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Powers RA, Burckley J, Centelles V. The Legality of Labor and Perceptions of Deservingness of Rights and Services for Sex Workers. ARCHIVES OF SEXUAL BEHAVIOR 2024:10.1007/s10508-024-02951-0. [PMID: 39138694 DOI: 10.1007/s10508-024-02951-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 06/25/2024] [Accepted: 06/28/2024] [Indexed: 08/15/2024]
Abstract
Access to social services like healthcare, education, housing, and welfare are integral to creating an equitable society. While many populations inherently benefit from these services, sex workers are often denied these rights and services because of the nature of their work. The purpose of this study was to examine perceptions of deservingness of sex workers for a wide range of rights and services. This study distinguished those attitudes across legal and illegal forms of sex work, identified attitudinal and demographic correlates associated with those perceptions, and examined potential interactions between respondents' gender and age. Participants included a nationwide sample of adults from the USA (n = 549). Results indicated that participants perceived legal sex work as more deserving of rights and services compared to illegal sex work. Perceptions of deservingness were associated with attitudes toward abortion, LGBTQ+ rights, and perceptions of government legitimacy. Overall, older individuals were less willing to extend rights and services to sex workers and women were more likely to perceive sex workers as deserving of rights and services. There was an interaction between gender and age. For illegal sex work, gender differences in perceptions converged as participants aged, whereas for legal sex work, gender differences were exacerbated with age, with men reporting particularly restrictive perceptions of deservingness.
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Affiliation(s)
- Ráchael A Powers
- School of Criminal Justice, University of Cincinnati, Cincinnati, OH, 45221, USA.
| | | | - Vanessa Centelles
- Department of Sociology, Colorado State University, Fort Collins, CO, USA
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Blanchette JE, Lewis CB, Shannon CS, Kanchibhatla A, Rieke J, Roche MJ, Johnson DA, Williams D, Webb S, Diaz CN, Lundgrin EL, Allen NA, Litchman ML, Hatipoglu B. Empowering emerging adults with type 1 diabetes: crafting a financial and health insurance toolkit through community-based participatory action research. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:75. [PMID: 39044303 PMCID: PMC11265338 DOI: 10.1186/s40900-024-00602-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/28/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Emerging adults aged 18-30 years face challenges during life transitions, with an added burden of navigating the health care system and additional costs associated with diabetes. This stress is compounded by overall low levels of health insurance literacy in this population, as people may not know about available financial and health care resources to minimize suboptimal diabetes outcomes. This study aimed to tailor a financial and health insurance toolkit to emerging adults with type 1 diabetes, including racially, ethnically diverse, and Medicaid-insured individuals, through community-based participatory action research. METHODS An academic research team and community members from a national organization held six online community advisory board (CAB) content-creation meetings to understand how to tailor a financial and health insurance Toolkit. The CAB was comprised of six racially and insurance-diverse emerging adults with type 1 diabetes and four content experts (clinical, financial, and insurance). Six 60-minute online CAB meetings were held via University Hospitals (UH)-encrypted Zoom over five months. Pre-reading materials were emailed to CAB members before the meetings. A moderator established the purpose of each meeting and briefly discussed meeting rules before each meeting commenced. During the meetings, the moderator guided the discussions and provided the CAB members opportunities to respond and build on one another's feedback. A deductive thematic qualitative analysis was utilized. Three researchers independently coded the cross-referenced and de-identified CAB meeting transcripts and then convened to reach a group consensus. Two CAB members performed member-checking. RESULTS The following key themes emerged to tailor the Toolkit: ensuring that content covers empowerment and self-advocacy, including genuine stories and multimedia visuals for aesthetics, addressing clinician bias, acknowledging racial and ethnic disparities in care, incorporating cultural representation, and demystifying Medicaid stigma. CONCLUSIONS By successfully partnering with the CAB and a community organization through a community-based participatory action research approach, we will develop a financial and health insurance Toolkit tailored to the needs of racially and ethnically diverse and Medicaid-insured emerging adults with type 1 diabetes.
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Affiliation(s)
- Julia E Blanchette
- Department of Medicine, Diabetes and Metabolic Care Center, Division of Endocrinology, University Hospitals, Cleveland, OH, USA.
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Claudia B Lewis
- Department of Medicine, Diabetes and Metabolic Care Center, Division of Endocrinology, University Hospitals, Cleveland, OH, USA
| | - Chantel S Shannon
- Department of Medicine, Diabetes and Metabolic Care Center, Division of Endocrinology, University Hospitals, Cleveland, OH, USA
- College of Public Health, Kent State University, Kent, OH, USA
| | - Anuhya Kanchibhatla
- Department of Medicine, Diabetes and Metabolic Care Center, Division of Endocrinology, University Hospitals, Cleveland, OH, USA
- Department of Nutrition, Undergraduate Studies, Case Western Reserve University, Cleveland, OH, USA
| | - Jorden Rieke
- Department of Medicine, Diabetes and Metabolic Care Center, Division of Endocrinology, University Hospitals, Cleveland, OH, USA
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Mary Jane Roche
- The Diabetes Link, Boston, MA, USA
- Young Adult Living with Type 1 Diabetes/Lay Person Community Member, New Hampshire, North Carolina, California, USA
| | - Dove-Anna Johnson
- Department of Medicine, Diabetes and Metabolic Care Center, Division of Endocrinology, University Hospitals, Cleveland, OH, USA
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Dionne Williams
- Department of Medicine, Diabetes and Metabolic Care Center, Division of Endocrinology, University Hospitals, Cleveland, OH, USA
| | - Shay Webb
- College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC, USA
- Young Adult Living with Type 1 Diabetes/Lay Person Community Member, New Hampshire, North Carolina, California, USA
| | - Crystal N Diaz
- Global Disease Biology, University of California, Davis, CA, USA
- Young Adult Living with Type 1 Diabetes/Lay Person Community Member, New Hampshire, North Carolina, California, USA
| | - Erika L Lundgrin
- Department of Medicine, Diabetes and Metabolic Care Center, Division of Endocrinology, University Hospitals, Cleveland, OH, USA
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Divison of Pediatric Endocrinology, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Nancy A Allen
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | | | - Betul Hatipoglu
- Department of Medicine, Diabetes and Metabolic Care Center, Division of Endocrinology, University Hospitals, Cleveland, OH, USA
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Mueller JT, Baker RS, Brooks MM. The uneven impact of Medicaid expansion on rural and urban Black, Latino/a, and White mortality. J Rural Health 2024. [PMID: 38987990 DOI: 10.1111/jrh.12859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 05/09/2024] [Accepted: 06/06/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE To determine the differential impact of Medicaid expansion on all-cause mortality between Black, Latino/a, and White populations in rural and urban areas, and assess how expansion impacted mortality disparities between these groups. METHODS We employ a county-level time-varying heterogenous treatment effects difference-in-difference analysis of Medicaid expansion on all-cause age-adjusted mortality for those 64 years of age or younger from 2009 to 2019. For all counties within the 50 US States and the District of Columbia, we use restricted-access vital statistics data to estimate Average Treatment Effect on the Treated (ATET) for all combinations of racial and ethnic group (Black, Latino/a, White), rurality (rural, urban), and sex. We then assess aggregate ATET, as well as how the ATET changed as time from expansion increased. FINDINGS Medicaid expansion led to a reduction in all-cause age-adjusted mortality for urban Black populations, but not rural Black populations. Urban White populations experienced mixed effects dependent on years after expansion. Latino/a populations saw no appreciable impact. While no effect was observed for rural Black and Latino/a populations, rural White all-cause age-adjusted mortality unexpectedly increased due to Medicaid expansion. These effects reduced rural- and urban-specific Black-White mortality disparities but did not shrink the rural-urban mortality gap. CONCLUSIONS The mortality-reducing impact of Medicaid expansion has been uneven across racial and ethnic groups and rural-urban status; suggesting that many populations-particularly rural individuals-are not seeing the same benefits as others. It is imperative that states work to ensure Medicaid expansion is being appropriately implemented in rural areas.
