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Mathieu J, Roy K, Robert MÈ, Akeblersane M, Descarreaux M, Marchand AA. Sociodemographic determinants of health inequities in low back pain: a narrative review. Front Public Health 2024; 12:1392074. [PMID: 39324158 PMCID: PMC11422063 DOI: 10.3389/fpubh.2024.1392074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 08/29/2024] [Indexed: 09/27/2024] Open
Abstract
Background Health equity is defined as the absence of unjust and avoidable disparities in access to healthcare, quality of care, or health outcomes. The World Health Organization (WHO) has developed a conceptual framework that outlines the main causes of health inequalities and how these contribute to health inequities within a population. Despite the WHO implementing health equity policies to ensure accessibility and quality of healthcare services, disparities persist in the management of patients suffering from low back pain (LBP). The objective of this study was to review the existing evidence on the impact of health inequities on the care trajectories and treatments provided to individuals with LBP. Methods A narrative review was performed, which included a literature search without language and study design restrictions in MEDLINE Ovid database, from January 1, 2000, to May 15, 2023. Search terms included free-text words for the key concepts of "low back pain," "health inequities," "care pathways," and "sociodemographic factors." Results Studies have revealed a statistically significant association between the prevalence of consultations for LBP and increasing age. Additionally, a significant association between healthcare utilization and gender was found, revealing that women were more likely to seek medical attention for LBP compared to men. Furthermore, notable disparities related to race and ethnicity were identified, more specifically in opioid prescriptions, spinal surgery recommendations, and access to complementary and alternative medical approaches for LBP. A cross-sectional analysis found that non-Hispanic White individuals with chronic LBP were more likely to be prescribed one or more pharmacological treatments. Lower socioeconomic status and level of education, as well as living in lower-income areas were also found to be associated with greater risks of receiving non-guideline concordant care, including opioid and MRI prescriptions, before undergoing any conservative treatments. Conclusion Persistent inequalities related to sociodemographic determinants significantly influence access to care and care pathways of patients suffering from LBP, underscoring the need for additional measures to achieve equitable health outcomes. Efforts are needed to better understand the needs and expectations of patients suffering from LBP and how their individual characteristics may affect their utilization of healthcare services.
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Affiliation(s)
- Janny Mathieu
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Kamille Roy
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Marie-Ève Robert
- Faculty of Medecine, Université de Montréal, Montréal, QC, Canada
| | - Meriem Akeblersane
- School of Medicine, Royal College of Surgeons in Ireland Bahrain, Busaiteen, Bahrain
| | - Martin Descarreaux
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Andrée-Anne Marchand
- Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
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Labaka A, Zamakola A, Arrue M, Arrieta H. Evaluating gender awareness, gender-related health knowledge and patient pain legitimation among nursing students: A quasi-experimental study. Nurse Educ Pract 2023; 72:103790. [PMID: 37769494 DOI: 10.1016/j.nepr.2023.103790] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/12/2023] [Accepted: 09/23/2023] [Indexed: 10/03/2023]
Abstract
The aim of the study was to measure the associations between and the evolution of gender awareness, gender-related health knowledge and patient pain legitimation among nursing students. BACKGROUND Evidence indicates that gender equity skills are still lacking among nurses. Indeed, several studies report gender-biased patient assessment and care, arguing that greater attention should be paid to the gender perspective at university, in order to train nurses who are sensitive to this issue. Recently, certain gender perspective measurement scales have been adapted to the nursing population, offering new opportunities for the educational field. DESIGN A quasi-experimental study was used for this study. METHODS This study was conducted in the second semester of the first year of the Nursing Degree run by the University of the Basque Country. A sample of 103 students enrolled in the Anthropology, Ethics and Legislation module completed the Nijmegen Gender Awareness in Medicine Scale, the Pain Legitimation Scale and the Gender Perspective Health Knowledge Scale before and after the second semester, during which part of the syllabus focused on developing gender equity skills. Data were collected between January - April 2022. RESULTS We found positive correlations between gender-related health knowledge and pain legitimation at post-test, and between said knowledge and gender sensitivity at both pre- and post-test (p < 0.05). The repeated measures indicated that traditional expositive teaching did not increase overall scores for gender awareness, gender-related health knowledge or pain legitimation. CONCLUSIONS The results suggest that gender-related health knowledge may be a key modifiable factor that leads to enhanced gender awareness in dealings with patients. However, traditional expositive lectures were not enough to produce a robust increase in gender awareness, pain legitimation or gender-related health knowledge levels. The effectiveness of active teaching methodologies should be tested, in order to help nursing students strengthen their resistance to clinical gender stereotypes and become active assets in the move from inequality to equity.
