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Tkachuk S, Ready E, Chan S, Hawkes J, Janzen Cheney T, Kapler J, Kreutzwiser D, Akagi L, Coombs M, Giguere P, Hughes C, Kelly D, Livingston S, Martel D, Naccarato M, Nhean S, Pozniak C, Ramsey T, Robinson L, Smith J, Swidrovich J, Symes J, Yoong D, Tseng A. Role of the pharmacist caring for people at risk of or living with HIV in Canada. Can Pharm J (Ott) 2024; 157:218-239. [PMID: 39310805 PMCID: PMC11412478 DOI: 10.1177/17151635241267350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/18/2023] [Accepted: 02/27/2024] [Indexed: 09/25/2024]
Affiliation(s)
- Stacey Tkachuk
- Women and Children’s Health Centre of British Columbia, Provincial Health Services Authority, Vancouver, British Columbia
- UBC Faculty of Pharmaceutical Sciences, Vancouver, British Columbia
| | - Erin Ready
- UBC Faculty of Pharmaceutical Sciences, Vancouver, British Columbia
- St. Paul’s Hospital Ambulatory Pharmacy, Providence Health Care, Vancouver, British Columbia
| | - Shanna Chan
- Winnipeg Regional Health Authority Regional Pharmacy Program, Winnipeg, Manitoba
| | - Jennifer Hawkes
- UBC Faculty of Pharmaceutical Sciences, Vancouver, British Columbia
- University Hospital of Northern BC, Northern Health, Prince George, British Columbia
| | - Tracy Janzen Cheney
- Winnipeg Regional Health Authority Regional Pharmacy Program, Winnipeg, Manitoba
| | - Jeff Kapler
- Southern Alberta Clinic, Alberta Health Services, Calgary, Alberta
| | | | - Linda Akagi
- St. Paul’s Hospital Ambulatory Pharmacy, Providence Health Care, Vancouver, British Columbia
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia
| | - Michael Coombs
- School of Pharmacy, Memorial University, St. John’s, Newfoundland
| | - Pierre Giguere
- Pharmacy Department, The Ottawa Hospital, Ottawa, Ontario
- Ottawa Hospital Research Institute, Ottawa, Ontario
- School of Pharmaceutical Sciences, University of Ottawa, Ottawa, Ontario
| | - Christine Hughes
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta
| | - Deborah Kelly
- School of Pharmacy, Memorial University, St. John’s, Newfoundland
| | - Sheri Livingston
- Tecumseh Byng Program, Windsor Regional Hospital, Windsor, Ontario
| | - Dominic Martel
- Pharmacy Department, Centre hospitalier de l’Université de Montréal (CHUM), Montreal, Quebec
- Centre de recherche du CHUM (CRCHUM), Montreal, Quebec
| | | | - Salin Nhean
- Luminis Health Doctors Community Medical Center, Lanham, Maryland, USA
| | - Carley Pozniak
- Positive Living Program, Royal University Hospital, Saskatoon, Saskatchewan
| | - Tasha Ramsey
- Pharmacy Department, Nova Scotia Health Authority, Halifax, Nova Scotia
- College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia
| | | | | | - Jaris Swidrovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Jodi Symes
- Pharmacy Department, Saint John Regional Hospital, Horizon Health Network, Saint John, New Brunswick
| | - Deborah Yoong
- St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario
| | - Alice Tseng
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
- Toronto General Hospital, University Health Network, Toronto, Ontario
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2
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Niño Cital S. The Need for Diverse Leadership in Veterinary Medicine. Vet Clin North Am Small Anim Pract 2024; 54:825-837. [PMID: 39003175 DOI: 10.1016/j.cvsm.2024.06.006] [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] [Indexed: 07/15/2024]
Abstract
Leadership teams composed of individuals from diverse backgrounds bring a more comprehensive range of experiences, perspectives, and approaches to the table. While promoting diversity, equity, inclusion, and belonging for ethical reasons is paramount, the benefits of hiring and recruiting Black, Indigenous, and other people of color individuals for leadership roles extend far beyond moral imperatives. Studies and market trends reveal a compelling connection between diversifying teams, in general, and leadership teams specifically. Recruiting diverse talent and palpable business increases, particularly in terms of profitability through increased customer reach, are 2 of the more notable advantages.
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Affiliation(s)
- Stephen Niño Cital
- Department of Neurobiology, Stanford University, 299 Campus Drive, Stanford, CA 94305, USA; Remedy Veterinary Specialists, San Francisco, CA 94103, USA.
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3
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Akalın N. Immigrant-blind care: How immigrants experience the "inclusive" health system as they access care. Soc Sci Med 2024; 348:116822. [PMID: 38569290 DOI: 10.1016/j.socscimed.2024.116822] [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: 05/17/2023] [Revised: 03/14/2024] [Accepted: 03/21/2024] [Indexed: 04/05/2024]
Abstract
A growing body of scholarship examines the varying impact of legal status and race on accessing healthcare. However, a notable gap persists in comprehending the supplementary mechanisms that hinder immigrants' pathway to seek care. Drawing on ethnographic observations in various clinical settings and in-depth interviews with 28 healthcare professionals and 12 documented Haitian immigrants in a city in Upstate New York, between 2019 and 2021, I demonstrate the tension between the conceptualization and implementation of inclusive care practices by healthcare providers. I argue that the mere expansion and adoption of inclusive discourse among providers do not inherently ensure equity and the removal of barriers to healthcare access. This work contributes to the social study of medicine and race and ethnic studies by introducing the innovative concept of "immigrant-blind." Through this concept, the research sheds light on how providers' conceptualization of inclusivity proclaims medical encounters to be devoid of stratifications and rationalizes their practices which mask the profound impact of immigration status and immigration on immigrant health. Furthermore, these practices reinforce existing divisions within care settings and medical encounters, where immigration laws and enforcement practices operate and further exacerbate stratifications. By examining providers' uninformed implementation of culturally competent care practices, the findings reveal that providers stigmatize and essentialize immigrants during medical encounters. This highlights the imperative for a more nuanced and informed approach to healthcare provision, where genuine inclusivity is upheld, and barriers to access are dismantled to foster equitable and dignified healthcare experiences for all.
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Lele AV, Brooks A, Miyagawa LA, Tesfalem A, Lundgren K, Cano RE, Ferro-Gonzalez N, Wongelemegist Y, Abdullahi A, Christianson JT, Huong JS, Nash PL, Wang WY, Fong CT, Theard MA, Wahlster S, Jannotta GE, Vavilala MS. Caseworker Cultural Mediator Involvement in Neurocritical Care for Patients and Families With Non-English Language Preference: A Quality Improvement Project. Cureus 2023; 15:e37687. [PMID: 37214078 PMCID: PMC10195074 DOI: 10.7759/cureus.37687] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/23/2023] Open
Abstract
Objective To describe Harborview Medical Center's experience with the involvement of caseworker cultural mediators (CCM) for patients requiring neurocritical care. Methods Using univariate and multivariate analysis (model adjusted for age, Glasgow Coma Scale score (GCS), Sequential Organ Failure Assessment (SOFA) Scores, mechanical ventilation, transition to comfort measures only (CMO), and death by neurologic criteria), we examined CCM team members' involvement in the care of Amharic/Cambodian/Khmer/Somali/Spanish/Vietnamese patients admitted to our neurocritical care service between 2014-2022, factors associated with CCM utilization, and changes in CCM utilization after a QI initiative was implemented in 2020 to encourage healthcare providers to consult the CCM team. Results Compared to eligible patients (n=827) who did not receive CCM referral, patients with CCM involvement (n=121) were younger (49 [interquartile range, IQR 38,63] vs. 56 [IQR 42,68] years, p = 0.002), had greater illness severity (admission GCS 8.5 [IQR 3,14] vs. 14 [IQR 7,15], p < 0.001, SOFA scores (5 [IQR 2,8] vs. 4 [IQR2,6], p = 0.007), and more frequently required mechanical ventilation (67% vs. 40%, odds ratio, OR 3.07, 95% CI 2.06,4.64), with higher all-cause mortality (20% vs. 12%, RR 1.83, 95% CI 1.09, 2.95), and with a higher rate of transition to CMO (11.6% vs. 6.2%, OR 2.00, 95% CI 1.03;3.66). The CCM QI initiative was independently associated with increased CCM involvement (aOR 4.22, 95% CI [2.32;7.66]). Overall, 4/10 attempts made by CCMs to reach out to the family to provide support were declined by the family. CCMs reported providing cultural/emotional support (n=96, 79%), end-of-life counseling (n=16, 13%), conflict mediation (n=15, 12.4%), and facilitating goals of care meetings (n=4, 3.3%). Conclusions Among eligible patients, CCM consultations appeared to occur in patients with higher disease severity. Our QI initiative increased CCM involvement.
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Affiliation(s)
- Abhijit V Lele
- Anesthesiology and Pain Medicine, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, USA
- Neurological Surgery, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, USA
| | - Anna Brooks
- Medicine, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, USA
| | | | | | - Kim Lundgren
- Interpreter Services, Harborview Medical Center, Seattle, USA
| | - Rosemary E Cano
- Interpreter Services, Harborview Medical Center, Seattle, USA
| | | | | | - Anab Abdullahi
- Interpreter Services, Harborview Medical Center, Seattle, USA
| | | | | | - Piper L Nash
- Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, USA
| | - Wei-Yun Wang
- Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, USA
| | - Christine T Fong
- Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, USA
| | - Marie-Angele Theard
- Anesthesiology and Pain Medicine, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, USA
| | - Sarah Wahlster
- Neurology, Harborview Medical Center, University of Washington, Seattle, USA
- Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, USA
- Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, USA
| | - Gemi E Jannotta
- Neurocritical Care Service, Harborview Medical Center, University of Washington, Seattle, USA
| | - Monica S Vavilala
- Anesthesiology and Pain Medicine, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, USA
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5
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Nagy GA, Cassiello-Robbins C, Anand D, Arnold ML, Coleman JN, Nwosu J, Singh RS, Woodward EN. Building a multicultural peer-consultation team: Planning, implementing, and early sustainment evaluation. Transcult Psychiatry 2022; 59:844-862. [PMID: 35866216 DOI: 10.1177/13634615221105117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This article represents an implementation-focused evaluation of a multicultural peer-consultation team situated within a psychiatry department in a large academic medical center in the Southern United States. The evaluation comprised anonymous self-report questionnaires (n = 14) as well as individual (n = 3) or group interviews (n = 10) conducted by outside independent evaluators. Participants were current and former team members (i.e., graduate trainees, mental health care providers, clinical and research staff members) who voluntarily participated in this multimethod implementation evaluation. Results indicated that attendance on the team had several important impacts on members, and most notably an increased ability to provide multiculturally competent care, that is treatment that carefully and routinely considers the influence of culture and context on patients and therefore their clinical presentation. Further, no negative impacts from participating on the team were noted. A primary strength of the team's sustainability is that participation on the team was deemed to be relevant and useful by current and former team members. A major barrier to participation on the team is competing demands, such as high clinical loads. We conclude that this model for multicultural peer-consultation holds promise as an effective and implementable educational method for mental health care professionals. We discuss strengths, limitations, and future directions for research.