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Affiliation(s)
- J Tom Mueller
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Regina S Baker
- Department of Sociology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Matthew M Brooks
- Department of Sociology, Florida State University, Tallahassee, Florida, USA
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Ajayi KV, Olowolaju S, Bolarinwa OA, Onyeka H. Association between patient-provider communication and withholding information due to privacy concerns among women in the United States: an analysis of the 2011 to 2018 Health Information National Trends Survey. BMC Health Serv Res 2023; 23:1155. [PMID: 37880666 PMCID: PMC10601290 DOI: 10.1186/s12913-023-10112-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 10/03/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Electronic medical record software is common in healthcare settings. However, data privacy and security challenges persist and may impede patients' willingness to disclose health information to their clinicians. Positive patient-provider communication may foster patient trust and subsequently reduce information nondisclosure. This study sought to characterize information-withholding behaviors among women and evaluate the association between positive patient-provider communication and women's health information-withholding behavior in the United States. METHODS Data were pooled from the 2011 to 2018 Health Information National Trends Survey. We used descriptive statistics, bivariate, and logistic regression analyses to investigate whether positive patient-provider communication significantly impacted health information-withholding behaviors. Data from 7,738 women were analyzed. RESULTS About 10.8% or 1 in 10 women endorsed withholding health information from their providers because of privacy or security concerns about their medical records. After adjusting for the covariates, higher positive patient-provider communication scores were associated with lower odds of withholding information from the provider because of privacy and security concerns (aOR 0.93; 95% CI = 0.90-0.95). Additionally, we found that age, race/ethnicity, educational status, psychological distress, and smoking status significantly predicted women's willingness to disclose health information. CONCLUSIONS Findings suggest that improving positive patient-provider communication quality may reduce women's privacy and security concerns and encourage them to disclose sensitive medical information.
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Affiliation(s)
- Kobi V Ajayi
- Department of Health Behavior, School of Public Health, Texas A&M University College Station, College Station, TX, USA
| | - Samson Olowolaju
- Department of Demography, College for Health, Community and Policy, University of Texas, San Antonio, TX, USA
| | - Obasanjo Afolabi Bolarinwa
- Department of Public Health, York St. John University, London, UK.
- Department of Demography and Population Studies, University of Witwatersrand, Johannesburg, South Africa.
| | - Henry Onyeka
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General/Mclean Hospital, Boston, MA, USA
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Bifulco L, Grzejszczak L, Velez I, Angelocci T, Anderson D. A qualitative investigation of uninsured patient and primary care provider perspectives on specialty care eConsults. BMC Health Serv Res 2023; 23:1133. [PMID: 37864170 PMCID: PMC10589958 DOI: 10.1186/s12913-023-10086-6] [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: 05/03/2023] [Accepted: 09/28/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Uninsured and underinsured patients face specialty care access disparities that prevent them from obtaining the care they need and negatively impact their health and well-being. We aimed to understand how making specialty care electronic consultations (eConsults) available at a multi-site Federally Qualified Health Center (FQHC) in central Texas affected uninsured patients' care-seeking experiences and impacted their ability to receive the needed care. METHODS We used concepts from Ecological Systems Theory to examine individual, interpersonal, organization-level, social, and health policy environment factors that impacted patients' access to specialty care and the use of eConsults. We conducted thematic analysis of semi-structured, qualitative interviews with patients about seeking specialty care while uninsured and with uninsured patients and FQHC PCPs about their experience using eConsults to obtain specialists' recommendations. RESULTS Patients and PCPs identified out-of-pocket cost, stigma, a paucity of local specialists willing to see uninsured patients, time and difficulty associated with travel and transportation to specialty visits, and health policy limitations as barriers to obtaining specialty care. Benefits of using eConsults for uninsured patients included minimizing/avoiding financial stress, expanding access to care, expanding scope of primary care, and expediting access to specialists. Concerns about the model included patients' limited understanding of eConsults, concern about cost, and worry whether eConsults could appropriately meet their specialty needs. CONCLUSIONS Findings suggest that eConsults delivered in a primary care FQHC addressed uninsured patients' specialty care access concerns. They helped to address financial and geographic barriers, provided time and cost savings to patients, expanded FQHC PCPs' knowledge and care provision options, and allowed patients to receive more care in primary care.
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Affiliation(s)
- Lauren Bifulco
- Weitzman Institute, 19 Grand Street, Middletown, CT, USA
| | | | - Idiana Velez
- Weitzman Institute, 19 Grand Street, Middletown, CT, USA
| | - Tracy Angelocci
- Lone Star Circle of Care, 205 East University, Suite 100, Georgetown, TX, USA
| | - Daren Anderson
- Weitzman Institute, 19 Grand Street, Middletown, CT, USA.
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Crable EL, Grogan CM, Purtle J, Roesch SC, Aarons GA. Tailoring dissemination strategies to increase evidence-informed policymaking for opioid use disorder treatment: study protocol. Implement Sci Commun 2023; 4:16. [PMID: 36797794 PMCID: PMC9936679 DOI: 10.1186/s43058-023-00396-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Policy is a powerful tool for systematically altering healthcare access and quality, but the research to policy gap impedes translating evidence-based practices into public policy and limits widespread improvements in service and population health outcomes. The US opioid epidemic disproportionately impacts Medicaid members who rely on publicly funded benefits to access evidence-based treatment including medications for opioid use disorder (MOUD). A myriad of misaligned policies and evidence-use behaviors by policymakers across federal agencies, state Medicaid agencies, and managed care organizations limit coverage of and access to MOUD for Medicaid members. Dissemination strategies that improve policymakers' use of current evidence are critical to improving MOUD benefits and reducing health disparities. However, no research describes key determinants of Medicaid policymakers' evidence use behaviors or preferences, and few studies have examined data-driven approaches to developing dissemination strategies to enhance evidence-informed policymaking. This study aims to identify determinants and intermediaries that influence policymakers' evidence use behaviors, then develop and test data-driven tailored dissemination strategies that promote MOUD coverage in benefit arrays. METHODS Guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, we will conduct a national survey of state Medicaid agency and managed care organization policymakers to identify determinants and intermediaries that influence how they seek, receive, and use research in their decision-making processes. We will use latent class methods to empirically identify subgroups of agencies with distinct evidence use behaviors. A 10-step dissemination strategy development and specification process will be used to tailor strategies to significant predictors identified for each latent class. Tailored dissemination strategies will be deployed to each class of policymakers and assessed for their acceptability, appropriateness, and feasibility for delivering evidence about MOUD benefit design. DISCUSSION This study will illuminate key determinants and intermediaries that influence policymakers' evidence use behaviors when designing benefits for MOUD. This study will produce a critically needed set of data-driven, tailored policy dissemination strategies. Study results will inform a subsequent multi-site trial measuring the effectiveness of tailored dissemination strategies on MOUD benefit design and implementation. Lessons from dissemination strategy development will inform future research about policymakers' evidence use preferences and offer a replicable process for tailoring dissemination strategies.