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Affiliation(s)
- Ainitze Labaka
- Department of Nursing II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Begiristain Doktorea Pasealekua 105, E-20014 Donostia-San Sebastián, Gipuzkoa, Spain
| | - Asier Zamakola
- Department of Nursing II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Begiristain Doktorea Pasealekua 105, E-20014 Donostia-San Sebastián, Gipuzkoa, Spain
| | - Marta Arrue
- Department of Nursing II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Begiristain Doktorea Pasealekua 105, E-20014 Donostia-San Sebastián, Gipuzkoa, Spain
| | - Haritz Arrieta
- Department of Nursing II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Begiristain Doktorea Pasealekua 105, E-20014 Donostia-San Sebastián, Gipuzkoa, Spain; Biodonostia Health Research Institute, Breast Cancer Group, Begiristain Doktorea Pasealekua s/n, E-20014 Donostia-San Sebastián, Gipuzkoa, Spain.
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Van Alboom M, Baert F, Bernardes SF, Bracke P, Goubert L. Public Chronic Pain Stigma and the Role of Pain Type and Patient Gender: An Experimental Vignette Study. THE JOURNAL OF PAIN 2023; 24:1798-1812. [PMID: 37196927 DOI: 10.1016/j.jpain.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/06/2023] [Accepted: 05/07/2023] [Indexed: 05/19/2023]
Abstract
Research exploring the specific manifestations of chronic pain (CP) public stigma is scarce. One potential factor influencing public stigma manifestations may be the CP type, that is, the presence (secondary CP) or absence (primary CP) of a clearly identifiable pathophysiology. Furthermore, patient gender may play a key role, whereby pain-related gender stereotypes may evoke distinct gender role expectations towards men and women experiencing CP. The aim of the research was 2-fold. First, by means of an experimental vignette design, the general population's cognitive, affective, and behavioral responses were investigated, both towards primary versus secondary CP and towards men versus women. Second, a potential interaction was examined between CP type and patient gender. The research is divided into 2 separate samples: individuals with CP (N = 729) and individuals without CP (N = 283). Factorial ANOVA models were estimated with CP type, patient gender, and participant gender included as factors, age as control variable. The findings support, partly, the general hypothesis of higher (perceived) public stigma towards individuals with primary (vs secondary) CP. No main effects of patient gender were observed. Gender bias in stigmatizing manifestations only emerged in certain contextual circumstances (ie, pain type and participant gender). Different interaction effects (with a combination of gender, patient gender, or CP type) were significant for the distinctive outcome variables. Interestingly, throughout the findings, different patterns of results are found in both samples. The study contributes to the literature on CP stigma, as well as the psychometric examination of items assessing stigmatizing manifestations. PERSPECTIVE: This study examined the role of contextual factors chronic pain type and patient gender into cognitive, affective, and behavioral stigmatizing manifestations coming from the general population towards individuals with chronic pain through an experimental vignette study. The study contributes to the chronic pain stigma literature, as well as the psychometric examination of items assessing stigmatizing manifestations.
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Affiliation(s)
- Maité Van Alboom
- Ghent University, Faculty of Psychology and Educational Sciences, Department of Experimental-Clinical and Health Psychology, Ghent, Belgium.