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Affiliation(s)
- Gabriela A Nagy
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine & School of Nursing, Durham, NC, USA
| | - Clair Cassiello-Robbins
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Deepika Anand
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Macey L Arnold
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Jessica N Coleman
- Duke University Department of Psychology and Neuroscience, Durham, NC, USA
| | - Joshua Nwosu
- Psychology Service, Washington DC Veterans Affairs Health Center, Washington, DC, USA
| | - R Sonia Singh
- VA Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Eva N Woodward
- VA Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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6
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She R, Mo PKH, Cai Y, Ma T, Liu Y, Lau JTF. Mental health service utilisation among transgender women sex workers who are at risk of mental health problems in Shenyang, China: An application of minority stress theory. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e981-e993. [PMID: 34240507 DOI: 10.1111/hsc.13501] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 05/26/2021] [Accepted: 06/22/2021] [Indexed: 06/13/2023]
Abstract
Transgender women sex workers (TGSW), as a highly stigmatised population, are at substantial risk for mental health problems but lack access to mental health care. This study investigated factors of mental health service utilisation (MHSU) behaviour and related behavioural intention among TGSW who were at risk of mental health problems in the past year [subsample 1: scored above the cut-off for probable depression or probable anxiety or had suicidal ideation (N = 126); subsample 2: perceived needs for mental health services (N = 109)]. A cross-sectional survey was conducted among TGSW in Shenyang, China during 2017-2018. Data on minority stress, coping, mental health and MHSU were collected. 10.3% of participants in subsample 1 and 14.7% in subsample 2 had sought help from mental health professionals in the last year. Unwillingness to disclose minority identity and gender non-affirmation were negatively associated with MHSU. Factors for behavioural intention of MHSU included unwillingness to disclose minority identity and social support for both subsamples and adaptive coping for subsample 2. Confidentiality concern, discrimination and cost were the most frequently endorsed barriers to mental health services. Interventions should promote gender affirmation, social support and adaptive coping as well as remove stigma to increase health service access and utilisation among minority populations.
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Affiliation(s)
- Rui She
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Phoenix K H Mo
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yong Cai
- Department of Community Health and Family Medicine, School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Tiecheng Ma
- Shenyang Consultation Centre of AIDS Aid and Health Service, Shenyang, China
| | - Yan Liu
- Shenyang Consultation Centre of AIDS Aid and Health Service, Shenyang, China
| | - Joseph T F Lau
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
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Carter JW, Salabarría-Peña Y, Fields EL, Robinson WT. Evaluating for health equity among a cluster of health departments implementing PrEP services. EVALUATION AND PROGRAM PLANNING 2022; 90:101981. [PMID: 34392968 PMCID: PMC11194854 DOI: 10.1016/j.evalprogplan.2021.101981] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 06/30/2021] [Accepted: 07/25/2021] [Indexed: 06/13/2023]
Abstract
African American/Black and Hispanic/Latino sexual and gender minority populations are disproportionately affected by HIV in the United States and continue to experience HIV-related disparities. CDC funded project PrIDE to support 12 health departments (HD) with implementing pre-exposure prophylaxis (PrEP) strategies for men who have sex with men (MSM) and transgender persons, with a health-equity focus established by HDs. Each HD conducted mixed-methods evaluation of at least one local strategy. CDC employed a cluster evaluation approach to maximize cross validation. As a result, this cluster evaluation focused on three HDs that evaluated health equity-focused PrEP implementation strategies. Findings suggest that integrating health equity strategies such as storytelling and healthcare worker (HCW) trainings can help reduce HIV-related disparities. Storytelling improved HCW's understanding of clients' experiences of stigma due to racial, gender, and sexual identities. Provider training increased competencies on culturally appropriate care and the use of clinic services by Black and Hispanic MSM and transgender persons. Good practices included community engagement, seeking leadership buy-in, and integration of programmatic staff in health equity and evaluation activities. Evaluating strategies and training policies addressing social determinants of health that adversely affect HIV outcomes may help mitigate barriers Black and Hispanic MSM and transgender populations encounter in their HIV prevention seeking efforts.
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Affiliation(s)
- Jarvis W Carter
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329 USA.
| | - Yamir Salabarría-Peña
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329 USA
| | - Errol L Fields
- Johns Hopkins School of Medicine, Department of Pediatrics, Division of Adolescent/Young Adult Medicine, 200 N. Wolfe St., Baltimore, MD, 21287, USA
| | - William T Robinson
- Louisiana Department of Health, Office of Public Health, 1450 Poydras St., New Orleans, LA, 70112, USA; Louisiana State University Health Sciences Center, School of Public Health 2020 Gravier St, New Orleans, LA, 70112, USA
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Nugus P, Travaglia J, MacGinley M, Colliver D, Mazaniello-Chezol M, Claudio F, Lewis LD. Conceptual foundations of organizational structure: re-structuring of women's health services. J Health Organ Manag 2021; ahead-of-print. [PMID: 34894117 DOI: 10.1108/jhom-09-2021-0364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Researchers often debate health service structure. Understanding of the practical implications of this debate is often limited by researchers' neglect to integrate participants' views on structural options with discourses those views represent. As a case study, this paper aims to discern the extent to which and how conceptual underpinnings of stakeholder views on women's health contextualize different positions in the debate over the ideal structure of health services. DESIGN/METHODOLOGY/APPROACH The researchers chose a self-standing, comprehensive women's health service facing the prospect of being dispersed into "mainstream" health services. The researchers gathered perspectives of 53 professional and consumer stakeholders in ten focus groups and seven semi-structured interviews, analyzed through inductive thematic analysis. FINDINGS "Women's marginalization" was the core theme of the debate over structure. The authors found clear patterns between views on the function of women's health services, women's health needs, ideal client group, ideal health service structure and particular feminist discourses. The desire to re-organize services into separate mainstream units reflected a liberal feminist discourse, conceiving marginalization as explicit demonstration of its effects, such as domestic abuse. The desire to maintain a comprehensive women's health service variously reflected post-structural feminism's emphasis on plurality of identities, and a radical feminist discourse, holding that womanhood itself constituted a category of marginalization - that is, merely being at risk of unmet health needs. ORIGINALITY/VALUE As a contribution to health organizational theory, the paper shows that the discernment of discursive underpinnings of particular stakeholder views can clarify options for the structure of health services.
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Affiliation(s)
| | - Joanne Travaglia
- Faculty of Health, University of Technology Sydney, Haymarket, Australia
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9
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Exploring Tertiary Health Science Student Willingness or Resistance to Cultural Competency and Safety Pedagogy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179184. [PMID: 34501772 PMCID: PMC8430816 DOI: 10.3390/ijerph18179184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 12/22/2022]
Abstract
There is an increasing body of literature that considers the relevance and experiences of cultural competency and safety training in health professional students. However, less is written about Australian tertiary learners’ experiences of engaging with cultural competency training. The aim of this study is to explore tertiary students’ willingness or resistance to cultural competency and safety pedagogy. Qualitative student feedback to a teaching unit was collected and triangulated with data from focus groups with tutors. Results were thematically analyzed. Willingness and resistance to cultural competency and safety teaching emerged as two key themes. Willingness to engage with the unit was largely due to student interest in the content, teaching environment and relevance of cultural competency to students’ future practice. Resistance was linked to the students feeling personally attacked, or culturally confronted, with tutors noting the topics around sexuality and white privilege being more resisted. Acknowledging reasons for student resistance and developing strategies to reduce resistance can facilitate more student engagement with cultural competency topics, ultimately leading to their future provision of culturally competent healthcare.
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10
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LaPlant WG, Kattari L, Ross LK, Zhan J, Druck JP. Perceptions of Emergency Care by Sexual and Gender Minorities in Colorado: Barriers, Quality, and Factors Affecting Identity Disclosure. West J Emerg Med 2021; 22:903-910. [PMID: 35354007 PMCID: PMC8328175 DOI: 10.5811/westjem.2021.3.49423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 03/02/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Expanding on data concerning emergency department (ED) use and avoidance by the sexual minority (those who identify as lesbian, gay, bisexual, queer, other [LGTBQ+]) and gender minority (those who identify as transgender, gender nonconforming, other) community may inform future ED LGTBQ+ training and clinical practice. Investigation objectives included characterizing rates of emergency care avoidance, identifying barriers to emergency care, and assessing emergency care quality and cultural competency for sexual and gender minorities. Methods In this population-based, cross-sectional needs assessment, sexual minority, gender minority, and/or cisgender heterosexual-identified participants were selected based on participants’ subscription to newsletters or social media accounts for One Colorado, an LGBTQ+ advocacy organization. Each participant completed a single digital survey that collected qualitative and quantitative data about ED perception, use, and demographics. Results A total of 477 LGBTQ+ or heterosexual-identified individuals (mean age = 44.3 (standard deviation [SD] = 16.7)) participated in the study. Lifetime emergency care avoidance rates for gender minorities were markedly increased (odds ratio [OR] 3.8, 95% confidence interval [CI], 2.2 – 6.6; P <.001), while avoidance rates for sexual minorities were similar to those of cisgender heterosexual respondents (17% vs 14%; P <.001). Gender minorities were more likely than sexual minorities to both avoid emergency care due to fear of discrimination (43% vs 15%; P =.002) and to have experienced discrimination during their last ED visit (OR 11, [95% CI, 5–24]; P <.001). No significant differences were observed between participants in care avoidance due to financial reasons or prior negative experiences. No cited ED factors that influenced identity disclosure decisions were distinctly predictive. Conclusion Gender minorities are more likely than sexual minorities and heterosexual cisgender individuals to report ED avoidance and discrimination at last ED visit. Future work characterizing deficits in LGBTQ+ ED care might reduce these avoidance and discrimination rates, enhancing the level of patient care provided to this population.