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Affiliation(s)
- Erika L Crable
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA. .,Child and Adolescent Services Research Center, San Diego, CA, USA. .,University of California, San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, USA.
| | - Colleen M Grogan
- Crown Family School of Social Work, Policy, and Practice, The University of Chicago, Chicago, IL, USA
| | - Jonathan Purtle
- Department of Public Health Policy and Management, New York University School of Global Public Health, New York City, NY, USA.,Global Center for Implementation Science, New York University School of Global Public Health, New York City, NY, USA
| | - Scott C Roesch
- Child and Adolescent Services Research Center, San Diego, CA, USA.,Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.,Child and Adolescent Services Research Center, San Diego, CA, USA.,University of California, San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, USA
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Call KT, Alarcon-Espinoza G, Arthur NSM, Jones-Webb R. Insurance-Based Discrimination Reports and Access to Care Among Nonelderly US Adults, 2011-2019. Am J Public Health 2023; 113:213-223. [PMID: 36480777 PMCID: PMC9850613 DOI: 10.2105/ajph.2022.307126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2022] [Indexed: 12/13/2022]
Abstract
Objectives. To report insurance-based discrimination rates for nonelderly adults with private, public, or no insurance between 2011 and 2019, a period marked by passage and implementation of the Affordable Care Act (ACA) and threats to it. Methods. We used 2011-2019 data from the biennial Minnesota Health Access Survey. Each year, about 4000 adults aged 18 to 64 years report experiences with insurance-based discrimination. Using logistic regressions, we examined associations between insurance-based discrimination and (1) sociodemographic factors and (2) indicators of access. Results. Insurance-based discrimination was stable over time and consistently related to insurance type: approximately 4% for adults with private insurance compared with adults with public insurance (21%) and no insurance (27%). Insurance-based discrimination persistently interfered with confidence in getting needed care and forgoing care. Conclusions. Policy changes from 2011 to 2019 affected access to health insurance, but high rates of insurance-based discrimination among adults with public insurance or no insurance were impervious to such changes. Public Health Implications. Stable rates of insurance-based discrimination during a time of increased access to health insurance via the ACA suggest deeper structural roots of health care inequities. We recommend several policy and system solutions. (Am J Public Health. 2023;113(2):213-223. https://doi.org/10.2105/AJPH.2022.307126).
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Affiliation(s)
- Kathleen Thiede Call
- Kathleen Thiede Call is with the School of Public Health, Division of Health Policy and Management, and the State Health Access Data Assistance Center (SHADAC), University of Minnesota, Minneapolis. At the time of this writing, Giovann Alarcon-Espinoza was with the School of Public Health, SHADAC, University of Minnesota, Minneapolis. Natalie Schwer Mac Arthur is with the School of Public Health, State Health Access Data Assistance Center, SHADAC, University of Minnesota, Minneapolis. Rhonda Jones-Webb is with the School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - Giovann Alarcon-Espinoza
- Kathleen Thiede Call is with the School of Public Health, Division of Health Policy and Management, and the State Health Access Data Assistance Center (SHADAC), University of Minnesota, Minneapolis. At the time of this writing, Giovann Alarcon-Espinoza was with the School of Public Health, SHADAC, University of Minnesota, Minneapolis. Natalie Schwer Mac Arthur is with the School of Public Health, State Health Access Data Assistance Center, SHADAC, University of Minnesota, Minneapolis. Rhonda Jones-Webb is with the School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - Natalie Schwer Mac Arthur
- Kathleen Thiede Call is with the School of Public Health, Division of Health Policy and Management, and the State Health Access Data Assistance Center (SHADAC), University of Minnesota, Minneapolis. At the time of this writing, Giovann Alarcon-Espinoza was with the School of Public Health, SHADAC, University of Minnesota, Minneapolis. Natalie Schwer Mac Arthur is with the School of Public Health, State Health Access Data Assistance Center, SHADAC, University of Minnesota, Minneapolis. Rhonda Jones-Webb is with the School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - Rhonda Jones-Webb
- Kathleen Thiede Call is with the School of Public Health, Division of Health Policy and Management, and the State Health Access Data Assistance Center (SHADAC), University of Minnesota, Minneapolis. At the time of this writing, Giovann Alarcon-Espinoza was with the School of Public Health, SHADAC, University of Minnesota, Minneapolis. Natalie Schwer Mac Arthur is with the School of Public Health, State Health Access Data Assistance Center, SHADAC, University of Minnesota, Minneapolis. Rhonda Jones-Webb is with the School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
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Markowitz W, Kausar K, Coffield E. Relationship between Patient Experience Scores and Health Insurance. Healthcare (Basel) 2022; 10:healthcare10112128. [PMID: 36360469 PMCID: PMC9690600 DOI: 10.3390/healthcare10112128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/01/2022] [Accepted: 10/12/2022] [Indexed: 12/04/2022] Open
Abstract
(1) Background: the patient experience may be a performance indicator in value-based reimbursement. Accordingly, providers have an incentive to understand factors that affect their patients’ experiences. This study evaluated the relationship between health insurance type and patient experience ratings. (2) Methods: individual-level demographic, health/healthcare, and patient experience data were extracted from the Full-Year Consolidated Data File of the 2019 Medical Expenditure Panel Surveys. A logistic regression was used to evaluate whether how persons—included in this study’s analytic sample (aged 18 and over with complete covariate information)—rated the healthcare they received from all their providers was associated with their health insurance types controlling for covariates. (3) Results: relative to people 18−64 years of age with private health insurance, people 18−64 years of age without health insurance were less likely to rank their healthcare as a 9 or 10—where a 10 indicates the best possible care—(OR: 0.69; p = 0.015) while people aged 65 years or over with Medicare (OR: 1.34; p = 0.002) or with Medicare/private health insurance (OR: 1.48; p < 0.001) were more likely to rank their healthcare as a 9 or 10. (4) Conclusions: Select health insurance types were associated with how patients rate their healthcare. Stakeholders could use this information to create programs aimed to improve patient experience.
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Affiliation(s)
- Walter Markowitz
- Department of Population Health, Hofstra University, Hempstead, NY 11549, USA
| | | | - Edward Coffield
- Department of Population Health, Hofstra University, Hempstead, NY 11549, USA
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Sorhaindo AM, Lavelanet AF. Why does abortion stigma matter? A scoping review and hybrid analysis of qualitative evidence illustrating the role of stigma in the quality of abortion care. Soc Sci Med 2022; 311:115271. [PMID: 36152401 PMCID: PMC9577010 DOI: 10.1016/j.socscimed.2022.115271] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 06/24/2022] [Accepted: 08/04/2022] [Indexed: 12/02/2022]
Abstract
Abortion stigma shapes the environment in which abortion is delivered and received and can have important implications for quality in abortion care. However, this has not previously been clearly articulated and evidenced. We conducted a scoping review of existing qualitative evidence to characterize the relationship between abortion stigma and quality in abortion care. Using a systematic process, we located 50 qualitative studies to include in our analysis. We applied the interface of the WHO quality of care and abortion stigma frameworks to the qualitative evidence to capture manifestations of the interaction between abortion stigma and quality in abortion care in the existing literature. Four overarching themes linked to abortion stigma emerged: A) abortion as a sin and other religious views; B) regulation of abortion; C) judgement, labelling and marking; and D) shame, denial, and secrecy. We further characterized the emerging ways in which abortion stigma operates to inhibit quality in abortion care into seven manifestations of the relationship between abortion stigma and quality in abortion care: 1) poor treatment and the repercussions, 2) gatekeeping and obstruction of access, 3) avoiding disclosure, 4) arduous and unnecessary requirements, 5) poor infrastructure and lack of resources, 6) punishment and threats and 7) lack of a designated place for abortion services. This evidence complements the abortion stigma-adapted WHO quality of care framework suggested by the International Network for the Reduction of Abortion Discrimination and Stigma (inroads) by illustrating specifically how the postulated stigma-related barriers to quality abortion care occur in practice. Further research should assess these manifestations in the quantitative literature and contribute to the development of quality in abortion care indicators that include measures of abortion stigma, and the development of abortion stigma reduction interventions to improve quality in abortion care.
