarcerated using the Revised Health Care System Distrust scale, a community-validated, 9-item measure comprised of 2 subscales (values and competence distrust). RESULTS Distrust was moderately and positively associated with participant age (rs = 0.150, p = 0.034), with the second-oldest quintile (33 to 42-year-olds) reporting the highest level of overall and competence distrust. Participants identifying as Non-Latinx White reported higher competence distrust compared to Latinx and Non-Latinx/Non-White respondents. CONCLUSIONS These preliminary findings suggest that select groups of prisoners may be less likely to trust the healthcare system, highlighting an impediment to receiving adequate care while incarcerated. Further study of this topic is warranted.
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Affiliation(s)
- Lindsey A Vandergrift
- Warren Alpert Medical School, Biomedical Department, Brown University, 69 Brown St G-9474, RI, 02903, Providence, USA.
| | - Paul P Christopher
- Warren Alpert Medical School, Biomedical Department, Brown University, 69 Brown St G-9474, RI, 02903, Providence, USA
- Department of Psychiatry and Human Behavior , Brown University , RI, 02912, Providence, USA
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100
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Savić-Kallesøe S, Middleton A, Milne R. Public trust and genomic medicine in Canada and the UK. Wellcome Open Res 2021; 6:124. [PMID: 34235273 PMCID: PMC8215560 DOI: 10.12688/wellcomeopenres.16831.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Genomic medicine could improve precise risk stratification, early prevention, and personalised treatment across a broad spectrum of disease. As this reality approaches, questions on the importance of public trust arise. The success of genomic medicine initiatives is influenced by the public's trust and willingness to engage. Specific social actors influential in the public's trust have been identified by the "Your DNA, Your Say" study, including doctors, researchers, and governments. This paper aims to identify and examine which specific social actors, if any, in Canada and the United Kingdom (UK) are the most trustworthy and influential to engage the public in genomic medicine research. Methods: Using data from the 'Your DNA, Your Say' study, logistic regression models and Pearson's chi-square tests were conducted to explore trust in social actors across Canada and the UK. Results: The results demonstrate Canada and the UK significantly differ in public trust and willingness to donate. Non-profit researchers, domestic doctors, and personal doctors were identified to be the most influential and trustworthy social actors in Canada and the UK. Conclusions: The comparative results indicate that both countries would benefit from engaging the public through doctors and non-profit researchers. The UK could additionally support public trust by engaging with the public through the National Health Service. However, the results suggest that whilst public trust is significant, it may be neither necessary nor sufficient in influencing willingness to donate. Future research could do well to investigate how the importance of public trust compares in countries with lower public trust.
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Affiliation(s)
- Sarah Savić-Kallesøe
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK
| | - Anna Middleton
- Society and Ethics Research, Wellcome Connecting Science, Cambridge, CB10 1SA, UK
- Faculty of Education, University of Cambridge, Cambridge, CB2 8PQ, UK
| | - Richard Milne
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK
- Society and Ethics Research, Wellcome Connecting Science, Cambridge, CB10 1SA, UK
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