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Affiliation(s)
- William G LaPlant
- Good Samaritan Medical Center, Department of Emergency Medicine, Brockton, Massachusetts
| | - Leonardo Kattari
- Michigan State University School of Social Work, East Lansing, Michigan
| | - Lexie K Ross
- University of Colorado School of Medicine, Aurora, Colorado
| | - Jennifer Zhan
- California Hospital Medical Center, Department of Emergency Medicine, Los Angeles, California
| | - Jeffrey P Druck
- Public Health Institute California Bridge Program, Oakland, California.,University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado
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11
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Cipollina R, Sanchez DT. Identity cues influence sexual minorities' anticipated treatment and disclosure intentions in healthcare settings: Exploring a multiple pathway model. J Health Psychol 2021; 27:1569-1582. [PMID: 33678046 DOI: 10.1177/1359105321995984] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The present work experimentally examines how identity cues that signal minority inclusion contribute to sexual minorities' (SM) healthcare visit expectations. We find that minority representation cues reduced SM's (N = 188) expectations of a healthcare provider's bias and increased perceived provider cultural competency which was, in turn, associated with lower anticipated identity-based devaluation and greater sexual orientation disclosure comfort. Providers' diversity-valuing statements had mixed effects highlighting the importance of more concrete indicators of inclusion in this context. This work suggests that a lack of identity safety cues in healthcare settings may contribute to disparate health outcomes for sexual minority populations.
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12
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Gessner M, Bishop MD, Martos A, Wilson BDM, Russell ST. Sexual Minority People's Perspectives of Sexual Health Care: Understanding Minority Stress in Sexual Health Settings. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2020; 17:607-618. [PMID: 33737988 PMCID: PMC7962798 DOI: 10.1007/s13178-019-00418-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Sexual minority individuals (e.g., lesbian, gay, bisexual people) face sexual health inequalities related to their experiences with providers in sexual health care settings, yet few prior studies have focused on these experiences. In the current study, we analyzed qualitative interviews with a diverse sample of 58 sexual minority individuals from three age cohorts in the United States to explore sexual minority people's perspectives of sexual health care. Thematic content analysis revealed four key themes: erasure, enacted stigma, felt stigma, and affirmative care. Subgroup differences in themes across gender, sexual identity, race/ethnicity, and age cohort were also assessed. Women and genderqueer participants reported erasure in the context of identity dismissal in family planning conversations, and men reported felt stigma in the context of hyperawareness of sexual minority identity. Some sexual minority people of color also reported intersectional felt stigma as a result of multiple marginalized identities. Additionally, fewer men reported erasure compared to women or genderqueer people and fewer gay and lesbian participants reported erasure than bisexual or queer people. Implications of these findings include the need for more sexual minority health care initiatives and training and the development of affirmative care practices for sexual minority populations, including those with multiple marginalized identities.
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Affiliation(s)
- McKenna Gessner
- Department of Human Development and Family Sciences, University of Texas at Austin, Austin, TX, USA
| | - Meg D. Bishop
- Department of Human Development and Family Sciences, University of Texas at Austin, Austin, TX, USA
| | - Alexander Martos
- The Williams Institute, University of California Los Angeles School of Law, Los Angeles, CA, USA
| | - Bianca D. M. Wilson
- The Williams Institute, University of California Los Angeles School of Law, Los Angeles, CA, USA
| | - Stephen T. Russell
- Department of Human Development and Family Sciences, University of Texas at Austin, Austin, TX, USA
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13
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Rosendale N, Fishman A, Goldman S, Pardo S, Scarborough A, Bennett A. Systematic Collection of Sexual Orientation and Gender Identity in a Public Health System: The San Francisco Health Network SO/GI Systems-Change Initiative. Jt Comm J Qual Patient Saf 2020; 46:549-557. [DOI: 10.1016/j.jcjq.2020.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 02/06/2020] [Accepted: 02/26/2020] [Indexed: 11/29/2022]
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14
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Lacombe-Duncan A, Newman PA, Bauer GR, Logie CH, Persad Y, Shokoohi M, O Brien N, Kaida A, de Pokomandy A, Loutfy M. Gender-affirming healthcare experiences and medical transition among transgender women living with HIV: a mixed-methods study. Sex Health 2020; 16:367-376. [PMID: 31283902 DOI: 10.1071/sh19011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/21/2019] [Indexed: 11/23/2022]
Abstract
Background Transgender (trans) women are overrepresented among people living with HIV, yet trans women living with HIV (WLWH) experience lower access to HIV care. Access to medical transition may facilitate access to HIV care among trans WLWH. This study sought to describe barriers and facilitators to access to medical transition among trans WLWH. METHODS This convergent parallel mixed-methods study drew on cross-sectional quantitative data from 48 trans WLWH analysed using descriptive and bivariate analyses, as well as qualitative semistructured interview data from a subsample of 11 participants analysed using framework analysis. The primary outcome was self-reported transition experience (completed or in the process of medical transition vs planning to but have not begun medical transition). Quantitative and qualitative results were merged and analysed for convergence, divergence and/or expansion of understanding. RESULTS Just over half the participants reported being fully completed medical transition or in the process of medical transition (52.1% (25/48); 95% confidence interval (CI) 37.5-67.6%), with one-fifth reporting planning to but not having begun medical transition (18.8% (9/48); 95% CI 8.3-29.2%). Factors significantly associated with not having begun one's medical transition included housing instability, transphobia, HIV-related stigma and barriers in access to care. Qualitative findings revealed varied transition experiences, influenced by community norms, passing and class privilege, HIV and structural barriers. Mixed-methods results showed positive relationships between trans WLWH and HIV care providers in terms of trans and HIV health care. CONCLUSIONS HIV-related stigma and social determinants of health limit access to medical transition for trans WLWH. Stigma must be addressed in a broad range of healthcare settings, in addition to structural barriers, to increase access to gender-affirming HIV care and medical transition for trans WLWH.
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Affiliation(s)
- Ashley Lacombe-Duncan
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, Michigan 48109-1106, USA; and Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario M5S 1V4, Canada; and Corresponding author.
| | - Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario M5S 1V4, Canada
| | - Greta R Bauer
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, Kresge Building, London, Ontario N6A 5C1, Canada
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario M5S 1V4, Canada; and Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario M5S 1B2, Canada
| | - Yasmeen Persad
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario M5S 1B2, Canada
| | - Mostafa Shokoohi
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, Kresge Building, London, Ontario N6A 5C1, Canada
| | - Nadia O Brien
- Chronic Viral Illness Service, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, Quebec H4A 3J1, Canada; and Family Medicine, McGill University, 5858 chemin de la Côte-des-Neiges, Montreal, Quebec H3S 1Z1, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, Quebec H4A 3J1, Canada; and Family Medicine, McGill University, 5858 chemin de la Côte-des-Neiges, Montreal, Quebec H3S 1Z1, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, Ontario M5S 1B2, Canada; and Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
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Dessources K, Hari A, Pineda E, Amneus MW, Sinno AK, Holschneider CH. Socially determined cervical cancer care navigation: An effective step toward health care equity and care optimization. Cancer 2020; 126:5060-5068. [DOI: 10.1002/cncr.33124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Kimberly Dessources
- Department of Surgery Memorial Sloan Kettering Cancer Center New York New York
| | - Anjali Hari
- Department of Obstetrics and Gynecology Olive View–UCLA Medical Center Sylmar California
- Department of Obstetrics and Gynecology David Geffen School of Medicine University of California at Los Angeles Los Angeles California
| | - Elizabeth Pineda
- Department of Obstetrics and Gynecology Olive View–UCLA Medical Center Sylmar California
- Department of Obstetrics and Gynecology David Geffen School of Medicine University of California at Los Angeles Los Angeles California
| | - Malaika W. Amneus
- Department of Obstetrics and Gynecology Kaiser Permanente Panorama City Panorama City California
| | - Abdulrahman K. Sinno
- Department of Obstetrics and Gynecology Olive View–UCLA Medical Center Sylmar California
- Department of Obstetrics and Gynecology David Geffen School of Medicine University of California at Los Angeles Los Angeles California
| | - Christine H. Holschneider
- Department of Obstetrics and Gynecology Olive View–UCLA Medical Center Sylmar California
- Department of Obstetrics and Gynecology David Geffen School of Medicine University of California at Los Angeles Los Angeles California
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Biswas S, Douthit NT, Mazuz K, Morrison Z, Patchell D, Ochion M, Eidelman L, Golan A, Alkan M, Dwolatzky T, Norcini J, Waksman I, Solomonov E, Clarfield AM. Implementing a Practical Global Health Curriculum: The Benefits and Challenges of Patient-Based Learning in the Community. Front Public Health 2020; 8:283. [PMID: 32766194 PMCID: PMC7379171 DOI: 10.3389/fpubh.2020.00283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/29/2020] [Indexed: 12/26/2022] Open
Abstract
Background: A growing number of medical schools across the world have incorporated global health (GH) into their curricula. While several schools focus GH education on lecture-based courses, our premise is that global health education should embody a holistic approach to patient care and medical education in local communities. Medical students may learn global health by focusing on real patients, their families and communities as part of a practical curriculum. Aims and Objectives: A unique GH curriculum was devised to compare student learning outcomes on a practical vs. lecture-based course. The premise was that learning from patients would result in a greater breadth of coverage of the global health syllabus as compared to that from a lecture-based course. Methods: A teaching and learning program was developed over 3 years to provide medical students interaction with real patients in the community on a first-preclinical-year Introduction to Global Health and Medical Anthropology course. Learning outcomes on the practical vs. lecture-based course were compared using thematic analysis of the written assignments of both courses: global health case reports and literature reviews, respectively. All members of three cohorts of students undertaking the course in successive academic years were compared (Group A: literature review; Groups B and C: case reports; n = 87). Results: Case reports provided evidence of a greater breadth of learning outcomes when compared to the literature review (p < 0.001). The writing of the case report was enhanced by completion of a field journal and family health needs assessment tool (p < 0.001). Students demonstrated a closeness to their patients that added depth, understanding and motivation to assist patients in health activities and advocate for their needs. Discussion: Placements with patients in the community provided students with a rich learning environment and facilitated the formation of relationships with patients to better understand the social determinants of health and advocate for improvements in their living and working conditions and access to healthcare. Conclusions: Global health may be better learned experientially by following patients rather than from frontal lectures. Patient-based learning inspires a commitment to the individual and facilitates medical schools in meeting their obligations to the communities they serve.
