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Medeiros P, Shetty J, Lamaj L, Cunningham J, Wanigaratne S, Guttmann A, Cohen E. Reported community engagement in health equity research published in high-impact medical journals: a scoping review. BMJ Open 2024; 14:e084952. [PMID: 39134436 PMCID: PMC11331902 DOI: 10.1136/bmjopen-2024-084952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 07/25/2024] [Indexed: 08/21/2024] Open
Abstract
OBJECTIVE To assess reported community engagement in the design and conduct of health equity-focused articles published in high-impact journals. DESIGN Scoping review follows guidance from the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. DATA SOURCES We selected the three highest-ranked journals from the 'Medicine-General and Internal' category including the Journal of the American Medical Association (JAMA), The Lancet and The New England Journal of Medicine (NEJM) along with all journals under their family of subspecialty journals (JAMA Network, The Lancet Group and the NEJM Group). Ovid MEDLINE was searched between 1 January 2021 to 22 September 2022. ELIGIBILITY CRITERIA We included health equity-focused articles and assessed for the reporting of community engagement at each stage of the research process. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data from articles that met the inclusionary criteria. Inter-rater reliability was assessed using Cohen's kappa to measure the agreement between two independent reviewers. Disagreements were adjudicated by a third independent reviewer. RESULTS 7616 articles were screened, 626 (8.2%) met our inclusion criteria: 457 (3.8%) were published by the JAMA Network; 167 (2.4%) by The Lancet Group; and 2 (0.2%) by the NEJM group. Most articles were from USA (68.4%) and focused on adult populations (57.7%). The majority of the articles focused on the topic of race/ethnicity (n=176, 28.1%), socioeconomic status (n=114, 18.2%) or multiple equity topics (n=111, 17.7%). The use of community engagement approaches was reported in 97 (15.5%) articles, of which 13 articles (13.4%) reported engagement at all stages. The most common form of reported engagement was in the acknowledgement or additional contribution section (n=86, 88.7%). CONCLUSIONS Community engagement is infrequently reported in health equity-focused research published in high-impact medical journals.
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Affiliation(s)
- Priscilla Medeiros
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | - Janavi Shetty
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | - Luiza Lamaj
- Faculty of Science, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Jessie Cunningham
- Health Sciences Library, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Susitha Wanigaratne
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Eyal Cohen
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Garcia RS, Hollis T, Baratta J, King Z, Faulks M, Ricketts M, Brown-Johnson C, Shankar M, Guerin A, Wong HN, Zulman DM, Floyd BD. Building Trust and Partnership with Black Pediatric Patients and their Caregivers. Acad Pediatr 2024; 24:216-227. [PMID: 37659602 DOI: 10.1016/j.acap.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/17/2023] [Accepted: 08/24/2023] [Indexed: 09/04/2023]
Abstract
Systemic racism embedded within the US health care system results in disproportionately worse health outcomes for Black pediatric patients and their caregivers. One meaningful mechanism through which these health disparities persist is through discriminatory treatment and anti-Black bias from clinicians. Strengthening care provided to Black pediatric patients and their caregivers requires that clinicians adopt culturally tailored communication strategies that promote health equity and counter racism. We conducted a scoping review of evidence-based communication practices in the medical literature that improve care for Black pediatric patients. We mapped the specific practices to the Presence 5 for Racial Justice framework and identified cross-cutting themes to describe practices across the five domains. There are three cross-cutting themes that underlie the recommended practices: 1) promote unbiased implementation of clinician communication strategies (eg, providing equitable recommendations for preventive care), 2) tailor care to Black pediatric patients (eg, explore the importance of the family unit), and 3) address racism experienced by Black pediatric patients and their caregivers (eg, acknowledge any previous negative experiences with the health care system). This review highlights communication practices that clinicians can adopt to build trusting relationships, empower Black families, and promote racial justice in clinical care. Future opportunities include expanding to system level change and validating these practices with patients and clinicians.