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Affiliation(s)
- Annik Mahalia Sorhaindo
- World Health Organization, Department of Reproductive Health and Research and the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), 20 Avenue Appia, 1211, Geneva, Switzerland.
| | - Antonella Francheska Lavelanet
- World Health Organization, Department of Reproductive Health and Research and the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), 20 Avenue Appia, 1211, Geneva, Switzerland
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Oo MM, Liabsuetrakul T, Boonathapat N, Aung HKK, Pungrassami P. Association of Health Insurance and Documentation with Stigma and Social Support Among Myanmar Migrants with Tuberculosis Before and During Thailand's Policy on Border Closure Due to COVID-19: a Cross-Sectional Study. J Racial Ethn Health Disparities 2022; 9:2495-2507. [PMID: 34811647 PMCID: PMC8608234 DOI: 10.1007/s40615-021-01185-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/31/2021] [Accepted: 11/02/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The objective of this study was to assess the effect of health insurance and documentation status on tuberculosis (TB)-related stigma and social support before and during Thailand's policy on border closure. METHODS A cross-sectional study was conducted in two TB clinics in Mae Sot district, a border area of Thailand. Myanmar migrants with new TB were interviewed before (between September 2019 and March 2020) and during Thailand's policy (between April 2020 and January 2021). We used multiple linear regression models to assess the association of health insurance and documentation status with stigma and social support before and during the policy on border closure. RESULTS Of 229 migrants diagnosed new TB recruited, 117 and 112 were interviewed before and during Thailand's policy on border closure. The relationship of stigma with health insurance and documentation status was modified by the policy. Migrants with health insurance reported significantly lower stigma during the policy compared to those without health insurance, whereas documented migrants had lower stigma before the policy compared to undocumented migrants. No significant association of health insurance and documentation status with social support was observed. Ethnicity, perceived TB severity and education level were also independently associated with TB-related stigma. CONCLUSION The relationships between health insurance, documentation status and TB-related stigma were modified by Thailand's policy on border closure among Myanmar migrants with TB in a border area of Myanmar and Thailand. Promotion of health insurance and well-planned documentation for migrants should be more discussed and strengthened among stakeholders and policymakers.
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Affiliation(s)
- Myo Minn Oo
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla Thailand
| | - Tippawan Liabsuetrakul
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla Thailand
| | | | - Htet Ko Ko Aung
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Kino S, Nishioka D, Ueno K, Saito M, Kondo N. Changes in social relationships by the initiation and termination of public assistance in the older Japanese population: A JAGES panel study. Soc Sci Med 2021; 293:114661. [PMID: 34942580 DOI: 10.1016/j.socscimed.2021.114661] [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: 06/15/2021] [Revised: 10/25/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
Abstract
Public assistance recipients in Japan are financially empowered by social welfare but are also exposed to social stigma. Therefore, when their status of receiving public assistance changes, the conditions of their social life likely change. We examined whether the social relationships of older adults receiving public welfare are influenced by either starting or terminating their use of public assistance. This study used the Japan Gerontological Evaluation Study panel data from 2013 to 2016. To measure social relationships, we used four indicators: the frequency of meeting with friends, the number of friends whom the participants had met with in the past month, their frequency of participating in sports clubs, and their frequency of participating in hobby clubs. In the analyses, changes in social relationships between 2013 and 2016 were used as the study outcomes. Linear regression analyses were conducted to examine if their social relationships changed before and after starting or terminating public assistance while adjusting for confounders. We found that people who stopped receiving public assistance experienced an increase in their frequency of meeting with friends (coefficient: 0.56; 95% CI: 0.06, 1.07), the number of friends (coefficient: 0.60; 95% CI: 0.20, 0.99), participation in sports clubs (coefficient: 0.91; 95% CI: 0.46, 1.39), and participation in hobby clubs (coefficient: 0.70; 95% CI: 0.26, 1.13) compared to those who continued to receive public assistance. Contrarily, the measured social relationships did not change after the participants started receiving public assistance. Our main findings were that terminating one's reception of public assistance increases informal socializing and social participation while starting public assistance does not interrupt pre-existing relationships. These findings contribute to the literature by adding that social relationships are not negatively influenced by either terminating or starting public assistance. Targeted promotions of social connections would effectively maintain the health statuses of low-income older adults.
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Affiliation(s)
- Shiho Kino
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan.
| | - Daisuke Nishioka
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan; Department of Medical Statistics, Research & Development Center, Osaka Medical and Pharmaceutical University, Osaka, Japan.
| | - Keiko Ueno
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan; Department of Health and Social Behavior, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Masashige Saito
- Faculty of Social Welfare, Nihon Fukushi University, Chita-gun, Aichi, Japan; Center for Well-being and Society, Nihon Fukushi University, Nagoya, Aichi, Japan.
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan; Department of Health and Social Behavior, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan; Japan Agency for Gerontological Evaluation Study (JAGES Agency), Tokyo, Japan.
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12
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Clouston SAP, Link BG. A retrospective on fundamental cause theory: State of the literature, and goals for the future. ANNUAL REVIEW OF SOCIOLOGY 2021; 47:131-156. [PMID: 34949900 PMCID: PMC8691558 DOI: 10.1146/annurev-soc-090320-094912] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Fundamental Cause Theory (FCT) was originally proposed to explain how socioeconomic inequalities in health emerged and persisted over time. The concept was that higher socioeconomic status helped some people to avoid risks and adopt protective strategies using flexible resources - knowledge, money, power, prestige and beneficial social connections. As a sociological theory, FCT addressed this issue by calling on social stratification, stigma, and racism as they affected medical treatments and health outcomes. The last comprehensive review was completed a decade ago. Since then, FCT has been tested, and new applications have extended central features. The current review consolidates key foci in the literature in order to guide future research in the field. Notable themes emerged around types of resources and their usage, approaches used to test the theory, and novel extensions. We conclude that after 25 years of use, there remain crucial questions to be addressed.