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Affiliation(s)
- Seema Biswas
- British Medical Journal Group, BMJ Case Reports, London, United Kingdom
| | - Nathan T Douthit
- Brookwood Baptist Health, Medical Education, Birmingham, AL, United States.,British Medical Journal Group, BMJ Case Reports, London, United Kingdom
| | - Keren Mazuz
- Hadassah Academic College, Jerusalem, Israel
| | - Zach Morrison
- Department of Surgery, Marshfield Medical Center, Marshfield, WI, United States
| | - Devin Patchell
- Department of Emergency Medicine, Mercy Health, Cincinnati, OH, United States
| | - Michael Ochion
- Department of Social Work, Municipal Health, Be'er Sheva Municipality, Be'er Sheva, Israel
| | - Leslie Eidelman
- Clalit Health Services, Gastroenterology Unit, Ambulatory Specialist Center, Ashkelon, Israel
| | - Agneta Golan
- Department of Neonatology, Soroka University Medical Center, Be'er Sheva, Israel.,Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Michael Alkan
- Department of Medicine, Ben Gurion University of the Negev, Be'er Sheva, Israel.,Medical School for International Health, BGU Faculty for Health Sciences, Be'er Sheva, Israel.,P.H.R. Open Clinic, Volunteer Physician, Tel Aviv-Yafo, Israel
| | - Tzvi Dwolatzky
- Geriatric Unit, Rambam Health Care Campus and Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - John Norcini
- Foundation for Advancement of International Medical Education and Research, Philadelphia, PA, United States.,Psychiatry Department, Upstate Medical University, Syracuse, NY, United States
| | - Igor Waksman
- Department of Surgery, Galilee Medical Center, Nahariya, Israel.,The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Evgeny Solomonov
- The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.,Department of General and Hepatobiliary Surgery, Ziv Medical Center, Safed, Israel
| | - A Mark Clarfield
- Department of Geriatrics, Soroka University Medical Center, Be'er Sheva, Israel.,Medical School for International Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.,Department of Geriatrics, McGill University, Montreal, QC, Canada
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17
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Schuller KA, Crawford RP. Impact of interpersonal client–provider relationship on satisfaction with mental healthcare among the LGBTQ+ population. J Ment Health 2020; 31:634-641. [DOI: 10.1080/09638237.2020.1793126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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18
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Brottman MR, Char DM, Hattori RA, Heeb R, Taff SD. Toward Cultural Competency in Health Care: A Scoping Review of the Diversity and Inclusion Education Literature. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:803-813. [PMID: 31567169 DOI: 10.1097/acm.0000000000002995] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
PURPOSE To explore best practices for increasing cultural competency and reducing health disparities, the authors conducted a scoping review of the existing literature. METHOD The review was guided by 2 questions: (1) Are health care professionals and medical students learning about implicit bias, health disparities, advocacy, and the needs of diverse patient populations? (2) What educational strategies are being used to increase student and educator cultural competency? In August 2016 and July 2018, the authors searched 10 databases (including Ovid MEDLINE, Embase, and Scopus) and MedEdPORTAL, respectively, using keywords related to multiple health professions and cultural competency or diversity and inclusion education and training. Publications from 2005 to August 2016 were included. Results were screened using a 2-phase process (title and abstract review followed by full-text review) to determine if articles met the inclusion or exclusion criteria. RESULTS The search identified 89 articles that specifically related to cultural competency or diversity and inclusion education and training within health care. Interventions ranged from single-day workshops to a 10-year curriculum. Eleven educational strategies used to teach cultural competency and about health disparities were identified. Many studies recommended using multiple educational strategies to develop knowledge, awareness, attitudes, and skills. Less than half of the studies reported favorable outcomes. Multiple studies highlighted the difficulty of implementing curricula without trained and knowledgeable faculty. CONCLUSIONS For the field to progress in supporting a culturally diverse patient population, comprehensive training of trainers, longitudinal evaluations of interventions, and the identification and establishment of best practices will be imperative.
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Affiliation(s)
- Melissa R Brottman
- M.R. Brottman is currently occupational therapist, Schwab Rehabilitation Hospital, Chicago, Illinois. At the time of writing, she was a third-year clinical doctorate student, Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri. D.M. Char is professor of emergency medicine and director of faculty development for emergency medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri. R.A. Hattori is senior project manager, Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri. R. Heeb was a third-year clinical doctorate student, Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri, at the time of writing. She is currently a rehabilitation and participation science doctoral student, Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri. S.D. Taff is associate professor of occupational therapy and medicine and director, Division of Professional Education, Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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19
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Willging C, Kano M, Green AE, Sturm R, Sklar M, Davies S, Eckstrand K. Enhancing primary care services for diverse sexual and gender minority populations: a developmental study protocol. BMJ Open 2020; 10:e032787. [PMID: 32102808 PMCID: PMC7045086 DOI: 10.1136/bmjopen-2019-032787] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Compared with heterosexual, cisgender populations, sexual and gender minority (SGM) people are more likely to suffer from serious health conditions and insufficient access to health services. Primary care is at the frontlines of healthcare delivery; yet, few clinics have resources or mechanisms in place to meet SGM patient needs. This developmental study protocol focuses on reducing health disparities among SGM patients by identifying, adapting and developing SGM practice guidelines/recommendations and implementation strategies for primary care clinics in urban and rural New Mexico. Using input from patients, healthcare advocates and providers, and researchers, the study will pilot a practice parameter and implementation toolkit to promote SGM-specific cultural competence at multiple service delivery levels. METHODS AND ANALYSIS We will recruit providers/staff from four Federally Qualified Health Centers (FQHCs) serving ethnically and geographically diverse communities. Incorporating the Implementation of Change Model and an intersectionality perspective, data collection includes a systematic review of SGM-specific practice guidelines/recommendations, focus groups and semistructured interviews, quantitative surveys and the Nominal Group Technique (NGT) with providers/staff. We will categorise guidelines/recommendations identified through the review by shared elements, use iterative processes of open and focused coding to analyse qualitative data from focus groups, interviews and the NGT, and apply descriptive statistics to assess survey data. Findings will provide the foundation for the toolkit. Focus groups with SGM patients will yield supplemental information for toolkit refinement. To investigate changes in primary care contexts following the toolkit's pilot, we will undertake systematic walkthroughs and document review at the FQHCs, analysing these data qualitatively to examine SGM inclusiveness. The structured data-informed Plan-Do-Study-Act method will enable further revision of the toolkit. Finally, focus groups, interviews and quantitative surveys with providers/staff will highlight changes made in the FQHCs to address SGM patient needs, barriers to sustainment of changes, satisfaction, acceptability, usability and feasibility of the toolkit. ETHICS AND DISSEMINATION The study has been reviewed and approved by the Pacific Institute for Research and Evaluation Institutional Review Board. Informed consent will be obtained from all participants before their involvement in research activities begins. Study results will be actively disseminated through peer-reviewed journals, conference presentations, social media and the internet, and community/stakeholder engagement activities.
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Affiliation(s)
- Cathleen Willging
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, Albuquerque, New Mexico, USA
| | - Miria Kano
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, Albuquerque, New Mexico, USA
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Robert Sturm
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, Albuquerque, New Mexico, USA
| | - Marisa Sklar
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Sonnie Davies
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, Albuquerque, New Mexico, USA
| | - Kristen Eckstrand
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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20
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Lacombe-Duncan A, Logie CH, Newman PA, Bauer GR, Kazemi M. A qualitative study of resilience among transgender women living with HIV in response to stigma in healthcare. AIDS Care 2020; 32:1008-1013. [PMID: 32070113 DOI: 10.1080/09540121.2020.1728212] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Stigma in healthcare is a pervasive adversity experienced by transgender (trans) women living with HIV (WLWH). Resilience is described as individual and collective processes of navigating and overcoming adversity. This qualitative study sought to explore resilience exhibited by trans WLWH in response to stigma in healthcare. Semi-structured, individual interviews were conducted in 2017-2018 with a purposive sample of trans WLWH (n = 11) participating in a community-based cohort study. Framework analysis was used to identify key themes, patterns within themes between participants, and patterns across themes among participants. Three overarching themes were identified. (1) Resilient responses to stigma in healthcare. Participants exhibited resilient personality traits and processes of resistance and transformation in response to stigma. (2) Motivations, benefits, and consequences of responding. Participants experienced self and altruistic driven motivations. Benefits included increased self-worth, economic resources, and leverage for better healthcare treatment, and reduced internalized stigma and isolation. Negative consequences included defensive provider reactions, being further stereotyped, and decreased physical and mental health. (3) Recommendations for systemic change. Participants recommended trans inclusion in service delivery, development, and management, as well as increased provider education. Providers can leverage trans WLWH's personal and collective strengths while working in solidarity to reduce stigma in healthcare settings.
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Affiliation(s)
- Ashley Lacombe-Duncan
- School of Social Work, University of Michigan, Ann Arbor, MI, USA.,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Greta R Bauer
- Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Canada
| | - Mina Kazemi
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
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21
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Accompagnement médical et communautaire dans un essai de prévention biomédicale : vers une nouvelle forme d’éducation ? PRAT PSYCHOL 2019. [DOI: 10.1016/j.prps.2018.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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22
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Rosendale N, Ostendorf T, Evans DA, Weathers A, Sico JJ, Randall J, Hinson HE. American Academy of Neurology members' preparedness to treat sexual and gender minorities. Neurology 2019; 93:159-166. [DOI: 10.1212/wnl.0000000000007829] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/29/2019] [Indexed: 02/06/2023] Open
Abstract
ObjectiveTo measure the attitudes and knowledge of American Academy of Neurology (AAN) member neurologists in caring for sexual and gender minority (SGM) patients (e.g., those who identify in the lesbian, gay, bisexual, transgender, queer, or questioning [LGBTQ+] spectrum) to inform future educational offerings.MethodsA questionnaire was created in an iterative process by the LGBTQ+ Survey Task Force, consisting of 21 questions examining self-reported knowledge, attitudes, and clinical preparedness in caring for SGM patients. Participants responded to each statement with a 5-point Likert scale (“strongly disagree” to “strongly agree”). The survey was distributed via electronic and conventional mail to a random, representative sample of 1,000 AAN members.ResultsThe response rate was 13.5% (n = 135). Most respondents (60%–66%) were aware of local and national barriers that inhibit SGM individuals from using health care services; the majority (73%–91%) felt comfortable assessing SGM patients. Over half believed sexual orientation (SO) and gender identity (GI) to be social determinants of health (61% and 57%, respectively). Yet a third would not tailor neurologic care based on a patient's SGM identity, and 43% believed that SO/GI has no bearing on the management of neurologic illness.ConclusionsMost neurologists surveyed were aware of overarching barriers to care experienced by SGM individuals; however, a minority of respondents recognized the intersection of SGM identity with neurologic health. Our results highlight awareness gaps that could be addressed via targeted educational opportunities, ensuring that neurologists provide high-quality neurologic care to patients of all sexual orientations and gender identities.