| | - Fleur Baert
- Ghent University, Faculty of Psychology and Educational Sciences, Department of Experimental-Clinical and Health Psychology, Ghent, Belgium
| | - Sónia F Bernardes
- ISCTE, University Institute of Lisbon, School of Social Sciences, Department of Social and Organizational Psychology, Lisboa, Portugal
| | - Piet Bracke
- Ghent University, Faculty of Political and Social Sciences, Department of Sociology, Ghent, Belgium
| | - Liesbet Goubert
- Ghent University, Faculty of Psychology and Educational Sciences, Department of Experimental-Clinical and Health Psychology, Ghent, Belgium
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Meidert U, Dönnges G, Bucher T, Wieber F, Gerber-Grote A. Unconscious Bias among Health Professionals: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6569. [PMID: 37623155 PMCID: PMC10454622 DOI: 10.3390/ijerph20166569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Unconscious biases are one of the causes of health disparities. Health professionals have prejudices against patients due to their race, gender, or other factors without their conscious knowledge. This review aimed to provide an overview of research on unconscious bias among health professionals and to investigate the biases that exist in different regions of the world, the health professions that are considered, and the research gaps that still exist. METHODS We conducted a scoping review by systematically searching PubMed/MEDLINE, CINAHL, PsycINFO, PsycARTICLES, and AMED. All records were double-screened and included if they were published between 2011 and 2021. RESULTS A total of 5186 records were found. After removing duplicates (n = 300), screening titles and abstracts (n = 4210), and full-text screening (n = 695), 87 articles from 81 studies remained. Studies originated from North America (n = 60), Europe (n = 13), and the rest of the world (n = 6), and two studies were of global scope. Racial bias was investigated most frequently (n = 46), followed by gender bias (n = 11), weight bias (n = 10), socio-economic status bias (n = 9), and mental illness bias (n = 7). Most of the studies were conducted by physicians (n = 51) and nurses (n = 20). Other health care professionals were rarely included in these studies. CONCLUSIONS Most studies show that health professionals have an implicit bias. Racial biases among physicians and nurses in the USA are well confirmed. Research is missing on other biases from other regions and other health professions.
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Affiliation(s)
- Ursula Meidert
- School of Health Sciences, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland; (G.D.); (T.B.); (F.W.); (A.G.-G.)
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Prego-Jimenez S, Pereda-Pereda E, Perez-Tejada J, Aliri J, Goñi-Balentziaga O, Labaka A. The Impact of Sexism and Gender Stereotypes on the Legitimization of Women's Low Back Pain. Pain Manag Nurs 2022; 23:591-595. [DOI: 10.1016/j.pmn.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 11/28/2022]
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Bernardes SF, Tomé-Pires C, Brandão T, Campos L, Teixeira F, Goubert L. Classism in pain assessment and management: the mediating role of female patient dehumanization and perceived life hardship. Pain 2021; 162:2854-2864. [PMID: 33769369 DOI: 10.1097/j.pain.0000000000002278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/09/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Compared with racism and sexism, classism in pain assessment and management practices (PAMPs) has been less investigated, and its mediating mechanisms are still unknown. Drawing on a social psychological model of dehumanization, this research aimed to test (1) the effect of patient socioeconomic status (SES; a proxy of social class) on PAMPs and (2) whether patient dehumanization and perceived life hardship mediated these effects. Two online experimental studies were conducted, in which patient SES was manipulated (low vs high) within-subjects. One-hundred sixty-two female medical students (study 1) and 105 female nurses (study 2) were presented with vignettes/images depicting 2 cases of women with chronic low-back pain, followed by videos of them performing a pain-inducing movement. Participants reported on patient dehumanization, perceived life hardship, and PAMPs. The low SES patient was perceived as less pain sensitive (medical students alone) but more disabled, credible, and her pain more attributed to psychological causes (by nurses alone). Medical students recommended less nonpharmacological treatments but prescribed slightly stronger medication. Medical students were less willing to provide individualized care to the low SES patient, whereas nurses showed the opposite pattern. Patient mechanistic dehumanization mediated SES effects on pain disability (medical students alone). Perceived life hardship mediated SES effects on pain disability, credibility (nurses alone), and intentions of providing individualized care (nurses alone). These finding bear novel contributions to the fields of pain, health service research, and social psychology and have important implications to the development of more effective future interventions to reduce classism in PAMPs.
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Affiliation(s)
- Sónia F Bernardes
- Iscte-Instituto Universitário de Lisboa, Centro de Investigação e Intervenção Social, Lisbon, Portugal
| | - Catarina Tomé-Pires
- CIP-Centro de Investigação em Psicologia, Universidade Autónoma de Lisboa, Lisbon, Portugal
| | - Tânia Brandão
- CIP-Centro de Investigação em Psicologia, Universidade Autónoma de Lisboa, Lisbon, Portugal
| | - Lúcia Campos
- Instituto de Ciências Sociais, Universidade de Lisboa, Lisbon, Portugal
| | - Filipa Teixeira
- Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Liesbet Goubert
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
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Brandão T, Campos L, de Ruddere L, Goubert L, Bernardes SF. Classism in Pain Care: The Role of Patient Socioeconomic Status on Nurses’ Pain Assessment and Management Practices. PAIN MEDICINE 2019; 20:2094-2105. [DOI: 10.1093/pm/pnz148] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objective
Research on social disparities in pain care has been mainly focused on the role of race/racism and sex/sexism. Classism in pain assessment and management practices has been much less investigated. We aimed to test the effect of patient socioeconomic status (SES; a proxy of social class) on nurses’ pain assessment and management practices and whether patient SES modulated the effects of patient distress and evidence of pathology on such practices.