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Affiliation(s)
- Raquel S Garcia
- Division of Primary Care and Population Health (RS Garcia, T Hollis, J Baratta, Z King, M Faulks, C Brown-Johnson, and DM Zulman), Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif; Department of Medicine (RS Garcia), Duke University School of Medicine, Durham, NC
| | - Taylor Hollis
- Division of Primary Care and Population Health (RS Garcia, T Hollis, J Baratta, Z King, M Faulks, C Brown-Johnson, and DM Zulman), Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif; University of Alabama at Birmingham Heersink School of Medicine (T Hollis)
| | - Juliana Baratta
- Division of Primary Care and Population Health (RS Garcia, T Hollis, J Baratta, Z King, M Faulks, C Brown-Johnson, and DM Zulman), Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif; Massachusetts Institute of Technology Sloan School of Management (J Baratta), Cambridge, Mass
| | - Zoe King
- Division of Primary Care and Population Health (RS Garcia, T Hollis, J Baratta, Z King, M Faulks, C Brown-Johnson, and DM Zulman), Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif; Stanford Prevention Research Center (Z King), Stanford University School of Medicine, Palo Alto, Calif
| | - Melvin Faulks
- Division of Primary Care and Population Health (RS Garcia, T Hollis, J Baratta, Z King, M Faulks, C Brown-Johnson, and DM Zulman), Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif
| | - Maya Ricketts
- Meharry Medical College School of Medicine (M Ricketts), Nashville, Tenn
| | - Cati Brown-Johnson
- Division of Primary Care and Population Health (RS Garcia, T Hollis, J Baratta, Z King, M Faulks, C Brown-Johnson, and DM Zulman), Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif
| | - Megha Shankar
- Division of General Internal Medicine (M Shankar), Department of Medicine, University of California San Diego, La Jolla, Calif; Presence Center (M Shankar), Stanford University School of Medicine, Stanford, Calif
| | - Allison Guerin
- Department of Pediatrics (A Guerin), Office of Pediatric Education and Office of Diversity, Equity, Inclusion, and Justice in Pediatrics, Stanford University School of Medicine, Palo Alto, Calif
| | - Hong-Nei Wong
- Lane Medical Library (HN Wong), Stanford University School of Medicine, Stanford, Calif
| | - Donna M Zulman
- Division of Primary Care and Population Health (RS Garcia, T Hollis, J Baratta, Z King, M Faulks, C Brown-Johnson, and DM Zulman), Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif
| | - Baraka D Floyd
- Department of Pediatrics (BD Floyd), Division of General Pediatrics and Office of Diversity Equity, Inclusion, and Justice in Pediatrics, Stanford University School of Medicine, Palo Alto, Calif.
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Kerrigan V, McGrath SY, Doig C, Herdman RM, Daly S, Puruntatameri P, Lee B, Hefler M, Ralph AP. Evaluating the impact of 'Ask the Specialist Plus': a training program for improving cultural safety and communication in hospital-based healthcare. BMC Health Serv Res 2024; 24:119. [PMID: 38254093 PMCID: PMC10804863 DOI: 10.1186/s12913-024-10565-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND First Nations peoples in colonised countries often feel culturally unsafe in hospitals, leading to high self-discharge rates, psychological distress and premature death. To address racism in healthcare, institutions have promised to deliver cultural safety training but there is limited evidence on how to teach cultural safety. To that end, we created Ask the Specialist Plus: a training program that focuses on improving healthcare providers intercultural communication skills to improve cultural safety. Our aim is to describe training implementation and to evaluate the training according to participants. METHODS Inspired by cultural safety, Critical Race Theory and Freirean pedagogy, Ask the Specialist Plus was piloted at Royal Darwin Hospital in Australia's Northern Territory in 2021. The format combined listening to an episode of a podcast called Ask the Specialist with weekly, one-hour face-to-face discussions with First Nations Specialists outside the clinical environment over 7 to 8 weeks. Weekly surveys evaluated teaching domains using five-point Likert scales and via free text comments. Quantitative data were collated in Excel and comments were collated in NVivo12. Results were presented following Kirkpatrick's evaluation model. RESULTS Fifteen sessions of Ask the Specialist Plus training were delivered. 90% of participants found the training valuable. Attendees enjoyed the unique format including use of the podcast as a catalyst for discussions. Delivery over two months allowed for flexibility to accommodate clinical demands and shift work. Students through to senior staff learnt new skills, discussed institutionally racist systems and committed to behaviour change. Considering racism is commonly denied in healthcare, the receptiveness of staff to discussing racism was noteworthy. The pilot also contributed to evidence that cultural safety should be co-taught by educators who represent racial and gender differences. CONCLUSION The Ask the Specialist Plus training program provides an effective model for cultural safety training with high potential to achieve behaviour change among diverse healthcare providers. The training provided practical information on how to improve communication and fostered critical consciousness among healthcare providers. The program demonstrated that training delivered weekly over two months to clinical departments can lead to positive changes through cycles of learning, action, and reflection.
