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Cortés DE, Progovac AM, Lu F, Lee E, Tran NM, Moyer MA, Odayar V, Rodgers CRR, Adams L, Chambers V, Delman J, Delman D, de Castro S, Sánchez Román MJ, Kaushal NA, Creedon TB, Sonik RA, Rodriguez Quinerly C, Nakash O, Moradi A, Abolaban H, Flomenhoft T, Nabisere R, Mann Z, Shu-Yeu Hou S, Shaikh FN, Flores MW, Jordan D, Carson N, Carle AC, Cook BL, McCormick D. Eliciting patient past experiences of healthcare discrimination as a potential pathway to reduce health disparities: A qualitative study of primary care staff. Health Serv Res 2024:e14373. [PMID: 39192536 DOI: 10.1111/1475-6773.14373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024] Open
Abstract
OBJECTIVE To understand whether and how primary care providers and staff elicit patients' past experiences of healthcare discrimination when providing care. DATA SOURCES/STUDY SETTING Twenty qualitative semi-structured interviews were conducted with healthcare staff in primary care roles to inform future interventions to integrate data about past experiences of healthcare discrimination into clinical care. STUDY DESIGN Qualitative study. DATA COLLECTION/EXTRACTION METHODS Data were collected via semi-structured qualitative interviews between December 2018 and January 2019, with health care staff in primary care roles at a hospital-based clinic within an urban safety-net health system that serves a patient population with significant racial, ethnic, and linguistic diversity. PRINCIPAL FINDINGS Providers did not routinely, or in a structured way, elicit information about past experiences of healthcare discrimination. Some providers believed that information about healthcare discrimination experiences could allow them to be more aware of and responsive to their patients' needs and to establish more trusting relationships. Others did not deem it appropriate or useful to elicit such information and were concerned about challenges in collecting and effectively using such data. CONCLUSIONS While providers see value in eliciting past experiences of discrimination, directly and systematically discussing such experiences with patients during a primary care encounter is challenging for them. Collecting this information in primary care settings will likely require implementation of multilevel systematic data collection strategies. Findings presented here can help identify clinic-level opportunities to do so.
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Affiliation(s)
- Dharma E Cortés
- Harvard Medical School, Boston, Massachusetts and Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - Ana M Progovac
- Harvard Medical School, Boston, Massachusetts and Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - Frederick Lu
- Warren Alpert Medical School of Brown University, Brown University Health, Providence, Rhode Island, USA
| | - Esther Lee
- University of Michigan, School of Public Health, Ann Arbor, Michigan, USA
| | | | | | - Varshini Odayar
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - Caryn R R Rodgers
- Department of Pediatrics and Department of Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Leslie Adams
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Valeria Chambers
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | | | | | | | | | | | | | | | | | - Ora Nakash
- Smith College School for Social Work, Northampton, Massachusetts, USA
| | - Afsaneh Moradi
- Blair Athol Medical Clinic, Adelaide, South Australia, Australia
| | - Heba Abolaban
- Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | | | - Ruth Nabisere
- Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - Ziva Mann
- Ascent Leadership Networks, New York, New York, USA
| | - Sherry Shu-Yeu Hou
- Public Policy and Population Health Observatory, McGill University, Montreal, Quebec, Canada
| | - Farah N Shaikh
- Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - Michael W Flores
- Harvard Medical School, Boston, Massachusetts and Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - Dierdre Jordan
- Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - Nicholas Carson
- Harvard Medical School, Boston, Massachusetts and Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - Adam C Carle
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, University of Cincinnati College of Arts and Sciences, Cincinnati, Ohio, USA
| | - Benjamin Lé Cook
- Harvard Medical School, Boston, Massachusetts and Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts, USA
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So M, Sedarski E, Parries M, Sick B. "Many people know nothing about us": narrative medicine applications at a student-run free clinic. J Interprof Care 2023; 37:1018-1026. [PMID: 37293751 DOI: 10.1080/13561820.2023.2218885] [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: 10/03/2022] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 06/10/2023]
Abstract
Narrative medicine is an approach to healthcare that acknowledges the stories of patients' lives both within and beyond the clinical setting. Narrative medicine has been increasingly recognized as a promising tool to support modern educational needs in health professions training, such as interprofessional practice, while enhancing quality of care. Here, we describe the development, implementation, and application of a narrative medicine program at the University of Minnesota Phillips Neighborhood Clinic. First, in a qualitative analysis of patient stories (n = 12) we identified themes regarding the value of the storytelling experience; patients' personal journeys; and patients' experiences in healthcare and other systems. Second, an interprofessional educational activity for student volunteers (n = 57) leveraging a patient narrative was observed to be satisfactory, significantly improve attitudes toward the underserved, and enhance quality of care from the perspectives of trainees. Together, findings from the two studies imply the potential benefits of broader incorporation of narrative medicine into interprofessional service settings, for both learners and patients.