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Affiliation(s)
- Sean A. P. Clouston
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Bruce G. Link
- School of Public Policy and Department of Sociology, University of California at Riverside, Riverside, CA, USA
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13
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Pharmacy Technicians, Stigma, and Compassion Fatigue: Front-Line Perspectives of Pharmacy and the US Opioid Epidemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126231. [PMID: 34207590 PMCID: PMC8296092 DOI: 10.3390/ijerph18126231] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/03/2021] [Accepted: 06/05/2021] [Indexed: 01/30/2023]
Abstract
The opioid epidemic in the United States has led to a quadrupling of opioid overdoses since the 1990s. Stigmas exist among healthcare professionals, and it is essential to educate the next generation of pharmacy technicians regarding opioid use disorder. The main objective of this study was to characterize the phenomenon of stigma through the pharmacy technician lens when taking care of patients who are using opioid medications. Grounded in Van Manen’s phenomenological approach and the Link and Phelan stigmatization model, a qualitative study was conducted from February to June 2020 to understand pharmacy technicians’ perceptions and attitudes towards patients using opioid medications. Focus groups (n = 46) with pharmacy technicians were conducted in-person and online over five months in 2020. Thematic analysis identified three themes that characterize the stigma and the relationship between pharmacy technicians and patients taking opioid medications: (1) pharmacy technician perspectives on stigma and patients with addictive opioid-use behavior; (2) current approaches of pharmacy technicians towards patients with addictive opioid-use behavior; (3) future approaches of pharmacy technicians towards patients with addictive opioid-use behavior. The findings highlight an “ever-present” negative connotation associated with the stigma that is formed from patient interaction. It is necessary to develop proper resources and educational materials to manage the stigma that exists in pharmacies throughout the nation. These resources will facilitate how to address and prevent the stigma among pharmacy technicians in the U.S.
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14
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Hopeck P. Care workers’ experiences discussing financial issues with families facing end-of-life decisions. QUALITATIVE RESEARCH IN MEDICINE & HEALTHCARE 2021. [DOI: 10.4081/qrmh.2020.9102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Numerous studies have confirmed the presence of financial difficulties for families when a loved one is at the end of life. However, few studies examine the discussions family members have with care workers about financial issues during end of life. The research presented here examines the experiences that care workers have with family members expressing financial concerns and how care workers respond. I conducted in-depth interviews with fifty-eight care workers, defined in this study as clergy, patient advocates, and nurses who had experiences talking with families about financial issues. Transcripts of the interviews served as the data set. I transcribed, coded and analyzed the data. Families talk about financial issues openly, although sometimes guiltily. Some families express difficulties implicitly, and in these cases, care workers often had to piece together information based on other statements and behaviors of the family. Care workers suggest solutions at the interpersonal, organizational, inter-organizational, social, and national levels. Findings also support prior research that it is important for families to have end-of-life discussions before death is imminent so that families may plan accordingly, and offer insights about care workers and their role in making financial discussions easier for families.
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15
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Psychological Distress and Attitudes Toward Seeking Professional Psychological Services Among Black Women: the Role of Past Mental Health Treatment. J Racial Ethn Health Disparities 2021; 9:527-537. [PMID: 33559107 DOI: 10.1007/s40615-021-00983-z] [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] [Received: 12/29/2020] [Revised: 01/16/2021] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
Black women are one of the most underserved and undertreated minority groups in the USA. While Black women generally do not seek professional psychological services to manage psychological distress, recent findings suggest an openness to mental health treatment as a form of self-care. This study investigated the relationship among symptoms of anxiety, depression, and post-traumatic stress as a predictor of attitudes toward professional psychological help (i.e., psychological openness, help-seeking propensity, and indifference to stigma) in a sample of 205 Black women. We also examined if past mental health treatment (i.e., counseling or therapy) moderated these relationships. Results indicated that symptoms of anxiety, depression, and post-traumatic stress were all negatively associated with help-seeking propensity and indifference to stigma. Only symptoms of post-traumatic stress were negatively associated with psychological openness. Findings also demonstrated that past mental health treatment moderated the relationship among depressive symptoms and help-seeking propensity and indifference to stigma, respectively. Specifically, as depressive symptoms increased, help-seeking propensity significantly decreased among participants who had not reported past mental health treatment. Additionally, indifference to stigma decreased with increased symptoms of depression, though the decline in indifference to stigma was greater among those who did not report past mental health treatment. We also found similar results for symptoms of post-traumatic stress with regard to indifference to stigma. Findings suggest that Black women's past mental health treatment may be relevant to understanding attitudes toward seeking professional psychological services when experiencing high psychological distress.
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16
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Alhusen JL, Bloom T, Laughon K, Behan L, Hughes RB. Perceptions of barriers to effective family planning services among women with disabilities. Disabil Health J 2020; 14:101055. [PMID: 33384277 DOI: 10.1016/j.dhjo.2020.101055] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/14/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Women with disabilities have the same rights as women without disabilities to prevent unintended pregnancy, yet little is known about their experiences in accessing family planning methods. OBJECTIVE This qualitative descriptive study explored perceptions of barriers to effective family planning services among women with disabilities. METHOD Semi-structured, open-ended interviews were conducted with 31 women with diverse disabilities as part of a larger study investigating risks and facilitators of unintended pregnancy among women with disabilities across the United States. RESULTS Analysis revealed multiple barriers experienced by women with disabilities in accessing effective family planning services needed to prevent unintended pregnancy. Barriers included physical or system barriers, financial limitations, and nonresponsive healthcare providers. Women also identified difficulties in finding appropriate family planning methods, both related and unrelated to disability. CONCLUSIONS This is the first in-depth exploration of barriers to accessing family planning services and challenges to finding effective family planning options among women with disabilities. The findings underscore the need for targeted interventions, improved provider training, and policy changes to optimize reproductive healthcare, improve access to family planning services, and prevent unintended pregnancy among women of childbearing age with diverse disabilities.
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Affiliation(s)
- Jeanne L Alhusen
- University of Virginia School of Nursing, 225 Jeanette Lancaster Avenue, Charlottesville, VA, 22903, USA.
| | - Tina Bloom
- University of Missouri Sinclair School of Nursing, S421 Sinclair School of Nursing, Columbia, MO, 65211, USA
| | - Kathryn Laughon
- University of Virginia School of Nursing, 225 Jeanette Lancaster Avenue, Charlottesville, VA, 22903, USA
| | - Lillian Behan
- University of Virginia School of Nursing, 225 Jeanette Lancaster Avenue, Charlottesville, VA, 22903, USA
| | - Rosemary B Hughes
- University of Montana Rural Institute for Inclusive Communities, 52 Corbin Hall, Missoula, MT, 59812, USA
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17
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Emerson AJ, Hegedus T, Mani R, Baxter GD. Chronic musculoskeletal pain experiences in marginalized populations: a mixed methods study protocol to understand the influence of geopolitical, historical, and societal factors. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1807803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Alicia J. Emerson
- High Point University, High Point, NC, USA
- Centre for Health, Activity, and Rehabilitation Research, University of Otago, Dunedin, New Zealand
| | | | - Ramakrishnan Mani
- Centre for Health, Activity, and Rehabilitation Research, University of Otago, Dunedin, New Zealand
| | - G. David Baxter
- Centre for Health, Activity, and Rehabilitation Research, University of Otago, Dunedin, New Zealand
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18
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Manelin EB. Health Care Quality Improvement and the Ambiguous Commodity of Care. Med Anthropol Q 2020; 34:361-377. [PMID: 32767465 DOI: 10.1111/maq.12608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 06/24/2020] [Accepted: 07/01/2020] [Indexed: 11/26/2022]
Abstract
Quality of care has become a major concern of the U.S.'s health care system in recent decades thanks to an energetic social movement and, more recently, interest from health insurers. Ethnographic research at a primary care clinic engaged in an array of quality improvement efforts revealed that physicians navigate two incommensurable views of quality: one aligned with the metric-oriented quality movement, and the other based on a humanistic vision of their professional role. Against the backdrop of a financialized health care system, these two views represent "differentiated ties" with respect to health care as a commodity. Furthermore, they are used to justify a broad division of labor where support staff and clinic leaders relieve physicians of responsibility for managing, implementing, and reporting quality efforts. These differentiated ties reveal the fundamental ambiguity of health care as a commodity, the resolution of which is a central-albeit implicit-motive of the quality movement.