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Affiliation(s)
- Vicki Kerrigan
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia.
| | - Stuart Yiwarr McGrath
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Cassandra Doig
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Rarrtjiwuy Melanie Herdman
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Shannon Daly
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Pirrawayingi Puruntatameri
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Bilawara Lee
- Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Marita Hefler
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Anna P Ralph
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
- Royal Darwin Hospital, Darwin, NT, 0811, Australia
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Brown LL, Wilkins ML, Pichon LC, Stewart JL, Sales JM, Audet CM, Hill SV, Pettit AC. Process Mapping to inform implementation of Trauma-Informed Care for youth aged 14-24 with HIV in the Southern United States. RESEARCH SQUARE 2023:rs.3.rs-3234952. [PMID: 37645914 PMCID: PMC10462242 DOI: 10.21203/rs.3.rs-3234952/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background Trauma-Informed Care (TIC) is an evidence-based approach for improving health outcomes by providing systematic, trauma- sensitive and -responsive care. Because TIC adoption varies by setting and population, Implementation Science (IS) is particularly well-suited to guide roll-out efforts. Process Mapping (PM) is an IS model for creating shared visual depictions of systems as they are to identify rate-limiting steps of intervention adoption, but guidance on how to apply PM to guide TIC adoption is lacking. Authors of this study aimed to develop a novel method for conducting TIC-focused PM. Methods A real-life TIC implementation study is presented to show how TIC-focused PM was conducted in the case example of a pediatric HIV clinic in a Southern urban area with a high burden of psychological trauma among youth with HIV. A five-phase PM model was applied to evince clinic standards of care, including Preparation, planning and process identification; Data and information gathering; Map generation; Analysis; and Taking it forward. Practices and conditions from four TIC domains were assessed, including Trauma responsive services; Practices of inclusivity, safety, and wellness; Training and sustaining trauma responsiveness; and Cultural responsiveness. Results The TIC-focused PM method indicated the case clinic provided limited and non-systematic patient trauma screening, assessment, and interventions; limited efforts to promote professional quality of life and elicit and integrate patient experiences and preferences for care; no ongoing efforts to train and prepare workforce for trauma- sensitive or -responsive care; and no clinic-specific efforts to promote diversity, equity, and inclusion for patients and personnel. Conclusion Principles and constructs of resilience-focused TIC were synthesized with a five-phase PM model to generate a baseline depiction of TIC in a pediatric HIV clinic. Results will inform the implementation of TIC in the clinic. Future champions may follow the TIC-focused PM model to guide context-tailored TIC adoption.