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Affiliation(s)
- Marvin So
- LifeLong Medical Care, William Jenkins Health Center, Richmond, California, US
- University of Minnesota Medical School, Minneapolis, Minnesota, US
| | - Emma Sedarski
- University of Minnesota College of Pharmacy, Minneapolis, Minnesota, US
| | - Megan Parries
- University of Minnesota College of Pharmacy, Minneapolis, Minnesota, US
| | - Brian Sick
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, US
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York JA, Valvano M, Hughes F, Sternke LM, Lauerer JA, Baker JA, Edlund B, Reich K, Pope C. Nursing leadership and influence in practice domains at a Veterans Affairs Health Care System. Nurs Outlook 2023; 71:101937. [PMID: 36965357 DOI: 10.1016/j.outlook.2023.101937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 02/04/2023] [Accepted: 02/04/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND Studies in Veteran populations have examined disparities in health service use, care quality, outcomes and increased demands for behavioral health. PURPOSE The purpose is to describe the development of nursing leadership roles that influenced practice improvements and demonstrated outcomes related to health disparities in a Veterans Affairs (VA) population over a 12-year period. METHODS The Sundean and colleagues' concept analysis of nurse leadership influence was applied to frame the initiative process and impacts. DISCUSSION Antecedents and processes that facilitated leadership development included mentorship, disparities expertise, partnerships, consultation, scholarship, dissemination, advocacy, education, and strong coauthor collaboration. Improvements and outcomes included access to services, improved health indicators, tools, workforce, funding, innovations, and nurse investigator studies, consistent with VA priorities and policy related to disparities and equity. Limitations and barriers were addressed. CONCLUSION This initiative models' strategies to increase nurse leadership in health equity and care transformation in health systems and community practices.
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Affiliation(s)
- Janet A York
- Ralph H. Johnson VAHCS, Charleston, SC; College of Nursing, Medical University of South Carolina, Charleston, SC; Even Health, Baltimore, Maryland.
| | - Mary Valvano
- Ralph H. Johnson VAHCS, Charleston, SC; Lyons VAHCS, Lyons, NJ
| | - Frederica Hughes
- Ralph H. Johnson VAHCS, Charleston, SC; College of Nursing, Medical University of South Carolina, Charleston, SC
| | - Lisa Marie Sternke
- Ralph H. Johnson VAHCS, Charleston, SC; College of Nursing, Medical University of South Carolina, Charleston, SC
| | - Joy A Lauerer
- College of Nursing, Medical University of South Carolina, Charleston, SC
| | | | - Barbara Edlund
- College of Nursing, Medical University of South Carolina, Charleston, SC; College of Nursing, Auburn University at Montgomery, Montgomery, AL
| | | | - Charlene Pope
- Ralph H. Johnson VAHCS, Charleston, SC; College of Nursing, Medical University of South Carolina, Charleston, SC; College of Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, SC
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4
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Hamed S, Bradby H, Ahlberg BM, Thapar-Björkert S. Racism in healthcare: a scoping review. BMC Public Health 2022; 22:988. [PMID: 35578322 PMCID: PMC9112453 DOI: 10.1186/s12889-022-13122-y] [Citation(s) in RCA: 82] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Racism constitutes a barrier towards achieving equitable healthcare as documented in research showing unequal processes of delivering, accessing, and receiving healthcare across countries and healthcare indicators. This review summarizes studies examining how racism is discussed and produced in the process of delivering, accessing and receiving healthcare across various national contexts. METHOD The PRISMA guidelines for scoping reviews were followed and databases were searched for peer reviewed empirical articles in English across national contexts. No starting date limitation was applied for this review. The end date was December 1, 2020. The review scoped 213 articles. The results were summarized, coded and thematically categorized in regards to the aim. RESULTS The review yielded the following categories: healthcare users' experiences of racism in healthcare; healthcare staff's experiences of racism; healthcare staff's racial attitudes and beliefs; effects of racism in healthcare on various treatment choices; healthcare staff's reflections on racism in healthcare and; antiracist training in healthcare. Racialized minorities experience inadequate healthcare and being dismissed in healthcare interactions. Experiences of racism are associated with lack of trust and delay in seeking healthcare. Racialized minority healthcare staff experience racism in their workplace from healthcare users and colleagues and lack of organizational support in managing racism. Research on healthcare staff's racial attitudes and beliefs demonstrate a range of negative stereotypes regarding racialized minority healthcare users who are viewed as difficult. Research on implicit racial bias illustrates that healthcare staff exhibit racial bias in favor of majority group. Healthcare staff's racial bias may influence medical decisions negatively. Studies examining healthcare staff's reflections on racism and antiracist training show that healthcare staff tend to construct healthcare as impartial and that healthcare staff do not readily discuss racism in their workplace. CONCLUSIONS The USA dominates the research. It is imperative that research covers other geo-political contexts. Research on racism in healthcare is mainly descriptive, atheoretical, uses racial categories uncritically and tends to ignore racialization processes making it difficult to conceptualize racism. Sociological research on racism could inform research on racism as it theoretically explains racism's structural embeddedness, which could aid in tackling racism to provide good quality care.