Design
Two experimental studies with a two (patient SES: low/high) by two (patient distress or evidence of pathology: absent/present) between-subject design.
Subjects
Female nurses participated in two experimental studies (N = 150/N = 158).
Methods
Nurses were presented with a vignette/picture depicting the clinical case of a female with chronic low back pain, followed by a video of the patient performing a pain-inducing movement. Afterwards, nurses reported their pain assessment and management practices.
Results
The low-SES patient’s pain was assessed as less intense, more attributed to psychological factors, and considered less credible (in the presence of distress cues) than the higher-SES patient’s pain. Higher SES buffered the detrimental impact of the presence of distress cues on pain assessment. No effects were found on management practices.
Conclusions
Our findings point to the potential buffering role of SES against the detrimental effect of certain clinical cues on pain assessments. This study contributes to highlighting the need for further investigation of the role of SES/social class on pain care and its underlying meanings and processes.
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Affiliation(s)
- Tânia Brandão
- CIP, Departamento de Psicologia, Universidade Autónoma de Lisboa, Lisboa, Portugal
| | - Lúcia Campos
- ISCTE-Instituto Universitário de Lisboa (ISCTE-IUL), Centro de Investigação e Intervenção Social (CIS-IUL), Lisboa, Portugal
| | - Lies de Ruddere
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Liesbet Goubert
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Sónia F Bernardes
- ISCTE-Instituto Universitário de Lisboa (ISCTE-IUL), Centro de Investigação e Intervenção Social (CIS-IUL), Lisboa, Portugal
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"Brave Men" and "Emotional Women": A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain. Pain Res Manag 2018; 2018:6358624. [PMID: 29682130 PMCID: PMC5845507 DOI: 10.1155/2018/6358624] [Citation(s) in RCA: 317] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/13/2018] [Accepted: 01/21/2018] [Indexed: 02/08/2023]
Abstract
Background Despite the large body of research on sex differences in pain, there is a lack of knowledge about the influence of gender in the patient-provider encounter. The purpose of this study was to review literature on gendered norms about men and women with pain and gender bias in the treatment of pain. The second aim was to analyze the results guided by the theoretical concepts of hegemonic masculinity and andronormativity. Methods A literature search of databases was conducted. A total of 77 articles met the inclusion criteria. The included articles were analyzed qualitatively, with an integrative approach. Results The included studies demonstrated a variety of gendered norms about men's and women's experience and expression of pain, their identity, lifestyle, and coping style. Gender bias in pain treatment was identified, as part of the patient-provider encounter and the professional's treatment decisions. It was discussed how gendered norms are consolidated by hegemonic masculinity and andronormativity. Conclusions Awareness about gendered norms is important, both in research and clinical practice, in order to counteract gender bias in health care and to support health-care professionals in providing more equitable care that is more capable to meet the need of all patients, men and women.
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Hirsh AT, Hollingshead NA, Matthias MS, Bair MJ, Kroenke K. The Influence of Patient Sex, Provider Sex, and Sexist Attitudes on Pain Treatment Decisions. THE JOURNAL OF PAIN 2014; 15:551-9. [DOI: 10.1016/j.jpain.2014.02.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 01/20/2014] [Accepted: 02/11/2014] [Indexed: 10/25/2022]
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Bernardes SF, Costa M, Carvalho H. Engendering Pain Management Practices: The Role of Physician Sex on Chronic Low-Back Pain Assessment and Treatment Prescriptions. THE JOURNAL OF PAIN 2013; 14:931-40. [DOI: 10.1016/j.jpain.2013.03.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 03/06/2013] [Accepted: 03/11/2013] [Indexed: 10/26/2022]
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