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Kyerematen B, Garcia R, Cox J, Zulman DM, Shankar M. Moving beyond inquiry: a secondary qualitative analysis on promoting racial justice in clinical care. BMC MEDICAL EDUCATION 2023; 23:180. [PMID: 36959597 PMCID: PMC10035470 DOI: 10.1186/s12909-023-04131-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Anti-Black racism is prevalent in medicine, and anti-racism training is needed in medical education. One such training is the Presence 5 for Racial Justice (P5RJ) Curriculum which covers evidence-based anti-racism communication strategies that promote health equity for Black patients. The P5RJ Curriculum was developed using feedback from clinicians and trainees with diversity, equity, and inclusion (DEI) experience. In this study, we identify themes in recommended anti-racism language and phrases that surveyed clinicians and trainees use to promote racial justice and health equity in clinical care for Black patients. METHODS Secondary analysis of survey responses to identify themes in qualitative data. DATASET Survey responses of specific phrases for anti-racism communication based on P5RJ Curriculum feedback. POPULATION STUDIED N = 50 respondents (27 clinicians, 17 medical trainees, 6 unreported) recruited through convenience sampling and listservs of clinicians with DEI experience. An inductive qualitative analysis was performed on survey responses to identify emerging themes. RESULTS Emerging themes from survey responses reflected four communication practices: "Inquiry" was the predominant practice (59%), followed by "Empathy" (25%), "Statements of Allyship" (9%), and "Self-Accountability" (8%). CONCLUSION Inquiry and empathy may be predominant communication practices when addressing anti-Black racism in medicine. There is an opportunity to expand anti-racism communication tools with statements of self-accountability and allyship. Future research is necessary to analyze the patient voice on clinician communication practices that promote anti-racism in clinical care.
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Affiliation(s)
- Baffour Kyerematen
- Department of Medicine, UC San Francisco, San Francisco, USA.
- Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, USA.
| | - Raquel Garcia
- Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, USA
- Duke University School of Medicine, Durham, USA
| | - Joy Cox
- Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, USA
- Rutgers New Jersey Medical School, Office of Primary Care and Community Initiatives, Newark, USA
| | - Donna M Zulman
- Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, USA
- Veterans Affairs Palo Alto Health Care System, Center for Innovation to Implementation, Palo Alto, USA
| | - Megha Shankar
- Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, USA
- UC San Diego Department of Medicine, Division of General Internal Medicine, San Diego, USA
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Yee K, Hoopes M, Giebultowicz S, Elliott MN, McConnell KJ. Implications of missingness in self-reported data for estimating racial and ethnic disparities in Medicaid quality measures. Health Serv Res 2022; 57:1370-1378. [PMID: 35802064 PMCID: PMC9643085 DOI: 10.1111/1475-6773.14025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To assess the feasibility and implications of imputing race and ethnicity for quality and utilization measurement in Medicaid. DATA SOURCES AND STUDY SETTING 2017 Oregon Medicaid claims from the Oregon Health Authority and electronic health records (EHR) from OCHIN, a clinical data research network, were used. STUDY DESIGN We cross-sectionally assessed Hispanic-White, Black-White, and Asian-White disparities in 22 quality and utilization measures, comparing self-reported race and ethnicity to imputed values from the Bayesian Improved Surname Geocoding (BISG) algorithm. DATA COLLECTION Race and ethnicity were obtained from self-reported data and imputed using BISG. PRINCIPAL FINDINGS 42.5%/4.9% of claims/EHR were missing self-reported data; BISG estimates were available for >99% of each and had good concordance (0.87-0.95) with Asian, Black, Hispanic, and White self-report. All estimated racial and ethnic disparities were statistically similar in self-reported and imputed EHR-based measures. However, within claims, BISG estimates and incomplete self-reported data yielded substantially different disparities in almost half of the measures, with BISG-based Black-White disparities generally larger than self-reported race and ethnicity data. CONCLUSIONS BISG imputation methods are feasible for Medicaid claims data and reduced missingness to <1%. Disparities may be larger than what is estimated using self-reported data with high rates of missingness.
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Affiliation(s)
- Kimberly Yee
- Oregon Health & Science University‐Portland State University School of Public HealthPortlandOregonUSA
| | | | | | | | - K. John McConnell
- Center for Health Systems Effectiveness at Oregon Health & Science UniversityPortlandOregonUSA
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