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Affiliation(s)
- Sarah Hamed
- Department of Sociology, Uppsala University, Uppsala, Sweden.
| | - Hannah Bradby
- Department of Sociology, Uppsala University, Uppsala, Sweden
| | - Beth Maina Ahlberg
- Department of Sociology, Uppsala University, Uppsala, Sweden.,Skaraborg Institute for Research and Development, Skövde, Sweden
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Galvao TF, Baldin Tiguman GM, Antonio BVR, de Alencar RRFR, Garcia LP, Silva MT. Perceived discrimination in health services and associated factors in Manaus Metropolitan Region, Brazil: a cross-sectional population-based study. ETHNICITY & HEALTH 2022; 27:847-857. [PMID: 32909824 DOI: 10.1080/13557858.2020.1817341] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/23/2020] [Indexed: 06/11/2023]
Abstract
Objectives: Discrimination is the differentiated treatment of individuals due to prejudgments. Discriminatory practices in health care result in negative effects on patients' health. In Brazil, skin color represents the main form of racial discrimination, which may have an impact on the accessibility and quality of health care. The Brazilian Amazon lacks investigations on this topic at the population level. This study aims to estimate the prevalence of perceived discrimination in health services and associated factors in the Manaus Metropolitan Region, state of Amazonas, Brazil.Design: A population-based cross-sectional study was conducted with a probabilistic sample of adults interviewed in 2015. The associated factors were investigated by calculating the prevalence ratio (PR) using Poisson regression with robust variance.Results: A total of 4,001 participants were included. The overall prevalence of perceived discrimination was 12.9% (95% confidence interval [CI]: 11.8-13.9%). When compared to the reference categories, women (PR = 1.43; 95%CI: 1.20-1.70), individuals with brown skin color (Brazilian mixed race; PR = 1.33; 95%CI: 1.04-1.71), people who suffer from hypertension (PR = 1.27;95%CI: 1.03-1.57), and people who frequently used health services (p≤0.03) experienced more discrimination from health professionals.Conclusions: The prevalence of perceived discrimination in health services in Manaus Metropolitan Region is frequent and is associated with ethnic, social and health-related factors. Investments in inclusive public health policies and a better quality of health assistance are required to tackle this problem.
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Affiliation(s)
- Tais Freire Galvao
- Faculty of Pharmaceutical Sciences, University of Campinas, Campinas, Brazil
| | | | | | | | - Leila Posenato Garcia
- Board Directory of Studies and Social Policies, Institute of Applied Economic Research, Brasília, Brazil
| | - Marcus Tolentino Silva
- Post-Graduate Program of Pharmaceutical Sciences, Universidade de Sorocaba, Sorocaba, Brazil
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Johnson TJ. Antiracism, Black Lives Matter, and Critical Race Theory: The ABCs of Promoting Racial Equity in Pediatric Practice. Pediatr Ann 2022; 51:e95-e106. [PMID: 35293809 DOI: 10.3928/19382359-20220217-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Police shootings of unarmed Black men, women, and children at the intersection of disparities in the setting of the coronavirus disease 2019 pandemic have resulted in a long overdue national awakening regarding race and racism in society. This article defines some of the key terms, providing a foundation to help promote equity in pediatric practice. Although no single article can result in full competency regarding such complex issues, it is meant to provide a foundation for pediatricians on a journey to deepen their knowledge and understanding toward a path to action. [Pediatr Ann. 2022;51(3):e95-e106.].