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Livelihood Risk, Culture, and the HIV Interface: Evidence from Lakeshore Border Communities in Buliisa District, Uganda. J Trop Med 2019; 2019:6496240. [PMID: 31223313 PMCID: PMC6541934 DOI: 10.1155/2019/6496240] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/28/2019] [Indexed: 01/22/2023] Open
Abstract
Background While studies have focused on HIV prevalence and incidence among fishing communities, there has been inadequate attention paid to the construction and perception of HIV risk among fisher folk. There has been limited research with respect to communities along Lake Albert on the border between Uganda and the Democratic Republic of Congo (DRC). Methods We conducted a qualitative study on three landing sites of Butiaba, Bugoigo, and Wanseko on the shores of Lake Albert along the border of Uganda and the Democratic Republic of Congo. Data were collected using 12 Focus Group Discussions and 15 key informant interviews. Analysis was done manually using content and thematic approaches. Results Lakeshore livelihoods split families between men, women, and children with varying degrees of exposure to HIV infection risk. Sustaining a thriving fish trade was dependent on taking high risks. For instance, profits were high when the lake was stormy. Landing sites were characterized by widespread prostitution, alcohol consumption, drug abuse, and child labour. Such behaviors negatively affected minors and in many ways predisposed them to HIV infection. The lake shore-border heterogeneity resulted in a population with varying HIV knowledge, attitudes, behavior, and competencies to risk perception and adaptation amidst negative masculinities and negative resilience. Conclusion The susceptibility of lakeshore communities to HIV is attributable to a complex combination of geo-socio, the available (health) services, economic, and cultural factors which converged around the fishing livelihood. This study reveals that HIV risk assessment is an interplay of plural rationalities within the circumstances and constraints that impinge on the daily lives by different actors. A lack of cohesion in a multiethnic setting with large numbers of outsiders and a large transient population made the available HIV interventions less effective.
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King J, Brosseau L, Guitard P, Laroche C, Barette JA, Cardinal D, Cavallo S, Laferrière L, Toupin-April K, Bérubé MÈ, O’Neil J, Castro J, Kidjo C, Fakhry S. Validation transculturelle de contenu de la version franco-canadienne de l’échelle COREQ. Physiother Can 2019; 71:222-230. [PMID: 31719718 PMCID: PMC6830411 DOI: 10.3138/ptc.2018-44.f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: The main purpose of this article is to produce a French-Canadian translation of the Consolidated criteria for reporting qualitative studies (COREQ) scale under the proposed name "échelle COREQ" and to assess the transcultural validity of its content. The secondary purpose is to examine the inter-rater reliability of the French-Canadian version of the COREQ scale. Method: A modified approach to Vallerand's methodology (1989) for cross-cultural validation was used. First, a parallel back-translation of the COREQ scale was performed, by both professionals and clinicians. Next, a first committee of experts(P1) examined the translations to create a first draft of the French-Canadian version of the COREQ scale. This draft was then evaluated and modified by a second committee of experts (P2). Finally, 28future professionals (master's students in physiotherapy) rated this second draft of the tool for clarity using a seven-point scale (1:very clear; 7:very ambiguous). The principal co-investigators then reviewed the problematic elements and proposed final changes. Two independent raters used this French-Canadian version of the COREQ scale to assess 13qualitative studies that were published in French after the year2007. The kappa coefficient was used to examine inter-rate reliability. Results: The different elements of the final version of the COREQ scale received an average ambiguity rating between 1.04 and 2.56. These low values show a high level of clarity for the French-Canadian version of the COREQ scale. In relation to the total score of the COREQ scale, inter-rater reliability (n = 2) is considered to be average to excellent for 62.5% of individual elements, according to the kappa values obtained. Conclusions: A valid French-Canadian version of the COREQ scale was created using this rigorous five-step process.
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Affiliation(s)
| | | | | | | | | | - Dominique Cardinal
- Gestionnaire du volet formation, Consortium national de formation en santé (CNFS), Volet Université d’Ottawa
| | | | - Lucie Laferrière
- Direction de la protection de la santé des Forces, ministère de la Défense nationale
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Chan LS, Macdonald ME, Cohen SR. Moving Culture beyond Ethnicity: Examining Dying in Hospital through a Cultural Lens. J Palliat Care 2018. [DOI: 10.1177/082585970902500207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Lisa S. Chan
- School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Mary Ellen Macdonald
- School of Nursing and Departments of Pediatrics and Oncology, McGill University, and Montreal Children's Hospital of the McGill University Health Center, Montreal, Quebec, Canada
| | - S. Robin Cohen
- Departments of Oncology and Medicine, McGill University, and Lady Davis Institute for Research, Montreal, Quebec, Canada
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Sowicz TJ, Bradway CK. Factors Affecting Sexual History Taking in a Health Center Serving Homeless Persons. QUALITATIVE HEALTH RESEARCH 2018; 28:1395-1405. [PMID: 29577844 DOI: 10.1177/1049732318765442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Low rates of documentation of sexual histories have been reported and research on sexual history taking (SHT) has focused on the content of, barriers to collecting, and interventions to improve documentation of sexual histories. Absent from this literature is an understanding of the contextual factors affecting SHT. To address this gap, a focused ethnography of one health center was conducted. Data were collected through observations of health care encounters and interviews with health care providers (HCPs). No SHT was observed and this was likely influenced by patients' characteristics, communication between patients and HCPs, the prioritization of patients' basic needs, and time constraints imposed upon encounters. Given that the health center studied serves patients experiencing homelessness, behavioral health concerns, and opioid use disorder, findings illuminate areas for future inquiry into a patient population affected by social as well as physiologic determinants of health and potentially at high risk for adverse sexual health outcomes.
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Affiliation(s)
- Timothy Joseph Sowicz
- 1 University of Pennsylvania, Philadelphia, Pennsylvania, USA
- 2 VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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27
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Di Ciaccio M, Protiere C, Rojas Castro D, Suzan-Monti M, Chas J, Cotte L, Siguier M, Cua E, Spire B, Molina JM, Preau M. The ANRS-Ipergay trial, an opportunity to use qualitative research to understand the perception of the "participant"-physician relationship. AIDS Care 2018; 30:41-47. [PMID: 29848004 DOI: 10.1080/09540121.2018.1468013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The ANRS-IPERGAY trial consisted in providing sexual activity-based antiretroviral prophylaxis for HIV prevention (PrEP) with a package of prevention tools (counselling, condoms, HIV and sexually transmitted infections' screening) to highly exposed HIV-negative men who have sex with men (MSM). Few data exist concerning the patient-physician relationship in the particular context of PrEP, where physicians discuss sexual behaviours with MSM who are not classic patients, in that consultation is for prevention purposes, not for illness. This study took place during the open-label extension of ANRS-IPERGAY trial when all participants received PrEP. In this qualitative study, we examined how physicians perceived their relationship with participants in the ANRS-IPERGAY trial. Of all 30 physicians involved in the trial who were contacted by email to participate in an interview about their opinions and perceptions of ANRS-IPERGAY 18 volunteered to participate in the current sub-study. We performed a vertical analysis for each interview to identify the extract in each physician's discourse concerning their relationship with MSM participants, and conducted a horizontal analysis to construct the thematic tree and subsequently investigate differences and similitudes between themes. An analysis of all physicians' discourses showed that the participant-physician relationship during the trial could be described through 4 themes: (i) personal experience of the relationship, (ii) trust and non-judgement, (iii) positive relational climate and (iv) influence of physician's characteristics (age, gender, etc.) on relationship. We found that the particular context of PrEP led some physicians to adopt a patient-as-partner approach during consultations rather than a paternalist or hierarchical approach. Indeed, the close follow-up provided by the trial and the active role of patients in their own prevention care trajectory, are more compatible with the patient-as-partner approach. The prescription of PrEP may lead to an evolution in patient-physician relationships and may even modify the professional identity of physicians.
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Affiliation(s)
- Marion Di Ciaccio
- a Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Aix Marseille Univ, INSERM, IRD, SESSTIM Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Marseille , France.,b Groupe de Recherche En Psychologie Sociale (GRePS) , Université Lyon 2 , Lyon , France.,c Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur , Marseille , France
| | - Christel Protiere
- a Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Aix Marseille Univ, INSERM, IRD, SESSTIM Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Marseille , France.,c Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur , Marseille , France
| | - Daniela Rojas Castro
- a Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Aix Marseille Univ, INSERM, IRD, SESSTIM Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Marseille , France.,b Groupe de Recherche En Psychologie Sociale (GRePS) , Université Lyon 2 , Lyon , France.,d AIDES (Mission Innovation Recherche Expérimentation) , Pantin , France.,e Coalition Internationale Sida , programme recherche communautaire , Pantin , France
| | - Marie Suzan-Monti
- a Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Aix Marseille Univ, INSERM, IRD, SESSTIM Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Marseille , France.,c Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur , Marseille , France
| | - Julie Chas
- f Département des Maladies Infectieuses , Hôpital Tenon , Paris , France
| | - Laurent Cotte
- g Hôpital de la Croix Rousse, Département des Maladies Infectieuses , Centre Hospitalier et Universitaire de Lyon , Lyon , France
| | - Martin Siguier
- h Hospital Saint-Louis, Department of Infectious Diseases, Assistance Publique Hôpitaux de Paris , University of Paris Diderot Paris 7, INSERM U941 , Paris , France
| | - Eric Cua
- i Département des Maladies Infectieuses , Hôpital de l'Archet , Nice , France
| | - Bruno Spire
- a Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Aix Marseille Univ, INSERM, IRD, SESSTIM Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Marseille , France.,c Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur , Marseille , France
| | - Jean-Michel Molina
- h Hospital Saint-Louis, Department of Infectious Diseases, Assistance Publique Hôpitaux de Paris , University of Paris Diderot Paris 7, INSERM U941 , Paris , France
| | - Marie Preau
- a Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Aix Marseille Univ, INSERM, IRD, SESSTIM Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Marseille , France.,b Groupe de Recherche En Psychologie Sociale (GRePS) , Université Lyon 2 , Lyon , France
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- a Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Aix Marseille Univ, INSERM, IRD, SESSTIM Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale , Marseille , France
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Beach MC, Laws MB, Rose G, Roter D, Lee Y, Chander G, Woodson T, Moore RD, Rogers W, Wilson IB. Effects of Minimal Versus Intensive Intervention to Enhance Motivational Interviewing in HIV Care. AIDS Behav 2018; 22:276-286. [PMID: 28578544 PMCID: PMC5712480 DOI: 10.1007/s10461-017-1794-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We conducted a randomized trial comparing the effect of two different levels of motivational interviewing training on clinician communication behaviors and patient experiences. We enrolled 12 HIV clinicians who attended a one-day MI workshop focusing on behavior change counseling skills. We then randomized clinicians to receive (or not) 3-5 rounds of personalized feedback from the MI trainer. We compared outcomes before and after the interventions and between the intervention groups. We tested time-by-study arm interactions to determine if one group improved more than the other. For all analyses, we used generalized estimating equations to account for clustering of patients within clinicians, with Gaussian or negative binomial distributions as appropriate. Patients of clinicians in both intervention groups rated their visits as more MI consistent (6.86 vs. 6.65, p = 0.005) and audio-recording analysis revealed that visits were more patient-centered (1.34 vs. 0.96, p = 0.003) with a more positive patient affect (22.36 vs. 20.84, p < 0.001) after versus before the intervention, without differences between intervention arms. Several specific clinician behaviors such as empathic statements, asking patient opinions and open-ended questions improved more in the workshop+feedback versus the workshop-only intervention arm. A few specific communication behaviors increased (total and complex reflections) after versus before the intervention, without differences between intervention arms. The workshop alone was as effective as the workshop plus feedback in improving patient experiences and overall communication measures. Certain communication behaviors improved more with the more intensive intervention, but these additional benefits may not warrant the extra financial and logistical resources required.