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19
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Kcomt L, Gorey KM, Barrett BJ, McCabe SE. Healthcare avoidance due to anticipated discrimination among transgender people: A call to create trans-affirmative environments. SSM Popul Health 2020; 11:100608. [PMID: 32529022 PMCID: PMC7276492 DOI: 10.1016/j.ssmph.2020.100608] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 12/01/2022] Open
Abstract
Transgender people encounter interpersonal and structural barriers to healthcare access that contribute to their postponement or avoidance of healthcare, which can lead to poor physical and mental health outcomes. Using the 2015 U.S. Transgender Survey, this study examined avoidance of healthcare due to anticipated discrimination among transgender adults aged 25 to 64 (N = 19,157). Multivariable logistic regression analysis was conducted to test whether gender identity/expression, socio-demographic, and transgender-specific factors were associated with healthcare avoidance. Almost one-quarter of the sample (22.8%) avoided healthcare due to anticipated discrimination. Transgender men had increased odds of healthcare avoidance (AOR = 1.32, 95% CI = 1.21–1.45) relative to transgender women. Living in poverty (AOR = 1.52, 95% CI = 1.40–1.65) and visual non-conformity (AOR = 1.48, 95% CI = 1.33–1.66) were significant risk factors. Having health insurance (AOR = 0.87, 95% CI = 0.79–0.96) and disclosure of transgender identity (AOR = 0.77, 95% CI = 0.68–0.87) were protective against healthcare avoidance. A significant interaction of gender identity/expression with health insurance was found; having health insurance moderated the association between gender identity/expression and healthcare avoidance. Providers should consider gender differences, socio-demographic, and transgender-specific factors to improve accessibility of services to transgender communities. A multi-level and multi-faceted approach should be used to create safe, trans-affirmative environments in health systems. Transgender people encounter barriers to healthcare access. Providers should consider transgender-specific factors to improve healthcare access. A multi-faceted approach should be used to create trans-affirmative health settings.
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Affiliation(s)
- Luisa Kcomt
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 North Ingalls, Ann Arbor, MI, 48109-5482, USA
| | - Kevin M Gorey
- School of Social Work, University of Windsor, 167 Ferry Street, Windsor, ON, N9A 0C5, Canada
| | - Betty Jo Barrett
- Women's and Gender Studies, University of Windsor, 401 Sunset Avenue, Windsor, ON, N9B 3P4, Canada
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 North Ingalls, Ann Arbor, MI, 48109-5482, USA.,Institute for Research on Women and Gender, University of Michigan, 1136 Lane Hall, 204 S. State Street, Ann Arbor, MI, 48109-1290, USA.,Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48104, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, Ann Arbor, MI, 48109, USA
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20
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Salhi BA, Tsai JW, Druck J, Ward‐Gaines J, White MH, Lopez BL. Toward Structural Competency in Emergency Medical Education. AEM EDUCATION AND TRAINING 2020; 4:S88-S97. [PMID: 32072112 PMCID: PMC7011420 DOI: 10.1002/aet2.10416] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/22/2019] [Accepted: 11/04/2019] [Indexed: 06/10/2023]
Abstract
As the emergency department (ED) is the "front door" of the hospital and the primary site by which most patients access the health care system, issues of inequity are especially salient for emergency medicine (EM) practice. Improving the health of ED patients, especially those who are stigmatized and disenfranchised, depends on having emergency physicians that are cognizant and attentive to their needs in and out of the medical encounter. EM resident education has traditionally incorporated a "cultural competency" model to equip residents with tools to combat individual bias and stigma. Although this framework has been influential in drawing attention to health inequities, it has also been criticized for its potential to efface differences within groups (such as socioeconomic differences), overstate cultural or racial differences, and unintentionally reinforce stereotypes or blaming of patients for their ill health or difficult circumstances. In contrast, emerging frameworks of structural competency call for physicians to recognize the ways in which health outcomes are influenced by complex, interrelated structural forces (e.g., poverty, racism, gender discrimination, immigration policy) and to attend to these causes of poor health. We present here the framework of structural competency, extending it to the unique ED setting. We provide tangible illustrations of the ways in which this framework is relevant to the ED setting and can be incorporated in EM education.
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Affiliation(s)
- Bisan A. Salhi
- Department of Emergency MedicineEmory UniversityAtlantaGA
- Department of AnthropologyEmory UniversityAtlantaGA
| | - Jennifer W. Tsai
- Department of Emergency MedicineYale School of MedicineNew HavenCT
| | - Jeffrey Druck
- Department of Emergency MedicineUniversity of Colorado at DenverDenverCO
| | | | | | - Bernard L. Lopez
- Department of Emergency MedicineThomas Jefferson UniversityPhiladelphiaPA
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21
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Hailemariam M, Felton JW, Key K, Greer D, Jefferson BL, Muhammad J, Miller R, Richie F, Robinson D, Saddler S, Spencer B, Summers M, White JMC, Johnson JE. Intersectionality, special populations, needs and suggestions: the Flint Women's study. Int J Equity Health 2020; 19:18. [PMID: 32005120 PMCID: PMC6995063 DOI: 10.1186/s12939-020-1133-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Equitable access to services that promote health and wellbeing is an important component of social justice. A community-engaged participatory qualitative study was conducted in Flint, Michigan, USA, to understand the needs of special populations (young women, perinatal women and new mothers, older women, women with disabilities, and LGBTQIA women) and elicit their ideas about solutions. METHODS In-depth interviews (n = 100) were conducted. Participants were either women living in the Flint area, human service providers in the area, or both. A team of community and academic coders analyzed the data using an a priori framework. RESULTS Participants identified needs of different groups of women and suggested ways to address them. Access to healthy food, reducing healthcare costs, and improving transportation, job opportunities and affordable quality housing were crosscutting themes across all groups of women. Mentoring support was said to protect vulnerable young women from the risk of human trafficking. Older women were said to gain a sense of purpose, build their social support and reduce their loneliness by engaging in mentoring younger women. Women with disabilities were reported to benefit from infrastructure accessibility and authentic inclusion in all areas of life. Providing help that considers their dignity, pride and self-worth were suggested. LGBTQIA women were reported to have housing needs due to discrimination; mostly turned down as renters and can be rejected from faith-based homeless shelters. LGBTQIA women would also benefit from increased sensitivity among healthcare providers. For all groups of women, streamlining access to social services and other resources, building social support networks and increasing awareness about existing resources were recommended. CONCLUSION Efforts directed towards improving women's health and wellbeing should include perspectives and suggestions of diverse groups of women from the community. Acting on suggestions that emanate from the community's lived experiences may reduce inequalities in health and wellbeing.