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Banton C, Glass‐Smith S, Garza J. Healthcare 2020: MOving Forward Through Leadership. JOURNAL OF LEADERSHIP STUDIES 2021. [DOI: 10.1002/jls.21732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Christa Banton
- Center for Workplace and DiversityUniversity of PhoenixPhoenixAZUSA
| | | | - Jose Garza
- Center for Workplace and DiversityUniversity of PhoenixPhoenixAZUSA
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McAlister M, Helton JD. A Comparison of the United States and Austrian Healthcare Needs and Systems. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211000162. [PMID: 33870743 PMCID: PMC8058800 DOI: 10.1177/00469580211000162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 01/16/2021] [Accepted: 02/03/2021] [Indexed: 11/16/2022]
Abstract
Austria and the United States have very different healthcare systems with Austria following a social insurance model and the United States following an out of pocket model however;gross domestic product on healthcare expenditures. There is a current gap in literature on how the United States and Austrian healthcare systems comparatively impact patient outcomes, especially when considering the mediating effects of societal norms such as exercise and mental self-care habits. The information presented could benefit the United States healthcare system if they adopted Austria's model, which expands access, and the Austrian healthcare system regulators could look to American standards of communication and care coordination to improve their healthcare system overall.
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Eliacin J, Cunningham B, Partin MR, Gravely A, Taylor BC, Gordon HS, Saha S, Burgess DJ. Veterans Affairs Providers' Beliefs About the Contributors to and Responsibility for Reducing Racial and Ethnic Health Care Disparities. Health Equity 2019; 3:436-448. [PMID: 31448354 PMCID: PMC6707034 DOI: 10.1089/heq.2019.0018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose: Providers' beliefs about the causes of disparities and the entities responsible for addressing these disparities are important in designing disparity-reduction interventions aimed at providers. This secondary analysis of a larger study is aimed at evaluating perceptions of providers regarding the underlying causes of racial health care disparities and their views of who is responsible for reducing them. Methods: We surveyed 232 providers at 3 Veterans Affairs (VA) Medical Centers. Results: Sixty-nine percent of participants believed that minority patients in the United States receive lower quality health care. Most participants (64%) attributed differences in quality of care for minority patients in the VA health care system primarily to patients' socioeconomic status, followed by patient behavior (43%) and provider behaviors (33%). In contrast, most participants believed that the VA and other health care organizations (75%) and providers (70%) bear the responsibility for reducing disparities, while less than half (45%) believed that patients were responsible. Among provider-level contributors to disparities, providers' poor communication was the most widely endorsed (48%), while differences in prescribing of medications (13%) and in provision of specialty referrals (12%) were the least endorsed. Conclusions: Although most providers in the study did not believe that providers contribute to disparities, they do believe that they, along with health care organizations, have the responsibility to help reduce them. Interventions might focus on directly offering providers concrete ways that they can help reduce disparities, rather than focusing on simply raising awareness about disparities and their contributions to them.
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Affiliation(s)
- Johanne Eliacin
- Center for Health information and Communication, CHIC, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana
- Department of Psychology, Indiana University Purdue University at Indianapolis, Indianapolis, Indiana
- Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana
- ACT Center of Indiana, Indianapolis, Indiana
| | - Brooke Cunningham
- Department of Family Medicine and Community Health, Minneapolis, Minnesota
| | - Melissa R. Partin
- Center for Chronic Disease Outcomes Research (a VA HSR&D Center of Excellence), Veterans Affairs Medical Center, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Amy Gravely
- Center for Chronic Disease Outcomes Research (a VA HSR&D Center of Excellence), Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Brent C. Taylor
- Center for Chronic Disease Outcomes Research (a VA HSR&D Center of Excellence), Veterans Affairs Medical Center, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Howard S. Gordon
- Jesse Brown Veterans Affairs Medical Center and Center of Innovation for Complex Chronic Healthcare, Chicago, Illinois
- Section of Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Somnath Saha
- Section of General Internal Medicine, VA Portland Health Care System, Portland, Oregon
- Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, Oregon
| | - Diana J. Burgess
- Center for Chronic Disease Outcomes Research (a VA HSR&D Center of Excellence), Veterans Affairs Medical Center, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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Gollust SE, Cunningham BA, Bokhour BG, Gordon HS, Pope C, Saha SS, Jones DM, Do T, Burgess DJ. What Causes Racial Health Care Disparities? A Mixed-Methods Study Reveals Variability in How Health Care Providers Perceive Causal Attributions. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2019; 55:46958018762840. [PMID: 29553296 PMCID: PMC5862368 DOI: 10.1177/0046958018762840] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Progress to address health care equity requires health care providers’ commitment, but their engagement may depend on their perceptions of the factors contributing to inequity. To understand providers’ perceptions of causes of racial health care disparities, a short survey was delivered to health care providers who work at 3 Veterans Health Administration sites, followed by qualitative interviews (N = 53). Survey data indicated that providers attributed the causes of disparities to social and economic conditions more than to patients’ or providers’ behaviors. Qualitative analysis revealed differences in the meaning that participants ascribed to these causal factors. Participants who believed providers contribute to disparities discussed race and racism more readily, identified the mechanisms through which disparities emerge, and contextualized patient-level factors more than those who believed providers contributed less to disparities. Differences in provider understanding of the underlying causal factors suggest a multidimensional approach to engage providers in health equity efforts.