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Affiliation(s)
| | | | - Gary Rose
- William James College, Boston, MA, USA
| | - Debra Roter
- Johns Hopkins University, Baltimore, MD, USA
| | - Yoojin Lee
- Brown School of Public Health, Providence, RI, USA
| | | | | | | | - William Rogers
- Institute for Health Care and Clinical Policy Studies, Tufts Medical Center, Boston, USA
| | - Ira B Wilson
- Brown School of Public Health, Providence, RI, USA
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Haider AH, Schneider EB, Kodadek LM, Adler RR, Ranjit A, Torain M, Shields RY, Snyder C, Schuur JD, Vail L, German D, Peterson S, Lau BD. Emergency Department Query for Patient-Centered Approaches to Sexual Orientation and Gender Identity : The EQUALITY Study. JAMA Intern Med 2017; 177:819-828. [PMID: 28437523 PMCID: PMC5818827 DOI: 10.1001/jamainternmed.2017.0906] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/27/2017] [Indexed: 01/01/2023]
Abstract
Importance The Institute of Medicine and The Joint Commission recommend routine documentation of patients' sexual orientation in health care settings. Currently, very few health care systems collect these data since patient preferences and health care professionals' support regarding collection of data about patient sexual orientation are unknown. Objective To identify the optimal patient-centered approach to collect sexual orientation data in the emergency department (ED) in the Emergency Department Query for Patient-Centered Approaches to Sexual Orientation and Gender Identity study. Design, Setting, and Participants An exploratory, sequential, mixed-methods design was used first to evaluate qualitative interviews conducted in the Baltimore, Maryland, and Washington, DC, areas. Fifty-three patients and 26 health care professionals participated in the qualitative interviews. Interviews were followed by a national online survey, in which 1516 (potential) patients (244 lesbian, 289 gay, 179 bisexual, and 804 straight) and 429 ED health care professionals (209 physicians and 220 nurses) participated. Survey participants were recruited using random digit dialing and address-based sampling techniques. Main Outcomes and Measures Qualitative interviews were used to obtain the perspectives of patients and health care professionals on sexual orientation data collection, and a quantitative survey was used to gauge patients' and health care professionals' willingness to provide or obtain sexual orientation information. Results Mean (SD) age of patient and clinician participants was 49 (16.4) and 51 (9.4) years, respectively. Qualitative interviews suggested that patients were less likely to refuse to provide sexual orientation than providers expected. Nationally, 154 patients (10.3%) reported that they would refuse to provide sexual orientation; however, 333 (77.8%) of all clinicians thought patients would refuse to provide sexual orientation. After adjustment for demographic characteristics, only bisexual patients had increased odds of refusing to provide sexual orientation compared with heterosexual patients (odds ratio, 2.40; 95% CI, 1.26-4.56). Conclusions and Relevance Patients and health care professionals have discordant views on routine collection of data on sexual orientation. A minority of patients would refuse to provide sexual orientation. Implementation of a standardized, patient-centered approach for routine collection of sexual orientation data is required on a national scale to help to identify and address health disparities among lesbian, gay, and bisexual populations.
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Affiliation(s)
- Adil H. Haider
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Surgery, Brigham & Women’s Hospital, Boston, Massachusetts
| | - Eric B. Schneider
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Surgery, Brigham & Women’s Hospital, Boston, Massachusetts
| | - Lisa M. Kodadek
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachel R. Adler
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Surgery, Brigham & Women’s Hospital, Boston, Massachusetts
| | - Anju Ranjit
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Surgery, Brigham & Women’s Hospital, Boston, Massachusetts
| | - Maya Torain
- Duke University School of Medicine, Durham, North Carolina
| | | | - Claire Snyder
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jeremiah D. Schuur
- Department of Emergency Medicine, Brigham & Women’s Hospital, Boston, Massachusetts
| | - Laura Vail
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Danielle German
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Susan Peterson
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brandyn D. Lau
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Carnevale FA, Macdonald ME, Razack S, Steinert Y. Promoting Cultural Awareness: A Faculty Development Workshop on Cultural Competency. Can J Nurs Res 2017; 47:18-40. [DOI: 10.1177/084456211504700203] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Rossi AL, Lopez EJ. Contextualizing Competence: Language and LGBT-Based Competency in Health Care. JOURNAL OF HOMOSEXUALITY 2017; 64:1330-1349. [PMID: 28467155 DOI: 10.1080/00918369.2017.1321361] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Changes in the language and terminology used to refer to individuals identifying as lesbian, gay, bisexual, and transgender (LGBT), as well as how best to discuss issues of sexual and gender identity, can prove challenging for health care providers due to (1) lack of training; (2) interdisciplinary issues; and (3) prejudices on personal and institutional levels. Given the importance of language in the relationship between health care provider and patient as well as the myriad ways in which language can reflect knowledge, skills, and attitudes, we contend that language is both a facilitator and inhibitor of competence. In this article, we discuss language as a means of exhibiting cultural competence as well as the barriers to facilitating this degree of competence. Communicative competence, a concept traditionally used in linguistics, is discussed as a framework for contextualizing LGBT-specific cultural competence in health care. Ideally, a professional will be considered competent once they (1) acquire a foundation in issues associated with LGBT individuals, as well as a basic understanding of appropriate vocabulary' (2) reconcile personal beliefs with their professional role; (3) create an inclusive healthcare environment such that the influence of personal biases does not negatively impact care; and (4) use identifiers suggested by the patient.
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Affiliation(s)
- Alexis L Rossi
- a Office of Student & Multicultural Affairs, Educational Innovation Institute, Medical College of Georgia at Augusta University , Augusta , Georgia , USA
| | - Eliot J Lopez
- b Department of Psychiatry , University of Texas Health Science Center San Antonio , San Antonio , Texas , USA
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Ziebarth DJ. Wholistic Health Care: Evolutionary Conceptual Analysis. JOURNAL OF RELIGION AND HEALTH 2016; 55:1800-1823. [PMID: 26895235 DOI: 10.1007/s10943-016-0199-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
While performing a data search to define "wholistic health care", it was evident that a definite gap existed in published literature. In addition, there are different definitions and several similar terms (whole person care, wholistic health, whole person health, wholism, etc.), which may cause confusion. The purpose of this paper was to present the analysis of "wholistic health care" using Rodgers' Evolutionary Method. The method allows for the historical and social nature of "wholistic health care" and how it changes over time. Attributes, antecedents, and consequences of wholistic health care were reduced using a descriptive matrix. In addition, attributes that consistently occurred in wholistic health care were presented as essential attributes. Definitions of Wholistic Health Care Provider(s), Wholistic Health, Wholistic Illness, Wholistic Healing, and Patient were created from the analysis of the literature review of attributes, antecedents, and consequences of wholistic health care. Wholistic Health Care is defined as the assessment, diagnosis, treatment and prevention of wholistic illness in human beings to maintain wholistic health or enhance wholistic healing. Identified wholistic health needs are addressed simultaneously by one or a team of allied health professionals in the provision of primary care, secondary care, and tertiary care. Wholistic health care is patient centered and considers the totality of the person (e.g., human development at a given age, genetic endowments, disease processes, environment, culture, experiences, relationships, communication, assets, attitudes, beliefs, and lifestyle behaviors). Patient centered refers to the patient as active participant in deciding the course of care. Essential attributes of wholistic health care are faith (spiritual) integrating, health promoting, disease managing, coordinating, empowering, and accessing health care. Wholistic health care may occur in collaboration with a faith-based organization to mobilize volunteers to support and promote individual, family, and community health. A gap existed in literature regarding the definition of wholistic health care. In addition, a lack of clarity was identified due to the use of the concept, similar or related concepts. Conceptual clarity was sought through identification and definitions of attributes, Powered by Editorial Manager(®) and ProduXion Manager(®) from Aries Systems Corporation antecedents, and consequences. The theoretical definition of wholistic health care and conceptual model can be used to support the presence of the concept, develop model-based applications, and consistently test effectiveness.
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Affiliation(s)
- Deborah Jean Ziebarth
- The Church Health Center, Memphis, TN, USA.
- University of Wisconsin, Milwaukee, Milwaukee, WI, USA.
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Malterud K, Bjorkman M. The Invisible Work of Closeting: A Qualitative Study About Strategies Used by Lesbian and Gay Persons to Conceal Their Sexual Orientation. JOURNAL OF HOMOSEXUALITY 2016; 63:1339-1354. [PMID: 26914706 DOI: 10.1080/00918369.2016.1157995] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The last decades have offered substantial improvement regarding human rights for lesbian and gay (LG) persons. Yet LG persons are often in the closet, concealing their sexual orientation. We present a qualitative study based on 182 histories submitted from 161 LG individuals to a Web site. The aim was to explore experiences of closeting among LG persons in Norway. A broad range of strategies was used for closeting, even among individuals who generally considered themselves to be out of the closet. Concealment was enacted by blunt denial, clever avoidance, or subtle vagueness. Other strategies included changing or eliminating the pronoun or name of the partner in ongoing conversations. Context-dependent concealment, differentiating between persons, situations, or arenas, was repeatedly applied for security or convenience. We propose a shift from "being in the closet" to "situated concealment of sexual orientation."
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Affiliation(s)
- Kirsti Malterud
- a Research Unit for General Practice , Uni Research Health , Bergen , Norway
- b Department of Global Public Health and Primary Care , University of Bergen , Bergen , Norway
- c Research Unit for General Practice in Copenhagen , Copenhagen , Denmark
| | - Mari Bjorkman
- a Research Unit for General Practice , Uni Research Health , Bergen , Norway
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Abstract
Access to health care services in Canada has been identified as an urgent priority, and chronic disease has been suggested as the most pressing health concern facing Canadians. Access to services for Canadians living with chronic disease, however, has received little emphasis in the research literature or in health policy reform documents. A systematic review of research into factors impeding or facilitating access to formal health services for people in Canada living with chronic illness is presented. The review includes 31 studies of Canadian populations published between 1990 and 2002; main results were analyzed for facilitators and barriers to access for people experiencing chronic disease. An underlying organizing construct of symmetry between consumers, providers, and the larger Canadian system is suggested as a relevant lens from which to view the findings. Finally, a discussion of the relationship between identified factors and the principles of primary health care is offered.
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Lacombe-Duncan A. An Intersectional Perspective on Access to HIV-Related Healthcare for Transgender Women. Transgend Health 2016; 1:137-141. [PMID: 29159304 PMCID: PMC5685282 DOI: 10.1089/trgh.2016.0018] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Transgender women experience decreased access to HIV-related healthcare relative to cisgender people, in part due to pervasive transphobia in healthcare. This perspective describes intersectionality as a salient theoretical approach to understanding this disparity, moving beyond transphobia to explore how intersecting systems of oppression, including cisnormativity, sexism/transmisogyny, classism, racism, and HIV-related, gender nonconformity, substance use, and sex work stigma influence HIV-related healthcare access for transgender women living with HIV. This perspective concludes with a discussion of how intersectionality-informed studies can be enhanced through studying underexplored intersections and bringing attention to women's resiliency and empowerment.