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Affiliation(s)
- Maji Hailemariam
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI USA
| | - Julia W. Felton
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI USA
| | - Kent Key
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI USA
- Community Based Organization Partners, Flint, MI USA
| | | | - Bernadel L. Jefferson
- Community Based Organization Partners, Flint, MI USA
- Community resident, Flint, MI USA
| | - Janice Muhammad
- Community Based Organization Partners, Flint, MI USA
- Community resident, Flint, MI USA
| | - Raven Miller
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI USA
| | - Fallon Richie
- Combined-Integrated Clinical and Counseling Program, University of South Alabama, Mobile, AL USA
| | | | - Sharon Saddler
- Community Based Organization Partners, Flint, MI USA
- Community resident, Flint, MI USA
| | - Bryan Spencer
- Community resident, Flint, MI USA
- My Exceptionality LLC, Flint, MI USA
| | - Monicia Summers
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI USA
| | - Jonne Mc Coy White
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI USA
| | - Jennifer E. Johnson
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI USA
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Okoro ON, Hillman LA, Cernasev A. " We get double slammed!": Healthcare experiences of perceived discrimination among low-income African-American women. WOMEN'S HEALTH (LONDON, ENGLAND) 2020; 16:1745506520953348. [PMID: 32856564 PMCID: PMC7457641 DOI: 10.1177/1745506520953348] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 05/27/2020] [Accepted: 07/20/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND On account of their racial/ethnic minority status, class, and gender, African-American women of low socioeconomic status are among the least privileged, underserved, and most marginalized groups in the United States. Generally, African Americans continue to experience poorer health outcomes, in which disparities have been attributed to socioeconomic inequities and structural racism. This objective of this study was to explore the lived experiences of low-income African-American women in interacting with the healthcare system and healthcare providers. METHODS Twenty-two in-depth one-on-one interviews were conducted with low-income African-American women. The audio-recorded interviews were transcribed verbatim. An inductive content analysis was performed, using an analytical software, Dedoose® to enabled hierarchical coding. Codes were grouped into categories which were further analyzed for similarities that led to the emergence of themes. RESULTS A key finding was the experience of discriminatory treatment. The three themes that emerged relevant to this category were (1) perceived discrimination based on race/ethnicity, (2) perceived discrimination based on socioeconomic status, and (3) stereotypical assumptions such as drug-seeking and having sexually transmitted diseases. CONCLUSION AND RECOMMENDATIONS Low-income African-American women experience less than satisfactory patient care, where participants attribute to their experience of being stereotyped and their perception of discrimination in the healthcare system and from providers. Patients' experiences within the healthcare system have implications for their healthcare-seeking behaviors and treatment outcomes. Healthcare personnel and providers need to be more aware of the potential for implicit bias toward this population. Healthcare workforce training on culturally responsive patient care approaches and more community engagement will help providers better understand the context of patients from this population and more effectively meet their healthcare needs.
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Affiliation(s)
- Olihe N Okoro
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, MN, USA
| | - Lisa A Hillman
- Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Alina Cernasev
- College of Pharmacy, The University of Tennessee Health Science Center, Nashville, TN, USA
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Busch SH, Golberstein E, Goldman HH, Loveridge C, Drake RE, Meara E. Effects of ACA Expansion of Dependent Coverage on Hospital-Based Care of Young Adults With Early Psychosis. Psychiatr Serv 2019; 70:1027-1033. [PMID: 31480928 PMCID: PMC7605277 DOI: 10.1176/appi.ps.201800492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Since 2010, the Affordable Care Act has required private health plans to extend dependent coverage to adults up to age 26. Because psychosis often begins in young adulthood, expanded private insurance benefits may affect early psychosis treatment. The authors examined changes in insurance coverage and hospital-based service use among young adults with psychosis before and after this change. METHODS The study included a national sample (2006-2013) of discharges and emergency department visits. Using a difference-in-differences study design, the authors compared changes in insurance coverage (measured as payer source), per capita admissions, and 30-day readmissions for psychosis before and after ACA dependent coverage expansion among targeted individuals (ages 20-25) and a comparison group (ages 27-29). RESULTS After dependent coverage expansion, hospitalization for psychosis among young adults was 5.8 percentage points more likely to be reimbursed by private insurance among the targeted age group (ages 20-25), compared with the slightly older age group (ages 27-29). Dependent coverage expansion was not associated with changes in overall insurance coverage, per capita admissions, or 30-day readmission for psychosis. CONCLUSIONS Although dependent coverage expansion was unrelated to changes in use of hospital-based treatments for psychosis among young adults, care was more likely to be covered by private insurance, and coverage of these hospitalizations by public insurance decreased. This shift from public to private insurance may reduce public spending on young-adult treatments for early-episode psychosis but may leave young adults without coverage for rehabilitation services.
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Affiliation(s)
- Susan H Busch
- Yale School of Public Health, Yale University, New Haven, Connecticut (Busch); Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis (Golberstein); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Goldman); Center for Health Information and Analysis, Boston (Loveridge); Westat, Rockville, Maryland (Drake); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, and National Bureau of Economic Research, Cambridge, Massachusetts (Meara)
| | - Ezra Golberstein
- Yale School of Public Health, Yale University, New Haven, Connecticut (Busch); Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis (Golberstein); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Goldman); Center for Health Information and Analysis, Boston (Loveridge); Westat, Rockville, Maryland (Drake); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, and National Bureau of Economic Research, Cambridge, Massachusetts (Meara)
| | - Howard H Goldman
- Yale School of Public Health, Yale University, New Haven, Connecticut (Busch); Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis (Golberstein); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Goldman); Center for Health Information and Analysis, Boston (Loveridge); Westat, Rockville, Maryland (Drake); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, and National Bureau of Economic Research, Cambridge, Massachusetts (Meara)
| | - Christine Loveridge
- Yale School of Public Health, Yale University, New Haven, Connecticut (Busch); Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis (Golberstein); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Goldman); Center for Health Information and Analysis, Boston (Loveridge); Westat, Rockville, Maryland (Drake); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, and National Bureau of Economic Research, Cambridge, Massachusetts (Meara)
| | - Robert E Drake
- Yale School of Public Health, Yale University, New Haven, Connecticut (Busch); Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis (Golberstein); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Goldman); Center for Health Information and Analysis, Boston (Loveridge); Westat, Rockville, Maryland (Drake); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, and National Bureau of Economic Research, Cambridge, Massachusetts (Meara)
| | - Ellen Meara
- Yale School of Public Health, Yale University, New Haven, Connecticut (Busch); Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis (Golberstein); Department of Psychiatry, University of Maryland School of Medicine, Baltimore (Goldman); Center for Health Information and Analysis, Boston (Loveridge); Westat, Rockville, Maryland (Drake); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, and National Bureau of Economic Research, Cambridge, Massachusetts (Meara)
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González-Agüero M, Chenhall R, Basnayake P, Vaughan C. Inequalities in the Age of Universal Health Coverage: Young Chileans with Diabetes Negotiating for Their Right to Health. Med Anthropol Q 2019; 34:210-226. [PMID: 31637732 DOI: 10.1111/maq.12555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 09/10/2019] [Accepted: 09/23/2019] [Indexed: 01/05/2023]
Abstract
While universal health coverage (UHC) has been praised as a powerful means to reduce inequalities and improve access to health globally, little has been said about how patients experience and understand its implementation locally. In this article, we explore the experiences of young Chileans with type 1 diabetes when seeking care in Santiago, within Chile's UHC program, which sought to improve people's access to health care. We argue that the implementation of UHC, within a structurally fragmented health system, did not lead to the promised equitable health care delivery. Although UHC aimed to equitably provide universal care, locally it materialized in heterogeneous configurations forcing individuals into positions of precarity and generating new inequalities. Furthermore, for the young people in the study, UHC intersected with their health insurance and socioeconomic status, impacting on the health care they could access, consequently making diabetes care and management a difficult challenge.