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Affiliation(s)
| | | | - Barbara G Bokhour
- 2 Center for Healthcare Organization and Implementation Research, ENRM Veterans Affairs Medical Center, Bedford, MA, USA.,3 Boston University, MA, USA
| | - Howard S Gordon
- 4 Jesse Brown Veterans Affairs Medical Center and Center of Innovation for Complex Chronic Healthcare, Chicago, IL, USA.,5 University of Illinois at Chicago, USA
| | - Charlene Pope
- 6 Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA.,7 Medical University of South Carolina, Charleston, USA
| | - Somnath S Saha
- 8 VA Portland Health Care System, OR, USA.,9 Oregon Health & Science University, Portland, USA
| | | | - Tam Do
- 11 Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, MN, USA
| | - Diana J Burgess
- 1 University of Minnesota, Minneapolis, USA.,11 Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, MN, USA
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11
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Burgess DJ, Bokhour BG, Cunningham BA, Do T, Eliacin J, Gordon HS, Gravely A, Jones DM, Partin MR, Pope C, Saha S, Taylor BC, Gollust SE. Communicating with providers about racial healthcare disparities: The role of providers' prior beliefs on their receptivity to different narrative frames. PATIENT EDUCATION AND COUNSELING 2019; 102:139-147. [PMID: 30266266 DOI: 10.1016/j.pec.2018.08.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 08/20/2018] [Accepted: 08/25/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Evaluate narratives aimed at motivating providers with different pre-existing beliefs to address racial healthcare disparities. METHODS Survey experiment with 280 providers. Providers were classified as high or low in attributing disparities to providers (HPA versus LPA) and were randomly assigned to a non-narrative control or 1 of 2 narratives: "Provider Success" (provider successfully resolved problem involving Black patient) and "Provider Bias" (Black patient experienced racial bias, which remained unresolved). Participants' reactions to narratives (including identification with narrative) and likelihood of participating in disparities-reduction activities were immediately assessed. Four weeks later, participation in those activities was assessed, including self-reported participation in a disparities-reduction training course (primary outcome). RESULTS Participation in training was higher among providers randomized to the Provider Success narrative compared to Provider Bias or Control. LPA participants had higher identification with Provider Success than Provider Bias narratives, whereas among HPA participants, differences in identification between the narratives were not significant. CONCLUSIONS Provider Success narratives led to greater participation in training than Provider Bias narratives, although providers' pre-existing beliefs influenced the narrative they identified with. PRACTICE IMPLICATIONS Provider Success narratives may be more effective at motivating providers to address disparities than Provider Bias narratives, though more research is needed.
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Affiliation(s)
- Diana J Burgess
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA; Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
| | - Barbara G Bokhour
- Center for Healthcare Organization and Implementation Research, ENRM Veterans Affairs Medical Center, MA, USA; Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | | | - Tam Do
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Johanne Eliacin
- Center for Health information and Communication, CHIC, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA; Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, IN, USA; Health Services Research, Regenstrief Institute, Inc., Indianapolis, IN, USA; ACT Center of Indiana, Indianapolis, IN, USA
| | - Howard S Gordon
- Jesse Brown Veterans Affairs Medical Center and Center of Innovation for Complex Chronic Healthcare, Chicago, IL, USA; Section of Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Amy Gravely
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA; Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Dina M Jones
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA; School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Melissa R Partin
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA; Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Charlene Pope
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA; Division General Pediatrics, Department of Pediatrics, College of Medicine, Medical University of South Carolina, Charleston, SC, USA; College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Somnath Saha
- Section of General Internal Medicine, VA Portland Health Care System, Portland, OR, USA; Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, OR, USA
| | - Brent C Taylor
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA; Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Sarah E Gollust
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
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