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Affiliation(s)
- Ashley Lacombe-Duncan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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Mulia N. Ironies in the Pursuit of Well-Being: The Perspectives of Low-Income, Substance-Using Women on Service Institutions. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/009145090202900404] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Interest in improving low-income, drug-using women's access to and utilization of care services tends to focus on remedies to personal, structural and gendered barriers to care. In contrast, this exploratory, qualitative study of women's perspectives illustrates how institutional rules, both within and across agencies, and informal provider practices can constrain women's use of health and social services. This paper draws attention to the ways in which low-income, drug-using women respond to obstacles and interpersonal tensions they experience in service settings. As a means of pursuing their material and social well-being, the women employ forms of resistance that are both protective and potentially harmful. This paper underscores the need to recognize how service institutions are implicated in drug users' everyday struggles for well-being.
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Allen JL, Mowbray O. Sexual orientation, treatment utilization, and barriers for alcohol related problems: Findings from a nationally representative sample. Drug Alcohol Depend 2016; 161:323-30. [PMID: 26936411 DOI: 10.1016/j.drugalcdep.2016.02.025] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/02/2016] [Accepted: 02/12/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gay, lesbian, and bisexual (GLB) individuals appear to have an increased likelihood of alcohol use disorders and treatment utilization for alcohol related problems compared to heterosexual individuals. Despite this increase, treatment utilization rates among GLB individuals remain low. In an effort to address this, our paper examined whether or not GLB individuals encounter unique barriers when pursuing treatment for alcohol related problems. METHODS Using data from the National Epidemiologic Survey on Alcohol Related Conditions (NESARC), we examined service sector specific factors, some of which included (a) utilization rates, (b) self-reported treatment barriers, and (c) whether or not there were emergent differences among GLB individuals, after controlling for socio-demographic and clinical characteristics. RESULTS Findings indicated that GLB individuals reported higher severity rates for alcohol use disorders when compared to heterosexual individuals, and were significantly more likely to utilize treatment services for alcohol related problems, however, not across all treatment sectors. While similar patterns were observed when examining barriers to treatment, bisexual individuals reported significantly more barriers than heterosexual and gay/lesbian individuals. CONCLUSION These findings underscored the importance of identifying and developing interventions that addresses treatment barriers associated with alcohol use service utilization among GLB populations, and creating improved outreach and education programs to better address stigmas associated with substance use and sexuality.
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Affiliation(s)
- Junior Lloyd Allen
- School of Social Work, University of Georgia, 279 Williams Street, Athens, GA 30605, United States.
| | - Orion Mowbray
- School of Social Work, University of Georgia, 279 Williams Street, Athens, GA 30605, United States.
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White Hughto JM, Reisner SL, Pachankis JE. Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions. Soc Sci Med 2015; 147:222-31. [PMID: 26599625 PMCID: PMC4689648 DOI: 10.1016/j.socscimed.2015.11.010] [Citation(s) in RCA: 812] [Impact Index Per Article: 90.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 11/05/2015] [Accepted: 11/06/2015] [Indexed: 11/23/2022]
Abstract
RATIONALE Transgender people in the United States experience widespread prejudice, discrimination, violence, and other forms of stigma. OBJECTIVE This critical review aims to integrate the literature on stigma towards transgender people in the U.S. RESULTS This review demonstrates that transgender stigma limits opportunities and access to resources in a number of critical domains (e.g., employment, healthcare), persistently affecting the physical and mental health of transgender people. The applied social ecological model employed here elucidates that transgender stigma operates at multiple levels (i.e., individual, interpersonal, structural) to impact health. Stigma prevention and coping interventions hold promise for reducing stigma and its adverse health-related effects in transgender populations. CONCLUSION Additional research is needed to document the causal relationship between stigma and adverse health as well as the mediators and moderators of stigma in US transgender populations. Multi-level interventions to prevent stigma towards transgender people are warranted.
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Affiliation(s)
- Jaclyn M White Hughto
- Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, CT, USA; The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Sari L Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA; Division of General Pediatrics, Children's Hospital/Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - John E Pachankis
- Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, CT, USA
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Chambers LA, Rueda S, Baker DN, Wilson MG, Deutsch R, Raeifar E, Rourke SB. Stigma, HIV and health: a qualitative synthesis. BMC Public Health 2015; 15:848. [PMID: 26334626 PMCID: PMC4557823 DOI: 10.1186/s12889-015-2197-0] [Citation(s) in RCA: 201] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 08/27/2015] [Indexed: 11/10/2022] Open
Abstract
Background HIV-related stigma continues to negatively impact the health and well-being of people living with HIV, with deleterious effects on their care, treatment and quality of life. A growing body of qualitative research has documented the relationship between HIV-related stigma and health. This review aims to synthesize qualitative evidence that explored the intersections of stigma and health for people with HIV. Methods A thematic summary was conducted that was guided by the qualitative metasummary technique developed by Sandelowski and Barraso. Literature searches yielded 8,622 references of which 55 qualitative studies were identified that illustrated HIV-related stigma in the context of health. Results The metasummary classified qualitative findings into three overarching categories: conceptualizing stigma which identified key dimensions of HIV-related stigma; experiencing stigma which highlighted experiences of stigma in the health context, and managing stigma which described ways in which stigma is avoided or addressed. To better illustrate these connections, the qualitative literature was summarized into the following themes: stigma within health care settings, the role of stigma in caring for one’s health, and strategies to address HIV-related stigma in the health context. A number of health care practices were identified – some rooted in institutional practices, others shaped by personal perceptions held by practitioners – that could be stigmatizing or discriminatory towards people with HIV. There existed interconnections between enacted stigma and felt stigma that influenced health care utilization, treatment adherence, and overall health and well-being of people with HIV. Intersectional stigma also emerged as instrumental in the stigma experiences of people living with HIV. A number of strategies to address stigma were identified including social support, education, self-efficacy, resilience activities, and advocacy. Conclusion This review of the qualitative evidence indicates that HIV-related stigma within health contexts is a broad social phenomenon that manifests within multiple social spheres, including health care environments. Findings from this review indicate that future stigma research should consider the social structures and societal practices – within and outside of health care environments – that perpetuate and reinforce stigma and discrimination towards people with HIV. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2197-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lori A Chambers
- School of Social Work, McMaster University, Kenneth Taylor Hall, KTH-319, 1280 Main St. West, Hamilton, ON, L8S 4M4, Canada.
| | - Sergio Rueda
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, c/o Research Services Office, 33 Russell St., T100, Toronto, ON, M5S 2S1, Canada. .,Department of Psychiatry, University of Toronto, 250 College St., 8th floor, Toronto, ON, M5T 1R8, Canada. .,Institute for Work & Health, 481 University Ave., Suite 800, Toronto, ON, M5G 2E9, Canada.
| | - D Nico Baker
- Ontario HIV Treatment Network, 1300 Yonge St., Suite 600, Toronto, ON, M4T 1X3, Canada.
| | - Michael G Wilson
- Ontario HIV Treatment Network, 1300 Yonge St., Suite 600, Toronto, ON, M4T 1X3, Canada. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, Communications Research Laboratory, CRL-209, 1280 Main St. West, Hamilton, ON, L8S 4M4, Canada. .,Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4M4, Canada. .,McMaster Health Forum, McMaster University, Mills Memorial Library, MML-417, 1280 Main St. West, Hamilton, ON, L8S 4M4, Canada.
| | - Rachel Deutsch
- Ontario HIV Treatment Network, 1300 Yonge St., Suite 600, Toronto, ON, M4T 1X3, Canada.
| | - Elmira Raeifar
- Department of Psychiatry, Weill Cornell Medical College, 21 Bloomingdale Rd., White Plains, NY, 10605, USA.
| | - Sean B Rourke
- Department of Psychiatry, University of Toronto, 250 College St., 8th floor, Toronto, ON, M5T 1R8, Canada. .,Ontario HIV Treatment Network, 1300 Yonge St., Suite 600, Toronto, ON, M4T 1X3, Canada. .,Centre for Research on Inner City Health, The Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria St, Toronto, ON, M5B 1 T8, Canada.
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- Ontario HIV Treatment Network, 1300 Yonge St., Suite 600, Toronto, ON, M4T 1X3, Canada
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Beach MC, Roter DL, Saha S, Korthuis PT, Eggly S, Cohn J, Sharp V, Moore RD, Wilson IB. Impact of a brief patient and provider intervention to improve the quality of communication about medication adherence among HIV patients. PATIENT EDUCATION AND COUNSELING 2015; 98:1078-83. [PMID: 26021185 PMCID: PMC4546873 DOI: 10.1016/j.pec.2015.05.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 04/13/2015] [Accepted: 05/14/2015] [Indexed: 05/10/2023]
Abstract
INTRODUCTION Medication adherence is essential in HIV care, yet provider communication about adherence is often suboptimal. We designed this study to improve patient-provider communication about HIV medication adherence. METHODS We randomized 26 providers at three HIV care sites to receive or not receive a one-hour communication skills training based on motivational interviewing principles applied to medication adherence. Prior to routine office visits, non-adherent patients of providers who received the training were coached to discuss adherence with their providers. Patients of providers who did not receive the training providers were not coached. We audio-recorded and coded patient-provider interactions using the roter interaction analysis system (RIAS). RESULTS There was more dialogue about therapeutic regimen in visits with intervention patients and providers (167 vs 128, respectively, p=.004), with the majority of statements coming from providers. These visits also included more brainstorming solutions to nonadherence (41% vs. 22%, p=0.026). Intervention compared with control visit providers engaged in more positive talk (44 vs. 38 statements, p=0.039), emotional talk (26 vs. 18 statements, p<0.001), and probing of patient opinion (3 vs. 2 statements, p=0.009). CONCLUSION A brief provider training combined with patient coaching sessions, improved provider communication behaviors and increased dialogue regarding medication adherence.