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Affiliation(s)
| | - Richard Chenhall
- Melbourne School of Population and Global Health, The University of Melbourne
| | - Prabhathi Basnayake
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne
| | - Cathy Vaughan
- Gender and Women's Health Unit, Melbourne School of Population and Global Health, The University of Melbourne
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Kovar CL, Fazzone P, Bynum S. Current challenges and opportunities to providing sexually transmitted disease services in STD clinics: A public health leadership perspective. Public Health Nurs 2019; 36:638-644. [PMID: 31328818 DOI: 10.1111/phn.12645] [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: 03/26/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess leaders' perceptions of challenges and opportunities to providing sexually transmitted disease (STD) services in public health departments. DESIGN AND SAMPLE Semi-structured interviews were conducted in 2017 with health directors and other designated leaders in 19 public health departments who have an STD clinic. Purposive sampling accounted for geographical differences, providing balanced representation of urban, suburban, and rural agencies in North Carolina. MEASUREMENT Audiotaped interviews were transcribed verbatim. All transcripts were independently coded, with cross comparison and agreement between researchers. Rigorous thematic and content analyses were performed. RESULTS Perceived stigma, funding constraints, and client-centered issues were identified as the greatest challenges to providing services. Opportunities to improve these services were offering comprehensive screening methods, quality improvement, and public health accreditation. Focused training on revenue and billing practices for staff was acknowledged as the most needed technical assistance. A "culture of free services", perceived by clients and staff, was revealed throughout several themes. CONCLUSIONS Leaders in publicly funded STD clinics face many challenges and opportunities to providing clinical services. Health directors often serve as change agents and improving the sexual health of communities remains a priority. Results of this study will assist in crafting future policy and practice for STD clinics in the public health sector.
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Affiliation(s)
- Cheryl L Kovar
- Advanced Nursing Practice & Education Department, College of Nursing, East Carolina University, Greenville, North Carolina
| | - Patricia Fazzone
- Advanced Nursing Practice & Education Department, College of Nursing, East Carolina University, Greenville, North Carolina
| | - Susan Bynum
- College of Nursing, East Carolina University, Greenville, North Carolina
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Bell HS, Odumosu F, Martinez-Hume AC, Howard HA, Hunt LM. Racialized Risk in Clinical Care: Clinician Vigilance and Patient Responsibility. Med Anthropol 2019; 38:224-238. [PMID: 29912575 PMCID: PMC6298860 DOI: 10.1080/01459740.2018.1476508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Racial/ethnic identity is contingent and arbitrary, yet it is commonly used to evaluate disease risk and treatment response. Drawing on open-ended interviews with patients and clinicians in two US clinics, we explore how racialized risk is conceptualized and how it impacts patient care and experience. We found that racial/ethnic risk was a common but poorly defined construct for both patients and clinicians, who intermingled concepts of genetics, biology, behavior, and culture, while disregarding historical or structural context. We argue that racializing risk embodies social power in marked and unmarked bodies, reinforcing inequality along racial lines and undermining equitable health care.
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Affiliation(s)
- Hannah S Bell
- a Department of Anthropology , Michigan State University , East Lansing , Michigan , USA
| | - Funmi Odumosu
- a Department of Anthropology , Michigan State University , East Lansing , Michigan , USA
| | - Anna C Martinez-Hume
- a Department of Anthropology , Michigan State University , East Lansing , Michigan , USA
| | - Heather A Howard
- a Department of Anthropology , Michigan State University , East Lansing , Michigan , USA
| | - Linda M Hunt
- a Department of Anthropology , Michigan State University , East Lansing , Michigan , USA
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Turan JM, Elafros MA, Logie CH, Banik S, Turan B, Crockett KB, Pescosolido B, Murray SM. Challenges and opportunities in examining and addressing intersectional stigma and health. BMC Med 2019; 17:7. [PMID: 30764816 PMCID: PMC6376691 DOI: 10.1186/s12916-018-1246-9] [Citation(s) in RCA: 369] [Impact Index Per Article: 73.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 12/19/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND 'Intersectional stigma' is a concept that has emerged to characterize the convergence of multiple stigmatized identities within a person or group, and to address their joint effects on health and wellbeing. While enquiry into the intersections of race, class, and gender serves as the historical and theoretical basis for intersectional stigma, there is little consensus on how best to characterize and analyze intersectional stigma, or on how to design interventions to address this complex phenomenon. The purpose of this paper is to highlight existing intersectional stigma literature, identify gaps in our methods for studying and addressing intersectional stigma, provide examples illustrating promising analytical approaches, and elucidate priorities for future health research. DISCUSSION Evidence from the existing scientific literature, as well as the examples presented here, suggest that people in diverse settings experience intersecting forms of stigma that influence their mental and physical health and corresponding health behaviors. As different stigmas are often correlated and interrelated, the health impact of intersectional stigma is complex, generating a broad range of vulnerabilities and risks. Qualitative, quantitative, and mixed methods approaches are required to reduce the significant knowledge gaps that remain in our understanding of intersectional stigma, shared identity, and their effects on health. CONCLUSIONS Stigmatized identities, while often analyzed in isolation, do not exist in a vacuum. Intersecting forms of stigma are a common reality, yet they remain poorly understood. The development of instruments and methods to better characterize the mechanisms and effects of intersectional stigma in relation to various health conditions around the globe is vital. Only then will healthcare providers, public health officials, and advocates be able to design health interventions that capitalize on the positive aspects of shared identity, while reducing the burden of stigma.
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Affiliation(s)
- Janet M. Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL 35294 USA
| | | | - Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, Toronto, ON Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada
| | - Swagata Banik
- Department of Public Health & Prevention Sciences, Baldwin Wallace University, Berea, OH USA
| | - Bulent Turan
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL USA
| | - Kaylee B. Crockett
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL USA
| | | | - Sarah M. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Abstract
Drawing on participant-observation and semi-structured interviews, this paper examines the local forms of clinical practice in a 26-bed acute psychiatric inpatient unit located within a private psychiatric hospital in the Northeastern United States. It focuses on how clinicians, staff, and management understand and utilize the concepts of culture, race, and ethnicity in their daily work, finding that a humanistic approach to care that that treats patients as "individuals" was dominant. Clinicians and staff categorized patients using descriptive, behavior based categories including language, propensity for violence, and whether patients are "from the streets." They also used additional forms of difference such as the patient's pathway to care, their illness category or severity, and whether they use drugs. These forms of difference were shaped by the urgent needs of daily work. These local practices of categorization directly affected the quality of care when staff members assigned cultural characteristics to group members and treated them differently as a result. These findings suggest that anthropologists and clinicians should focus on the way new forms of cultural difference are constructed in small social settings in order to provide equitable treatment to all patients.
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Affiliation(s)
- Seth Donal Hannah
- Social Sciences Department, California Polytechnic State University, Building 47, Room 13, San Luis Obispo, CA, 93407, USA.
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Brunson EK, Mulligan JM, Andaya E, Melo MA, Sered S. Unrequited Engagement: Misadventures in Advocating for Medicaid Expansion. AMERICAN ANTHROPOLOGIST 2018. [DOI: 10.1111/aman.13064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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