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Affiliation(s)
- Mary Catherine Beach
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, USA; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, USA; Department of Health, Behavior & Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA; Welch Center for Prevention, Epidemiology and Clinical Research, USA.
| | - Debra L Roter
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, USA; Department of Health, Behavior & Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Somnath Saha
- Portland VA Medical Center, Portland, USA; Department of Medicine, Oregon Health Sciences University, Portland, USA
| | - P Todd Korthuis
- Department of Medicine, Oregon Health Sciences University, Portland, USA
| | - Susan Eggly
- Department of Medicine, Wayne State University, Detroit, USA
| | - Jonathan Cohn
- Department of Medicine, Wayne State University, Detroit, USA
| | | | - Richard D Moore
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, USA; Department of Health, Behavior & Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Ira B Wilson
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, USA
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Bosse JD, Nesteby JA, Randall CE. Integrating Sexual Minority Health Issues into a Health Assessment Class. J Prof Nurs 2015; 31:498-507. [PMID: 26653044 DOI: 10.1016/j.profnurs.2015.04.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Indexed: 10/23/2022]
Abstract
The health needs of the lesbian, gay, bisexual, and transgender (LGBT) population are traditionally overlooked by the health care community and are rendered invisible by most nursing school curricula. Initial contact with a nurse during a health history and assessment can have an impact on whether the person will feel comfortable disclosing his or her identity, returning for services, or following plans of care. Because the first interaction with a nurse can be critical, the health assessment course is an appropriate place in the curriculum to discuss the needs of the LGBT community. This article includes a discussion of unique health risks to the LGBT population, benefits, and challenges of incorporating these issues into the classroom and recommendations for including the care of this population into a health assessment nursing course. Specific communication techniques are provided that may be helpful during history taking and physical examination with a patient who is LGBT. Guidance regarding physical examination of the transgender patient is also included. These suggestions will be helpful to nurse faculty who teach health assessment, nursing students, educators who design and implement professional development and continuing education for established nurses, preceptors in the clinical setting, and any nurse who is unfamiliar with the needs and concerns specific to the LGBT population.
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Affiliation(s)
- Jordon D Bosse
- Doctoral student, St. Joseph's College of Maine, Standish, ME, 04084..
| | - J Aleah Nesteby
- Nurse Practitioner, Baystate Medical Center, Springfield, MA, 01199..
| | - Carla E Randall
- Doctoral student, St. Joseph's College of Maine, Standish, ME, 04084.; Associate Professor of Nursing, University of Southern Maine, Lewiston-Auburn College, Lewiston, ME, 04240..
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Houston E, Mikrut C, Guy A, Fominaya AW, Tatum AK, Kim JH, Brown A. Another look at depressive symptoms and antiretroviral therapy adherence: The role of treatment self-efficacy. J Health Psychol 2015; 21:2138-47. [PMID: 25712489 DOI: 10.1177/1359105315571976] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Depression has been strongly associated with poor HIV treatment adherence, but little research has explored how individuals manage to follow their regimens despite symptoms of major depression. Using a sample of antiretroviral therapy patients with clinically significant depressive symptoms (n = 84), we examined whether patients with optimal adherence differed from those with suboptimal adherence in terms of the types of depressive symptoms experienced and treatment self-efficacy. There were no significant differences between participants with regard to types of depressive symptoms. Findings indicate that patients with high treatment self-efficacy were more likely to report optimal levels of adherence than patients with low self-efficacy.
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Affiliation(s)
| | | | - Arryn Guy
- Illinois Institute of Technology, USA
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Houston E, Fominaya AW. Antiretroviral therapy adherence in a sample of men with low socioeconomic status: The role of task-specific treatment self-efficacy. PSYCHOL HEALTH MED 2014; 20:896-905. [PMID: 25439192 DOI: 10.1080/13548506.2014.986137] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Disparities continue to persist in HIV care and treatment outcomes among racial/ethnic minorities, men who have sex with men (MSM), and individuals with low socioeconomic status. Much research has identified treatment self-efficacy as a key factor in antiretroviral therapy adherence and subsequent treatment outcomes. Few studies, however, have elaborated on these links and their potential in reducing HIV treatment disparities by examining the role of task-specific types of treatment self-efficacy. In this study, we examined the effect of four types of task-specific treatment self-efficacy on antiretroviral adherence among patients in a predominantly racial/ethnic minority sample of HIV-seropositive MSM with low socioeconomic status. We grouped participants by duration of treatment to determine whether certain types of self-efficacy were more salient based on treatment experience. We found that participants with optimal adherence tended to have higher levels of task-specific self-efficacy related to medication management and mood management than participants with suboptimal adherence. After a Bonferroni correction for multiple comparisons, only task-specific self-efficacy for medication management showed significant effects on adherence. Findings suggest that using focused, task-specific measures of treatment self-efficacy could strengthen our ability to aid patients at risk for adherence difficulties and tailor interventions to more effectively meet their needs.
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Affiliation(s)
- Eric Houston
- a Department of Psychology , Illinois Institute of Technology , Chicago , IL 60616 , USA
| | - Adam W Fominaya
- a Department of Psychology , Illinois Institute of Technology , Chicago , IL 60616 , USA
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Baker K, Beagan B. Making Assumptions, Making Space: An Anthropological Critique of Cultural Competency and Its Relevance to Queer Patients. Med Anthropol Q 2014; 28:578-98. [DOI: 10.1111/maq.12129] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kelly Baker
- Department of Anthropology; Western University
| | - Brenda Beagan
- School of Occupational Therapy; Dalhousie University
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Hagen DB, Galupo MP. Trans*Individuals’ Experiences of Gendered Language with Health Care Providers: Recommendations for Practitioners. Int J Transgend 2014. [DOI: 10.1080/15532739.2014.890560] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Assefa Y, Lynen L, Wouters E, Rasschaert F, Peeters K, Van Damme W. How to improve patient retention in an antiretroviral treatment program in Ethiopia: a mixed-methods study. BMC Health Serv Res 2014; 14:45. [PMID: 24475889 PMCID: PMC3915035 DOI: 10.1186/1472-6963-14-45] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 01/24/2014] [Indexed: 11/24/2022] Open
Abstract
Background Patient retention, defined as continuous engagement of patients in care, is one of the crucial indicators for monitoring and evaluating the performance of antiretroviral treatment (ART) programs. It has been identified that suboptimal patient retention in care is one of the challenges of ART programs in many settings. ART programs have, therefore, been striving hard to identify and implement interventions that improve their suboptimal levels of retention. The objective of this study was to develop a framework for improving patient retention in care based on interventions implemented in health facilities that have achieved higher levels of retention in care. Methods A mixed-methods study, based on the positive deviance approach, was conducted in Ethiopia in 2011/12. Quantitative data were collected to estimate and compare the levels of retention in care in nine health facilities. Key informant interviews and focus group discussions were conducted to identify a package of interventions implemented in the health facilities with relatively higher or improving levels of retention. Results Retention in care in the Ethiopian ART program was found to be variable across health facilities. Among hospitals, the poorest performer had 0.46 (0.35, 0.60) times less retention than the reference; among health centers, the poorest performers had 0.44 (0.28, 0.70) times less retention than the reference. Health facilities with higher and improving patient retention were found to implement a comprehensive package of interventions: (1) retention promoting activities by health facilities, (2) retention promoting activities by community-based organizations, (3) coordination of these activities by case manager(s), and (4) patient information systems by data clerk(s). On the contrary, such interventions were either poorly implemented or did not exist in health facilities with lower retention in care. A framework to improve retention in care was developed based on the evidence found by applying the positive deviance approach. Conclusion A framework for improving retention in care of patients on ART was developed. We recommend that health facilities implement the framework, monitor and evaluate their levels of retention in care, and, if necessary, adapt the framework to their own contexts.
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Beagan BL, Chiasson A, Fiske CA, Forseth SD, Hosein AC, Myers MR, Stang JE. Working with transgender clients: learning from physicians and nurses to improve occupational therapy practice. The Canadian Journal of Occupational Therapy 2013; 80:82-91. [PMID: 23926760 DOI: 10.1177/0008417413484450] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Gender identity disorder and the process of transitioning involve both mental and physical health, yet there is virtually no discussion of transgender health care in occupational therapy. PURPOSE This study draws on interviews with primary-care nurses and physicians about their experience with transgender health care, extending the insights gleaned there to make suggestions for occupational therapy practice with this population. METHOD Semi-structured interviews were conducted with 12 primary care nurses and 9 physicians who had clinical experience with lesbian, gay, and bisexual patients. FINDINGS Participants felt uncertain about transgender care, wanting more specialized knowledge. Collaborating with patients, acknowledging stigma, ensuring inclusive systems and procedures, navigating health care, and providing holistic care emerged as key elements for best practice. Advocacy was a crucial part of care provision. IMPLICATIONS Suggestions are provided for therapists to ensure that space and interactions are welcoming to transgender clients as well as suggestions for occupational therapy intervention in the transitioning process.
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Affiliation(s)
- Brenda L Beagan
- School of Occupational Therapy, Dalhousie University, 5869 University Avenue, Forrest Building, Room 215, P.O. Box 15000, Halifax, Nova Scotia, Canada B3H 4R2.
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Assefa Y, Worku A, Wouters E, Koole O, Haile Mariam D, Van Damme W. Simplified tools for measuring retention in care in antiretroviral treatment program in Ethiopia: cohort and current retention in care. PLoS One 2012; 7:e38555. [PMID: 22701663 PMCID: PMC3372511 DOI: 10.1371/journal.pone.0038555] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 05/09/2012] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Patient retention in care is a critical challenge for antiretroviral treatment programs. This is mainly because retention in care is related to adherence to treatment and patient survival. It is therefore imperative that health facilities and programs measure patient retention in care. However, the currently available tools, such as Kaplan Meier, for measuring retention in care have a lot of practical limitations. The objective of this study was to develop simplified tools for measuring retention in care. METHODS Retrospective cohort data were collected from patient registers in nine health facilities in Ethiopia. Retention in care was the primary outcome for the study. Tools were developed to measure "current retention" in care during a specific period of time for a specific "ART-age group" and "cohort retention" in care among patients who were followed for the last "Y" number of years on ART. "Probability of retention" based on the tool for "cohort retention" in care was compared with "probability of retention" based on Kaplan Meier. RESULTS We found that the new tools enable to measure "current retention" and "cohort retention" in care. We also found that the tools were easy to use and did not require advanced statistical skills. Both "current retention" and "cohort retention" are lower among patients in the first two "ART-age groups" and "ART-age cohorts" than in subsequent "ART-age groups" and "ART-age cohorts". The "probability of retention" based on the new tools were found to be similar to the "probability of retention" based on Kaplan Meier. CONCLUSION The simplified tools for "current retention" and "cohort retention" will enable practitioners and program managers to measure and monitor rates of retention in care easily and appropriately. We therefore recommend that health facilities and programs start to use these tools in their efforts to improve retention in care and patient outcomes.
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Affiliation(s)
- Yibeltal Assefa
- Federal HIV/AIDS Prevention and Control Office, Addis Ababa, Ethiopia.
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Affiliation(s)
- Ruth P McNair
- Northside Clinic, Melbourne, VIC
- Department of General Practice, University of Melbourne, Melbourne, VIC
| | - Tonda L Hughes
- Department of Health Systems Science, College of Nursing, University of Illinois, Chicago, Ill, USA
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